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Norton B, Pelkonen O, Watkins J, Mann S. Localised intestinal Kaposi sarcoma in a patient with non-coeliac seronegative villous atrophy. BMJ Case Rep 2023; 16:e254073. [PMID: 37751975 PMCID: PMC10533734 DOI: 10.1136/bcr-2022-254073] [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] [Indexed: 09/30/2023] Open
Abstract
Seronegative villous atrophy (SNVA) is a diagnostic challenge for gastroenterologists, which is defined by villous atrophy and negative coeliac serology. Non-coeliac forms of SNVA, such as autoimmune enteropathy, can be life-threatening leading to intractable diarrhoea and severe malabsorption that require systemic immunosuppression. When all known causes have been excluded, it is termed idiopathic villous atrophy (IVA). We present a case of non-coeliac SNVA complicated by Kaposi sarcoma (KS). A previously well HIV-negative man in his 30s presented with a 4-month history of watery diarrhoea and 25 kg weight loss. After prolonged investigation, he was diagnosed with non-coeliac SNVA without an identified aetiology that would be consistent with IVA. Clinical recovery was achieved with parenteral nutrition for type II intestinal failure and immunosuppression using high-dose corticosteroids. On subsequent gastroscopy, he was diagnosed with localised intestinal KS prompting cessation of all immunosuppression but remained in clinical remission.
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Affiliation(s)
- Benjamin Norton
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, London, UK
- Department of Gastroenterology, Digestive Diseases & Surgery Institute, Cleveland Clinic London, London, UK
| | - Otso Pelkonen
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
| | | | - Steven Mann
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
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2
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Wehbe H, Obaitan I, Al-Haddad MA, Tong Y, Mahendraker N, DeWitt JM, Bick B, Fogel E, Zyromski N, Gutta A, Sherman S, Watkins J, Gromski M, Saleem N, Easler JJ. Profile of and risk factors for early unplanned readmissions in patients with acute necrotizing pancreatitis. Pancreatology 2023; 23:465-472. [PMID: 37330391 DOI: 10.1016/j.pan.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/04/2023] [Accepted: 05/28/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) complicates up to 15% of acute pancreatitis cases. ANP has historically been associated with a significant risk for readmission, but there are currently no studies exploring factors that associate with risk for unplanned, early (<30-day) readmissions in this patient population. METHODS We performed a retrospective review of all consecutive patients presenting to hospitals in the Indiana University (IU) Health system with pancreatic necrosis between December 2016 and June 2020. Patients younger than 18 years of age, without confirmed pancreatic necrosis and those that suffered in-hospital mortality were excluded. Logistic regression was performed to identify potential predictors of early readmission in this group of patients. RESULTS One hundred and sixty-two patients met study criteria. 27.7% of the cohort was readmitted within 30-days of index discharge. The median time to readmission was 10 days (IQR 5-17 days). The most frequent reason for readmission was abdominal pain (75.6%), followed by nausea and vomiting in (35.6%). Discharge to home was associated with 93% lower odds of readmission. We found no additional clinical factors that predicted early readmission. CONCLUSION Patients with ANP have a significant risk for early (<30 days) readmission. Direct discharge to home, rather than short or long-term rehabilitation facilities, is associated with lower odds of early readmission. Analysis was otherwise negative for independent, clinical predictors of early unplanned readmissions in ANP.
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Affiliation(s)
- H Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - I Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Y Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J M DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
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3
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Banga S, Cardoso R, Castellani C, Srivastava S, Watkins J, Lima J. Cardiac MRI as an Imaging Tool in Titin Variant-Related Dilated Cardiomyopathy. Cardiovasc Revasc Med 2023; 52:86-93. [PMID: 36934006 DOI: 10.1016/j.carrev.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Dilated Cardiomyopathy is a common myocardial disease characterized by dilation and loss of function of one or both ventricles. A variety of etiologies have been implicated including genetic variation. Advancement in genetic sequencing, and diagnostic imaging allows for detection of genetic mutations in sarcomere protein titin (TTN) and high resolution assessment of cardiac function. This review article discusses the role of cardiac MRI in diagnosing dilated cardiomyopathy in patients with TTN variant related cardiomyopathy.
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Affiliation(s)
- Sandeep Banga
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA.
| | | | - Carson Castellani
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shaurya Srivastava
- Division of Internal Medicine, Michigan State University, Lansing, MI, USA
| | - Jennifer Watkins
- Division of Cardiology, Michigan State University, Sparrow Hospital, Lansing, MI, USA
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
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4
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Funingana I, Trotman J, Ambrose J, Roberts T, Watkins J, Ridley M, Gilson B, Freeman S, Jimenez-Linan M, Sosinsky A, Tadross J, Tarpey P, Brenton J. 7P Integration of whole genome sequencing (WGS) into NHS pathways for high-grade ovarian cancer (HGOC): A single-centre prospective experience. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100861] [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: 02/27/2023] Open
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5
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Hayes AR, Luong TV, Banks J, Shah H, Watkins J, Lim E, Patel A, Grossman AB, Navalkissoor S, Krell D, Caplin ME. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): Prevalence, clinicopathological characteristics and survival outcome in a cohort of 311 patients with well-differentiated lung neuroendocrine tumours. J Neuroendocrinol 2022; 34:e13184. [PMID: 36121922 DOI: 10.1111/jne.13184] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is considered to be a rare condition associated with lung neuroendocrine tumours (NET), and its natural history is poorly described. We aimed to assess the prevalence and clinicopathologic characteristics of DIPNECH in the lung NET population, and to investigate predictors of time-to-progression (TTP) and overall survival (OS). METHODS We retrospectively identified patients diagnosed with DIPNECH between April 2005 and December 2020. Clinical data were collected from medical records. The relationship between baseline characteristics and TTP and OS was analysed using the Kaplan-Meier method. Univariate analysis was performed using the Cox proportional hazards model. RESULTS Of 311 patients with well-differentiated lung NETs, 61 (20%) had DIPNECH and were included in the study. Baseline demographics described 95% female, 59% never smokers and mean body mass index 34.4 kg m-2 ; 77% were typical carcinoids (TC), 13% atypical carcinoids (AC), and 10% both TC and AC (multicentric). At presentation, 54% of patients were asymptomatic. Multicentric NETs were demonstrated in 16 (26%) on histopathology, and a further 32 (52%) had synchronous NETs suggested on imaging (multiple nodules ≥ 5 mm). Seven (11%) patients developed metastases and the median OS from time of first metastasis was 37 months. AC histopathology and NET TNM stage ≥ IIA were associated with poorer TTP and OS. Of the DIPNECH cohort, the 15-year survival rate was 86%. CONCLUSIONS DIPNECH may be more prevalent in the lung NET population than previously appreciated, especially in women. Although our results confirm that DIPNECH is predominantly an indolent disease associated with TC, 23% developed AC and these patients may warrant closer observation.
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Affiliation(s)
- Aimee R Hayes
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Tu Vinh Luong
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Jamie Banks
- Medical School, University College of London, London, UK
| | - Heer Shah
- Medical School, University College of London, London, UK
| | - Jennifer Watkins
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton Hospital, London, UK
| | - Anant Patel
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Ashley B Grossman
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Daniel Krell
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
- University College of London, London, UK
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Smith H, Watkins J, Otis M, Hebden JN, Wright MO. Health care-associated infections studies project: An American journal of infection control and national healthcare safety network data quality collaboration case study - Chapter 2 Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance case study vignettes. Am J Infect Control 2022; 50:695-698. [PMID: 35276310 DOI: 10.1016/j.ajic.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of three of the surveillance concepts included in the Patient Safety Component, Chapter 2 - Identifying Healthcare-associated Infections (HAI) for NHSN Surveillance. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).
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Affiliation(s)
- Henrietta Smith
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer Watkins
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; CACI International Inc, Atlanta, GA
| | - Melissa Otis
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; CACI International Inc, Atlanta, GA.
| | - Joan N Hebden
- Independent Infection Prevention Consultant, Baltimore, MD
| | - Marc-Oliver Wright
- Department of Clinical Affairs, Professional Disposables International, Woodcliff Lake, NJ
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Al Kharusi S, Anton G, Badhrees I, Barbeau P, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao G, Cen W, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Darroch L, Daugherty S, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski M, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen E, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell M, Johnson A, Karelin A, Kaufman L, Koffas T, Krücken R, Kuchenkov A, Kumar K, Lan Y, Larson A, Lenardo B, Leonard D, Li G, Li S, Li Z, Licciardi C, Lin Y, MacLellan R, McElroy T, Michel T, Mong B, Moore D, Murray K, Njoya O, Nusair O, Odian A, Ostrovskiy I, Perna A, Piepke A, Pocar A, Retière F, Robinson A, Rowson P, Ruddell D, Runge J, Schmidt S, Sinclair D, Skarpaas K, Soma A, Stekhanov V, Tarka M, Thibado S, Todd J, Tolba T, Totev T, Tsang R, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen L, Wichoski U, Wrede G, Wu S, Xia Q, Yahne D, Yang L, Yen YR, Zeldovich O, Ziegler T. Search for Majoron-emitting modes of
Xe136
double beta decay with the complete EXO-200 dataset. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.104.112002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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8
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van Schewick CM, Lowe DM, Burns SO, Workman S, Symes A, Guzman D, Moreira F, Watkins J, Clark I, Grimbacher B. Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation. J Clin Immunol 2021; 42:46-59. [PMID: 34599484 PMCID: PMC8821476 DOI: 10.1007/s10875-021-01104-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/18/2021] [Indexed: 01/22/2023]
Abstract
Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients' bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.
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Affiliation(s)
- Cornelia M van Schewick
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Center for Translational Cell Research, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Str. 115, 79106, Freiburg, Germany
| | - David M Lowe
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | - Sarita Workman
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | - Andrew Symes
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | - David Guzman
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | - Fernando Moreira
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK
| | | | - Ian Clark
- Pathology Department, Royal Free Hospital, London, UK.
- Department of Pathology, Health Science Center, The University of Tennessee, 930 Madison Ave, Suite 500, Memphis, TN, 38163, USA.
| | - Bodo Grimbacher
- Institute of Immunity and Transplantation, Royal Free Hospital, University College London, London, UK.
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Center for Translational Cell Research, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Str. 115, 79106, Freiburg, Germany.
- DZIF - German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany.
- CIBSS - Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany.
- RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany.
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Watkins J, Gross C, Godfrey-Johnson D, Allen-Bridson K, Hebden JN, Wright MO. Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration. Am J Infect Control 2021; 49:1075-1077. [PMID: 33609589 PMCID: PMC7948031 DOI: 10.1016/j.ajic.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of the Pneumonia (PNEU), Ventilator-associated event (VAE), and Bloodstream infections (BSI) surveillance definitions to a patient with COVID-19. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among Infection Preventionists (IPs) and encourage accurate determination of HAI events.
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Affiliation(s)
| | | | | | - Katherine Allen-Bridson
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joan N Hebden
- Independent Infection Prevention Consultant, Baltimore, MD
| | - Marc-Oliver Wright
- Professional Disposables International, Department of Clinical Affairs, Woodcliff Lake, NJ
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10
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Hall A, Cotoi C, Luong TV, Watkins J, Bhathal P, Quaglia A. Collagen and elastic fibres in acute and chronic liver injury. Sci Rep 2021; 11:14569. [PMID: 34267266 PMCID: PMC8282791 DOI: 10.1038/s41598-021-93566-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
The histological distinction between acute and chronic liver injury is a challenging aspect of liver histopathology. It is traditionally based on the interpretation of morphological changes to the extracellular matrix (ECM) at sites of hepatocyte loss using histochemical stains. Our aim was to investigate whether immunohistochemistry and multiplexing for collagen type (I & III) and elastic fibres and a modified Victoria blue method could be helpful. We studied 43 livers removed at transplantation for acute liver failure (ALF, 20 cases) or cirrhosis (23) plus 8 normal controls. In ALF the periportal ECM was normal in 2 cases, contained mainly collagen I associated with a ductular reaction in 6 cases, and delicate elastic strands in 11 cases. Periportal deposition of mainly collagen I and mature elastic fibres was observed in cirrhosis. In ALF the perisinusoidal ECM was intact in 4 cases, collapsed or condensed but of normal composition (predominantly collagen III) in 2 cases, and collapsed and condensed containing mostly collagen I in 17 cases (7 including delicate immature elastic strands). In contrast, bridging fibrous septa of cirrhosis contained abundant collagen 1 and bundles of mature elastin. We propose the use of a scale and the use of immunohistochemistry and multiplexing in additional to histochemical stains to characterise the ECM changes in acute and chronic liver injury.
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Affiliation(s)
- Andrew Hall
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Corina Cotoi
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Tu Vinh Luong
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Prithi Bhathal
- Department of Pathology, University of Melbourne, Parkville, VIC, Australia
| | - Alberto Quaglia
- Department of Cellular Pathology, Royal Free Hospital and UCL Cancer Institute, London, UK.
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11
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Connoley D, Patel PJ, Hogan B, Tanwar S, Rhodes F, Parkes J, Burt A, Watkins J, Sievert W, Rosenberg W. The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study. BMC Gastroenterol 2021; 21:268. [PMID: 34182924 PMCID: PMC8240375 DOI: 10.1186/s12876-021-01795-5] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/20/2021] [Indexed: 01/06/2023] Open
Abstract
Background Alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.
Methods Observational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality. Results ELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823–0.968) and 0.923 (95% CI 0.866–0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908–0.960); non-alcohol = 0.907 (95% CI 0.895–0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55–4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39–2.99, p < 0.001). Conclusions ELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01795-5.
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Affiliation(s)
- Declan Connoley
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia.,Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.,The Royal Free London NHS Foundation Trust, London, UK
| | - Preya Janubhai Patel
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.,The Royal Free London NHS Foundation Trust, London, UK
| | - Brian Hogan
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK
| | - Freya Rhodes
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.,The Royal Free London NHS Foundation Trust, London, UK
| | - Julie Parkes
- Primary Care, Public Health and Medical Statistics, University of Southampton, Southampton, UK
| | - Alastair Burt
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jennifer Watkins
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK
| | - William Sievert
- Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK. .,The Royal Free London NHS Foundation Trust, London, UK.
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12
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Williams O, Williams C, Turner D, Bull M, Watkins J, Hurt L. An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study. J Public Health (Oxf) 2021; 44:606-613. [PMID: 33993283 PMCID: PMC8194567 DOI: 10.1093/pubmed/fdab150] [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] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions. Methods Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R. Results About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34). Conclusions There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.
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Affiliation(s)
- O Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - C Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - D Turner
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - M Bull
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - J Watkins
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - L Hurt
- Cardiff University, Cardiff CF14 4YS, UK
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13
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Allam M, Hidalgo Salinas C, Machairas N, Kostakis ID, Watkins J, Fusai GK. Solid Pseudopapillary Neoplasms of the Pancreas: a Single-Center Experience and Review of the Literature. J Gastrointest Cancer 2021; 53:460-465. [PMID: 33877570 DOI: 10.1007/s12029-021-00638-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Pancreatic solid pseudopapillary neoplasms (SPNs) are rare borderline tumours mainly affecting young female patients. The number of patients diagnosed with SPNs has increased significantly in the last decades owing to the increased use of cross-sectional imaging investigating different abdominal symptoms, whilst a significant proportion are incidentally discovered during the process of evaluating other pathologies. We herein present our institutional experience of patients with SPN who underwent curative resection focusing on clinical, pathological features, and the long-term outcomes. METHODS All patients undergoing pancreatectomy in our institution for SPN from January 2010 until December 2018 were included. Clinical, perioperative, histological, and long-term outcomes were collected and analysed. RESULTS During the inclusion period, a total of 19 patients had a pathological diagnosis of SPNs after surgical resection. Sixteen of them were female (84%), while the median patient age was 30 (range 16-66) years. Nine patients (47%) underwent distal pancreatectomy and splenectomy, 2 (11%) underwent spleen preserving distal pancreatectomy, 6 (32%) underwent pancreatoduodenectomy, one (5%) underwent total pancreatectomy, and one (5%) central pancreatectomy. Seventeen patients underwent R0 resection. During a median follow-up of 23 months, no tumour recurrence or death was recorded. CONCLUSION In our experience, SPNs are rare tumours with low malignant potentials. Surgical resection remains the gold standard treatment and is associated with good prognosis.
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Affiliation(s)
- Moustafa Allam
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Camila Hidalgo Salinas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK.
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Giuseppe Kito Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
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14
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Laskaratos FM, Levi A, Schwach G, Pfragner R, Hall A, Xia D, von Stempel C, Bretherton J, Thanapirom K, Alexander S, Ogunbiyi O, Watkins J, Luong TV, Toumpanakis C, Mandair D, Caplin M, Rombouts K. Transcriptomic Profiling of In Vitro Tumor-Stromal Cell Paracrine Crosstalk Identifies Involvement of the Integrin Signaling Pathway in the Pathogenesis of Mesenteric Fibrosis in Human Small Intestinal Neuroendocrine Neoplasms. Front Oncol 2021; 11:629665. [PMID: 33718208 PMCID: PMC7943728 DOI: 10.3389/fonc.2021.629665] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022] Open
Abstract
Aim Analysis of the pathophysiology of mesenteric fibrosis (MF) in small intestinal neuroendocrine tumors (SI-NETs) in an in vitro paracrine model and in human SI-NET tissue samples. Methods An indirect co-culture model of SI-NET cells KRJ-I and P-STS with stromal cells HEK293 was designed to evaluate the paracrine effects on cell metabolic activity, gene expression by RT2 PCR Profilers to analyse cancer and fibrosis related genes, and RNA sequencing. The integrin signaling pathway, a specific Ingenuity enriched pathway, was further explored in a cohort of human SI-NET tissues by performing protein analysis and immunohistochemistry. Results RT Profiler array analysis demonstrated several genes to be significantly up- or down-regulated in a cell specific manner as a result of the paracrine effect. This was further confirmed by employing RNA sequencing revealing multiple signaling pathways involved in carcinogenesis and fibrogenesis that were significantly affected in these cell lines. A significant upregulation in the expression of various integrin pathway – related genes was identified in the mesenteric mass of fibrotic SI-NET as confirmed by RT-qPCR and immunohistochemistry. Protein analysis demonstrated downstream activation of the MAPK and mTOR pathways in some patients with fibrotic SI-NETs. Conclusion This study has provided the first comprehensive analysis of the crosstalk of SI-NET cells with stromal cells. A novel pathway – the integrin pathway – was identified and further validated and confirmed in a cohort of human SI-NET tissue featured by a dual role in fibrogenesis/carcinogenesis within the neoplastic fibrotic microenvironment.
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Affiliation(s)
- Faidon-Marios Laskaratos
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom.,Regenerative Medicine and Fibrosis Group, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Ana Levi
- Regenerative Medicine and Fibrosis Group, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Gert Schwach
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Roswitha Pfragner
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Andrew Hall
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dong Xia
- Royal Veterinary College, University of London, London, United Kingdom
| | - Conrad von Stempel
- Radiology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Josephine Bretherton
- Radiology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Kessarin Thanapirom
- Regenerative Medicine and Fibrosis Group, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
| | - Sarah Alexander
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Olagunju Ogunbiyi
- Department of Colorectal Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jennifer Watkins
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tu Vinh Luong
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Krista Rombouts
- Regenerative Medicine and Fibrosis Group, Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, United Kingdom
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15
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Chea N, Sapiano MRP, Zhou L, Epstein L, Guh A, Edwards JR, Allen-Bridson K, Russo V, Watkins J, Pouch SM, Magill SS. Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015-2018. Transpl Infect Dis 2021; 23:e13589. [PMID: 33617680 PMCID: PMC8380253 DOI: 10.1111/tid.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
Liver transplant recipients are at high risk for surgical site infections (SSIs). Limited data are available on SSI epidemiology following liver transplant procedures (LTPs). We analyzed data on SSIs from 2015 to 2018 reported to CDC's National Healthcare Safety Network to determine rates, pathogen distribution, and antimicrobial resistance after LTPs and other hepatic, biliary, or pancreatic procedures (BILIs). LTP and BILI SSI rates were 5.7% and 5.9%, respectively. The odds of SSI after LTP were lower than after BILI (adjusted odds ratio = 0.70, 95% confidence interval 0.57-0.85). Among LTP SSIs, 43.1% were caused by Enterococcus spp., 17.2% by Candida spp., and 15.0% by coagulase-negative Staphylococcus spp. (CNS). Percentages of SSIs caused by Enterococcus faecium or CNS were higher after LTPs than BILIs, whereas percentages of SSIs caused by Enterobacteriaceae, Enterococcus faecalis, or viridans streptococci were higher after BILIs. Antimicrobial resistance was common in LTP SSI pathogens, including E. faecium (69.4% vancomycin resistant); Escherichia coli (68.8% fluoroquinolone non-susceptible and 44.7% extended spectrum cephalosporin [ESC] non-susceptible); and Klebsiella pneumoniae and K. oxytoca (39.4% fluoroquinolone non-susceptible and 54.5% ESC non-susceptible). National LTP SSI pathogen and resistance data can help prioritize studies to determine effective interventions to prevent SSIs and reduce antimicrobial resistance in liver transplant recipients.
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Affiliation(s)
- Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Lantana Consulting Group, Inc, East Thetford, VT, USA
| | - Liang Zhou
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | - Lauren Epstein
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alice Guh
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan R Edwards
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine Allen-Bridson
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victoria Russo
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | - Jennifer Watkins
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | | | - Shelley S Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Hayes AR, Mak IYF, Evans N, Naik R, Crawford A, Khoo B, Grossman AB, Navalkissoor S, Watkins J, Luong TV, Mandair D, Toumpanakis C, Thirlwell C, Caplin ME, Meyer T. Understanding the Treatment Algorithm of Patients with Metastatic Pancreatic Neuroendocrine Neoplasms: A Single-Institution Retrospective Analysis Comparing Outcomes of Chemotherapy, Molecular Targeted Therapy, and Peptide Receptor Radionuclide Therapy in 255 Patients. Neuroendocrinology 2021; 111:863-875. [PMID: 32950978 DOI: 10.1159/000511662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of therapeutic options for patients with pancreatic neuroendocrine neoplasms (PNEN) has increased, but the optimal therapeutic algorithm has not been defined due to lack of randomised trials comparing different modalities. METHODS We performed a retrospective study in patients with metastatic PNEN treated with ≥1 line of systemic therapy. The relationship between baseline characteristics, treatment type, and time to treatment failure (TTF), time to progression (TTP), and overall survival (OS) was analysed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. RESULTS Two hundred and fifty-five patients with metastatic PNEN had 491 evaluable lines of therapy. Independent predictors of TTF included treatment type, Ki-67, tumour grade, and chromogranin A. To reduce selection bias, a subgroup of 114 patients with grade 2 (G2) metastatic pancreatic neuroendocrine tumours (PNET) was analysed separately. These patients had received 234 lines of treatment (105 chemotherapy, 82 molecular targeted therapy, and 47 peptide receptor radionuclide therapy [PRRT]). In the G2 cohort, TTF and TTP were superior for PRRT compared with both chemotherapy and molecular targeted therapy. OS in the G2 cohort was also superior for those that had received PRRT compared with those that had not (median 84 vs. 56 months; HR 0.55, 95% CI: 0.31-0.98, p = 0.04). CONCLUSIONS This study suggests that PRRT is associated with superior clinical outcomes relative to other systemic therapies for G2 metastatic PNET. Prospective studies are required to confirm these observations.
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Affiliation(s)
- Aimee R Hayes
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom,
- Department of Oncology, Royal Free Hospital, London, United Kingdom,
| | - Ingrid Y F Mak
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Nicholas Evans
- Medical School, University College London, London, United Kingdom
| | - Rishi Naik
- Medical School, University College London, London, United Kingdom
| | | | - Bernard Khoo
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Ashley B Grossman
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Shaunak Navalkissoor
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
- Department of Nuclear Medicine, Royal Free Hospital, London, United Kingdom
| | - Jennifer Watkins
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
- Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom
| | - Tu Vinh Luong
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
- Department of Cellular Pathology, Royal Free Hospital, London, United Kingdom
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Christina Thirlwell
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Tim Meyer
- Department of Oncology, Royal Free Hospital, London, United Kingdom
- UCL Cancer Institute, University College London, London, United Kingdom
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17
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Fogelson N, Watkins J. Liver Mobilization for Right Diaphragm Surgery in Diaphragmatic Endometriosis. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.029] [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: 10/23/2022]
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18
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Laskaratos FM, Liu M, Malczewska A, Ogunbiyi O, Watkins J, Luong TV, Mandair D, Caplin M, Toumpanakis C. Evaluation of circulating transcript analysis (NETest) in small intestinal neuroendocrine neoplasms after surgical resection. Endocrine 2020; 69:430-440. [PMID: 32291735 PMCID: PMC7392928 DOI: 10.1007/s12020-020-02289-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Surgical resection is the only effective curative strategy for small intestinal neuroendocrine neoplasms (SINENs). Nevertheless, the evaluation of residual disease and prediction of disease recurrence/progression remains a problematic issue. METHODS We evaluated 13 SINENs that underwent surgical resection of the primary tumour and/or mesenteric mass. Patients were divided in three groups: (a) Group 1: SINENs that underwent resection with curative intent, (b) Group 2: SINENs treated with resection in the setting of metastatic disease, which remained stable and (c) Group 3: SINENs treated with resection in the setting of metastatic disease, with evidence of any progression at follow-up. NETest and chromogranin A were measured pre-operatively and post-operatively during a 22-month median follow-up period and compared with imaging studies. NETest score <20% was determined as normal, 20-40% low, 41-79% intermediate and ≥80% high score. RESULTS NETest score was raised in all (100%) SINENs pre-operatively. Surgery with curative intent resulted in NETest score reduction from 78.25 ± 15.32 to 25.25 ± 1.75 (p < 0.05). Low NETest scores post-operatively were evident in all cases without clinical evidence of residual disease (Group 1). However, the low disease activity score suggested the presence of microscopic residual disease. In three cases (75%) with stable disease (Group 2) the NETest score was low consistent with indolent disease. In the progressive disease group (Group 3), a high NETest score was present in three cases (60%) and an intermediate NETest score in the remainder (40%). CONCLUSIONS Blood NETest scores accurately identified SINENs and were significantly decreased by curative surgery. Monitoring NETest post-operatively may facilitate management by identifying the presence of residual/progressive disease.
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Affiliation(s)
- Faidon-Marios Laskaratos
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK.
| | - Man Liu
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Anna Malczewska
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
| | | | | | - Tu Vinh Luong
- Histopathology Department, Royal Free Hospital, London, UK
| | - Dalvinder Mandair
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Martyn Caplin
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
| | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
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19
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Luong TV, Nisa Z, Watkins J, Hayes AR. Should immunohistochemical expression of mismatch repair (MMR) proteins and microsatellite instability (MSI) analysis be routinely performed for poorly differentiated colorectal neuroendocrine carcinomas? Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200058. [PMID: 32729847 PMCID: PMC7424324 DOI: 10.1530/edm-20-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
SUMMARY Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are typically associated with poor outcomes. The mechanisms of their aggressiveness are still being investigated. Microsatellite instability (MSI) has recently been found in colorectal NECs showing aberrant methylation of the MLH1 gene and is associated with improved prognosis. We present a 76-year-old lady with an ascending colon tumour showing features of a pT3 N0 R0, large cell NEC (LCNEC) following right hemicolectomy. The adjacent mucosa showed a sessile serrated lesion (SSL) with low-grade dysplasia. Immunohistochemistry showed loss of expression for MLH1 and PMS2 in both the LCNEC and dysplastic SSL. Molecular analysis indicated the sporadic nature of the MLH1 mismatch repair (MMR) protein-deficient status. Our patient did not receive adjuvant therapy and she is alive and disease-free after 34 months follow-up. This finding, similar to early-stage MMR-deficient colorectal adenocarcinoma, is likely practice-changing and will be critical in guiding the appropriate treatment pathway for these patients. We propose that testing of MMR status become routine for early-stage colorectal NECs. LEARNING POINTS Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are known to be aggressive and typically associated with poor outcomes. A subset of colorectal NECs can display microsatellite instability (MSI) with mismatch repair (MMR) protein-deficient status. MMR-deficient colorectal NECs have been found to have a better prognosis compared with MMR-proficient NECs. MMR status can be detected using immunohistochemistry. Immunohistochemistry for MMR status is routinely performed for colorectal adenocarcinomas. Immunohistochemical expression of MMR protein and MSI analysis should be performed routinely for early-stage colorectal NECs in order to identify a subgroup of MMR-deficient NECs which are associated with a significantly more favourable prognosis.
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Affiliation(s)
- Tu Vinh Luong
- The Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
- Neuroendocrine Tumour Unit, ENETS Center of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Zaibun Nisa
- The Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- The Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
- Neuroendocrine Tumour Unit, ENETS Center of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Aimee R Hayes
- Neuroendocrine Tumour Unit, ENETS Center of Excellence, Royal Free London NHS Foundation Trust, London, UK
- Department of Medical Oncology, Royal Free London NHS Foundation Trust, London, UK
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20
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Al Kharusi S, Anton G, Badhrees I, Barbeau PS, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao GF, Cen WR, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Darroch L, Daugherty SJ, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski MJ, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen EV, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell MJ, Johnson A, Karelin A, Kaufman LJ, Koffas T, Kostensalo J, Krücken R, Kuchenkov A, Kumar KS, Lan Y, Larson A, Lenardo BG, Leonard DS, Li GS, Li S, Li Z, Licciardi C, Lin YH, MacLellan R, McElroy T, Michel T, Mong B, Moore DC, Murray K, Nakarmi P, Njoya O, Nusair O, Odian A, Ostrovskiy I, Piepke A, Pocar A, Retière F, Robinson AL, Rowson PC, Ruddell D, Runge J, Schmidt S, Sinclair D, Skarpaas K, Soma AK, Stekhanov V, Suhonen J, Tarka M, Thibado S, Todd J, Tolba T, Totev TI, Tsang R, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen LJ, Wichoski U, Wrede G, Wu SX, Xia Q, Yahne DR, Yang L, Yen YR, Zeldovich OY, Ziegler T. Measurement of the Spectral Shape of the β-Decay of ^{137}Xe to the Ground State of ^{137}Cs in EXO-200 and Comparison with Theory. Phys Rev Lett 2020; 124:232502. [PMID: 32603173 DOI: 10.1103/physrevlett.124.232502] [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] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden nonunique β-decay transition ^{137}Xe(7/2^{-})→^{137}Cs(7/2^{+}). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultralow background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal to background ratio of more than 99 to 1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden nonunique β-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.
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Affiliation(s)
- S Al Kharusi
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - G Anton
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - I Badhrees
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - P S Barbeau
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - D Beck
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - V Belov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Bhatta
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Breidenbach
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Brunner
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G F Cao
- Institute of High Energy Physics, Beijing 100049, China
| | - W R Cen
- Institute of High Energy Physics, Beijing 100049, China
| | - C Chambers
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - B Cleveland
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - M Coon
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - A Craycraft
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - L Darroch
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - S J Daugherty
- Physics Department and CEEM, Indiana University, Bloomington, Indiana 47405, USA
| | - J Davis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Delaquis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | | | - R DeVoe
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - J Dilling
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Dolgolenko
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Echevers
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - W Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - D Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - J Farine
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - S Feyzbakhsh
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - P Fierlinger
- Technische Universität München, Physikdepartment and Excellence Cluster Universe, Garching 80805, Germany
| | - D Fudenberg
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - P Gautam
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R Gornea
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Gratta
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - C Hall
- Physics Department, University of Maryland, College Park, Maryland 20742, USA
| | - E V Hansen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Hoessl
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - P Hufschmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - M Hughes
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Iverson
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - A Jamil
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Jessiman
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M J Jewell
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - A Johnson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A Karelin
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - L J Kaufman
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Koffas
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - J Kostensalo
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Kuchenkov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - K S Kumar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Y Lan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Larson
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - B G Lenardo
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - D S Leonard
- IBS Center for Underground Physics, Daejeon 34126, Korea
| | - G S Li
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - S Li
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Z Li
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Licciardi
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - Y H Lin
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R MacLellan
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - T McElroy
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - T Michel
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - B Mong
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D C Moore
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - K Murray
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - P Nakarmi
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - O Njoya
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - O Nusair
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Odian
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Piepke
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - F Retière
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A L Robinson
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - P C Rowson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D Ruddell
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - J Runge
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - S Schmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - D Sinclair
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - K Skarpaas
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A K Soma
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - V Stekhanov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - J Suhonen
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - M Tarka
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - S Thibado
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - J Todd
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Tolba
- Institute of High Energy Physics, Beijing 100049, China
| | - T I Totev
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - R Tsang
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - B Veenstra
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - V Veeraraghavan
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - P Vogel
- Kellogg Lab, Caltech, Pasadena, California 91125, USA
| | - J-L Vuilleumier
- LHEP, Albert Einstein Center, University of Bern, Bern CH-3012, Switzerland
| | - M Wagenpfeil
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - J Watkins
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M Weber
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - L J Wen
- Institute of High Energy Physics, Beijing 100049, China
| | - U Wichoski
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Wrede
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - S X Wu
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - Q Xia
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - D R Yahne
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - O Ya Zeldovich
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Ziegler
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
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Watkins J, Maruthappu M. Public health and economic responses to COVID-19: finding the tipping point. Public Health 2020; 191:21-22. [PMID: 33476938 PMCID: PMC7245272 DOI: 10.1016/j.puhe.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Watkins
- PILAR Research and Education, London, UK.
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Laskaratos FM, Mandair D, Hall A, Alexander S, von Stempel C, Bretherton J, Luong T, Watkins J, Ogunbiyi O, Rombouts K, Caplin M, Toumpanakis C. Clinicopathological correlations of mesenteric fibrosis and evaluation of a novel biomarker for fibrosis detection in small bowel neuroendocrine neoplasms. Endocrine 2020; 67:718-726. [PMID: 31598848 PMCID: PMC7054371 DOI: 10.1007/s12020-019-02107-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Mesenteric fibrosis (MF) in small intestinal neuroendocrine neoplasms (SINENs) is often associated with significant morbidity and mortality. The detection of MF is usually based on radiological criteria, but no previous studies have attempted a prospective, multidimensional assessment of mesenteric desmoplasia to determine the accuracy of radiological measurements. There is also a lack of non-invasive biomarkers for the detection of image-negative MF. METHODS A multidimensional assessment of MF incorporating radiological, surgical and histological parameters was performed in a prospective cohort of 34 patients with SINENs who underwent primary resection. Pre-operative blood samples were collected in 20 cases to evaluate a set of five profibrotic circulating transcripts-the "fibrosome"-that is included as an "omic" component of the NETest. RESULTS There was a significant correlation between radiological and surgical assessments of MF (p < 0.05). However, there were several cases of image-negative MF. The NETest-fibrosome demonstrated an accuracy of 100% for the detection of microscopic MF. CONCLUSIONS The detection of MF by radiological criteria has limitations. The NETest-fibrosome is a promising biomarker for fibrosis detection and further validation of these results would be needed in larger, multicentre studies.
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Affiliation(s)
- Faidon-Marios Laskaratos
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust and University College London, London, UK.
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Andrew Hall
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Alexander
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Conrad von Stempel
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | | | - TuVinh Luong
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Olagunju Ogunbiyi
- Department of Colorectal Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Krista Rombouts
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust and University College London, London, UK
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust and University College London, London, UK
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Bagchi S, Watkins J, Norrick B, Scalise E, Pollock DA, Allen-Bridson K. Accuracy of catheter-associated urinary tract infections reported to the National Healthcare Safety Network, January 2010 through July 2018. Am J Infect Control 2020; 48:207-211. [PMID: 31326261 DOI: 10.1016/j.ajic.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surveillance of health care-associated, catheter-associated urinary tract infections (CAUTI) are the corner stone of infection prevention activity. The Centers for Disease Control and Prevention's National Healthcare Safety Network provides standard definitions for CAUTI surveillance, which have been updated periodically to increase objectivity, credibility, and reliability of urinary tract infection definitions. Several state health departments have validated CAUTI data that provided insights into accuracy of CAUTI reporting and adherence to CAUTI definition. METHODS Data accuracy measures included pooled mean sensitivity, specificity, positive predictive value, and negative predictive value. Total CAUTI error rate was computed as proportion of mismatches among total records. The impact of 2015 CAUTI definition changes were tested by comparing pooled accuracy estimates of validations prior to 2015 with post-2015. RESULTS At least 19 state health departments conducted CAUTI validations and indicated pooled mean sensitivity of 88.3%, specificity of 98.8%, positive predictive value of 93.6%, and negative predictive value of 97.6% of CAUTI reporting to the National Healthcare Safety Network. Among CAUTIs misclassified (121), 66% were underreported and 34% were overreported. CAUTI classification error rate declined significantly from 4.3% (pre-2015) to 2.4% (post-2015). Reasons for CAUTI misclassifications included: misapplication of CAUTI definition, misapplication of general health care-associated infection definitions, and clinical judgement over surveillance definition. CONCLUSIONS CAUTI underreporting is a major concern; validations provide transparency, education, and relationship building to improve reporting accuracy.
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Laskaratos FM, Armeni E, Shah H, Megapanou M, Papantoniou D, Hayes AR, Navalkissoor S, Gnanasegaran G, von Stempel C, Phillips E, Furnace M, Kamieniarz L, Kousteni M, Luong TV, Watkins J, Mandair D, Caplin M, Toumpanakis C. Predictors of antiproliferative effect of lanreotide autogel in advanced gastroenteropancreatic neuroendocrine neoplasms. Endocrine 2020; 67:233-242. [PMID: 31556004 PMCID: PMC6968981 DOI: 10.1007/s12020-019-02086-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The antiproliferative properties of lanreotide autogel (LAN) in gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) were demonstrated in the CLARINET study. However, there is limited literature regarding factors that affect progression-free survival (PFS) in patients with GEP NENs treated with LAN. METHODS We identified a total of 191 treatment-naive patients with advanced GEP NENs and positive SSTR uptake on imaging (Octreoscan or 68Gallium DOTATATE Positron Emission Tomography [68GaPET]) who received first-line LAN monotherapy, albeit at various starting doses (60, 90 or 120 mg/month). A group of 102 patients who initiated treatment at the standard dose of 120 mg/month were included in the study and further evaluated by univariate and multivariate analyses to identify predictors of PFS. RESULTS The location of tumour primary was in the small bowel in 63 (62%), pancreas in 31 (30%) and colon/rectum in 8 patients (8%). The tumours were well-differentiated, and the majority were grade 1 (52%), or 2 (38%). About 60% of cases had progressive disease at the time of treatment initiation. Most patients with available pretreatment nuclear medicine imaging (Octreoscan or 68Ga PET) had a Krenning score of 3 (44%) or 4 (50%). The median PFS for the entire cohort was 19 months (95% CI 12, 26 months). The univariate analysis demonstrated that grade 2 tumours, progressive disease at baseline and metastatic liver disease were associated with a significantly shorter PFS, while other evaluated variables did not affect PFS at a statistically significant level. However, at multivariate analysis only the tumour grade remained statistically significant. CONCLUSIONS The current study showed that, of many evaluated variables, only the tumour grade was predictive of PFS duration and this should be considered during patient selection for treatment.
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Affiliation(s)
- Faidon-Marios Laskaratos
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK.
| | - Eleni Armeni
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | | | - Maria Megapanou
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Papantoniou
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Aimee R Hayes
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Shaunak Navalkissoor
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Conrad von Stempel
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Edward Phillips
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Myles Furnace
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Tu Vinh Luong
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Academic Centre for Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Dalvinder Mandair
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Martyn Caplin
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
| | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, UK
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25
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Anton G, Badhrees I, Barbeau PS, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao GF, Cen WR, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Danilov M, Darroch L, Daugherty SJ, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski MJ, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen EV, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell MJ, Johnson A, Karelin A, Kaufman LJ, Koffas T, Krücken R, Kuchenkov A, Kumar KS, Lan Y, Larson A, Lenardo BG, Leonard DS, Li GS, Li S, Li Z, Licciardi C, Lin YH, MacLellan R, McElroy T, Michel T, Mong B, Moore DC, Murray K, Njoya O, Nusair O, Odian A, Ostrovskiy I, Piepke A, Pocar A, Retière F, Robinson AL, Rowson PC, Ruddell D, Runge J, Schmidt S, Sinclair D, Soma AK, Stekhanov V, Tarka M, Todd J, Tolba T, Totev TI, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen LJ, Wichoski U, Wrede G, Wu SX, Xia Q, Yahne DR, Yang L, Yen YR, Zeldovich OY, Ziegler T. Search for Neutrinoless Double-β Decay with the Complete EXO-200 Dataset. Phys Rev Lett 2019; 123:161802. [PMID: 31702371 DOI: 10.1103/physrevlett.123.161802] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/30/2019] [Indexed: 06/10/2023]
Abstract
A search for neutrinoless double-β decay (0νββ) in ^{136}Xe is performed with the full EXO-200 dataset using a deep neural network to discriminate between 0νββ and background events. Relative to previous analyses, the signal detection efficiency has been raised from 80.8% to 96.4±3.0%, and the energy resolution of the detector at the Q value of ^{136}Xe 0νββ has been improved from σ/E=1.23% to 1.15±0.02% with the upgraded detector. Accounting for the new data, the median 90% confidence level 0νββ half-life sensitivity for this analysis is 5.0×10^{25} yr with a total ^{136}Xe exposure of 234.1 kg yr. No statistically significant evidence for 0νββ is observed, leading to a lower limit on the 0νββ half-life of 3.5×10^{25} yr at the 90% confidence level.
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Affiliation(s)
- G Anton
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - I Badhrees
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - P S Barbeau
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - D Beck
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - V Belov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - T Bhatta
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Breidenbach
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Brunner
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G F Cao
- Institute of High Energy Physics, Beijing 100049, China
| | - W R Cen
- Institute of High Energy Physics, Beijing 100049, China
| | - C Chambers
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - B Cleveland
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - M Coon
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - A Craycraft
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - M Danilov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - L Darroch
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - S J Daugherty
- Physics Department and CEEM, Indiana University, Bloomington, Indiana 47405, USA
| | - J Davis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Delaquis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | | | - R DeVoe
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - J Dilling
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Dolgolenko
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Echevers
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - W Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - D Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - J Farine
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - S Feyzbakhsh
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - P Fierlinger
- Physik Department and Excellence Cluster Universe, Technische Universität München, Garching 80805, Germany
| | - D Fudenberg
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - P Gautam
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R Gornea
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Gratta
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - C Hall
- Physics Department, University of Maryland, College Park, Maryland 20742, USA
| | - E V Hansen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Hoessl
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - P Hufschmidt
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - M Hughes
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Iverson
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - A Jamil
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Jessiman
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M J Jewell
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - A Johnson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A Karelin
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - L J Kaufman
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Koffas
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Kuchenkov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - K S Kumar
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - Y Lan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Larson
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - B G Lenardo
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - D S Leonard
- IBS Center for Underground Physics, Daejeon 34126, Korea
| | - G S Li
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - S Li
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Z Li
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Licciardi
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - Y H Lin
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R MacLellan
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - T McElroy
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - T Michel
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - B Mong
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D C Moore
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - K Murray
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - O Njoya
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - O Nusair
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Odian
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Piepke
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - F Retière
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A L Robinson
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - P C Rowson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D Ruddell
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - J Runge
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - S Schmidt
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - D Sinclair
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A K Soma
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - V Stekhanov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - M Tarka
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - J Todd
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Tolba
- Institute of High Energy Physics, Beijing 100049, China
| | - T I Totev
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - B Veenstra
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - V Veeraraghavan
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - P Vogel
- Kellogg Lab, Caltech, Pasadena, California 91125, USA
| | - J-L Vuilleumier
- LHEP, Albert Einstein Center, University of Bern, Bern CH-3012, Switzerland
| | - M Wagenpfeil
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - J Watkins
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M Weber
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - L J Wen
- Institute of High Energy Physics, Beijing 100049, China
| | - U Wichoski
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Wrede
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - S X Wu
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - Q Xia
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - D R Yahne
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - L Yang
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - O Ya Zeldovich
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - T Ziegler
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
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Coburn J, Unterberg E, Barton J, Rudakov D, Bykov I, Parish C, Wilcox R, Lasnier C, Abrams T, Watkins J, Hillis D, Bourham M. Erosion characterization of SiC and Ti3SiC2 on DIII-D using focused ion beam micro-trenches. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2019.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
We report a rare presentation of metastatic renal cell carcinoma (RCC) in a 71-year-old man who presented with persistent shoulder pain. MRI revealed widespread lytic lesions within the bones suggestive of metastatic disease but extensive imaging including CT chest, abdomen and pelvis with contrast and fluorodeoxyglucose-positron emission tomography did not identify a primary cancer. The diagnosis was ultimately made from a targeted bone and subsequently targeted liver biopsy, whereby immunohistochemistry was consistent with metastatic RCC (mRCC). While bone metastases in RCC are very common, it is extremely rare for patients to present with mRCC and no identifiable renal primary.
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Affiliation(s)
- Laura Woodhouse
- Oncology, Royal Free London NHS Foundation Trust, London, UK
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Singh S, Siriwardana PN, Johnston EW, Watkins J, Bandula S, Illing RO, Davidson BR. In response to letter to the editor from Ma et al. 2019 regarding perivascular extension of microwave ablation zone. Int J Hyperthermia 2019; 36:445. [PMID: 30905224 DOI: 10.1080/02656736.2019.1587011] [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: 10/27/2022] Open
Affiliation(s)
- Saurabh Singh
- a Centre of Medical Imaging, University College London , London , UK
| | - Pulathis Nilantha Siriwardana
- b Department of Surgery, Hepatopancreatobiliary and Liver Transplant Surgery Unit, Royal Free Hospital , University College London , London , UK
| | | | - Jennifer Watkins
- c Department of Cellular Pathology , Royal Free London NHS Foundation Trust , London , UK
| | - Steven Bandula
- d Interventional Oncology Service and Centre of Medical Imaging, University College London , London , UK
| | - Rowland Oliver Illing
- d Interventional Oncology Service and Centre of Medical Imaging, University College London , London , UK
| | - Brian Ritchie Davidson
- b Department of Surgery, Hepatopancreatobiliary and Liver Transplant Surgery Unit, Royal Free Hospital , University College London , London , UK
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Galanopoulos M, McFadyen R, Drami I, Naik R, Evans N, Luong TV, Watkins J, Caplin M, Toumpanakis C. Challenging the Current Risk Factors of Appendiceal Neuroendocrine Neoplasms: Can They Accurately Predict Local Lymph Nodal Invasion? Results from a Large Case Series. Neuroendocrinology 2019; 109:179-186. [PMID: 31060039 DOI: 10.1159/000499381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Appendiceal neuroendocrine neoplasms (ANEN) are uncommon entities, which run mostly an indolent course. Appendicectomy alone is usually curative, except for in a selected group of patients that are deemed to be at risk of loco-regional metastases, in whom a completion right hemicolectomy (RHC) is recommended. The current "Guidelines" criteria for the latter have been controversial, and may result in overtreatment, which is concerning for a young patient population. OBJECTIVE The aim of this study is to evaluate the prognostic value of the current criteria in identifying more accurately those at-risk patients. METHODS This was a retrospective study of the 263 cases of ANEN referred for advice or management to a tertiary referral unit over a 10-year period. Seventy-two patients underwent RHC, based on criteria, suggested by International Guidelines. Each one of those was assessed to identify whether it correlated with lymph node invasion (LNI) at the RHC surgical specimen. RESULTS Tumour grade (p < 0.001), vascular (p = 0.044) and lymph vessel invasion (p < 0.001) were all found to be statistically significant independent risk factors for LNI identified following RHC, whilst tumour size (p = 0.375) and mesoappendiceal invasion (MAI) (p = 0.317) were not statistically significant. However, deep MAI and tumour size >2 cm showed a correlation with each other on LNI positive subgroup analysis. Location in appendiceal base made LNI more likely but again was not significant (p = 0.133). CONCLUSIONS Higher tumour grade and lymphovascular invasion should be considered as the most important risk prognosticators. Surprisingly, tumour size was not found to be significant in our cohort. Further international multicentre studies with large numbers of patients are needed to fully validate those data.
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Affiliation(s)
- Michail Galanopoulos
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Rory McFadyen
- Medical School, University College London, London, United Kingdom
| | - Ioanna Drami
- Department of Colorectal Surgery, Royal Free Hospital, London, United Kingdom
| | - Rishi Naik
- Medical School, University College London, London, United Kingdom
| | - Nicholas Evans
- Medical School, University College London, London, United Kingdom
| | - Tu Vinh Luong
- Department of Histopathology, Royal Free Hospital, London, United Kingdom
| | - Jennifer Watkins
- Department of Histopathology, Royal Free Hospital, London, United Kingdom
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom,
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Bagchi S, Watkins J, Pollock DA, Edwards JR, Allen-Bridson K. State health department validations of central line-associated bloodstream infection events reported via the National Healthcare Safety Network. Am J Infect Control 2018; 46:1290-1295. [PMID: 29903420 DOI: 10.1016/j.ajic.2018.04.233] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous state health departments (SHDs) have validated central line-associated bloodstream infection (CLABSI) data, and results from these studies provide important insights into the accuracy of CLABSI reporting to the National Healthcare Safety Network (NHSN) and remediable shortcomings in adherence to the CLABSI definition and criteria. METHODS State CLABSI validation results were obtained from peer-reviewed publications, reports on SHD Web sites, and via personal communications with the SHD health care-associated infections coordinator. Data accuracy measures included pooled mean sensitivity, specificity, positive predictive value, and negative predictive value. Total CLABSI error rate was computed as the proportion of mismatches among total records reviewed. When available, reasons for CLABSI misclassification reported by SHDs were reviewed. RESULTS At least 23 SHDs that have completed CLABSI validations indicated sensitivity (pooled mean, 82.9%), specificity (pooled mean, 98.5%), positive predictive value (pooled mean, 94.1%), and negative predictive value (pooled mean, 95.9%) of CLABSI reporting. The pooled error rate of CLABSI reporting was 4.4%. Reasons for CLABSI misclassification included incorrect secondary bloodstream infection attribution, misapplication of CLABSI definition, missed case finding, applying clinical over surveillance definitions, misapplication of laboratory-confirmed bloodstream infection 2 definition, and misapplication of general NHSN definitions. CONCLUSIONS CLABSI underreporting remains a major concern; validations conducted by SHDs provide an important impetus for improved reporting. SHDs are uniquely positioned to engage facilities in collaborative validation reviews that allow transparency, education, and relationship building.
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Affiliation(s)
- Suparna Bagchi
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | | | - Daniel A Pollock
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan R Edwards
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Katherine Allen-Bridson
- National Healthcare Safety Network, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Ren J, Donovan D, Watkins J, Wang HQ, Rudakov D, Murphy C, McLean A, Lasnier C, Unterberg E, Thomas D, Boivin R. The surface eroding thermocouple for fast heat flux measurement in DIII-D. Rev Sci Instrum 2018; 89:10J122. [PMID: 30399945 DOI: 10.1063/1.5038677] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
A novel type of surface eroding thermocouple (SETC) has been tested and demonstrated in the small angle slot (SAS) divertor of DIII-D for fast local heat flux measurements. The thermojunction of the SETC is formed between two thin (10 μm) ribbons, which are filed over to create microfiber junctions. These thermocouples are able to be exposed directly to the plasma at surface temperatures exceeding 2000 °C and are capable of sub-10 ms time resolution. Before installation in SAS, the SETCs were exposed in the lower DIII-D divertor during L-mode and H-mode discharges, from which results are presented. In preliminary tests, SETCs proved to be a qualified diagnostic to accurately measure both the intra-edge localized mode (ELM) and inter-ELM heat flux during H-mode shots with high frequency ELMs (hundreds of Hz) and to resolve heat flux profiles during strike point sweeps. The heat fluxes measured by using SETCs are consistent with the heat fluxes measured by using IR cameras and Langmuir probes. These new diagnostic capabilities will complement the existing IR camera measurements and will be of particularly significant value to measure surface heat flux in the SAS divertor or other regions where the IR camera lacks line of sight.
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Affiliation(s)
- J Ren
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - D Donovan
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - J Watkins
- Sandia National Laboratories, Livermore, California 94551, USA
| | - H Q Wang
- Oak Ridge Associated Universities, Oak Ridge, Tennessee 37830, USA
| | - D Rudakov
- University of California San Diego, San Diego, California 92093, USA
| | - C Murphy
- General Atomics, San Diego, California 92186-5608, USA
| | - A McLean
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Lasnier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Unterberg
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - D Thomas
- General Atomics, San Diego, California 92186-5608, USA
| | - R Boivin
- General Atomics, San Diego, California 92186-5608, USA
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Maurice JB, Yu D, Watkins J. A 41-Year-Old Man With Abdominal Pain, Deranged Liver Function, and Fevers. Gastroenterology 2018; 154:26-27. [PMID: 29178971 DOI: 10.1053/j.gastro.2017.05.034] [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: 03/01/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/02/2022]
Affiliation(s)
| | - Dominic Yu
- Royal Free Hospital, Hepatology, Pond St, London, United Kingdom
| | - Jennifer Watkins
- Royal Free Hospital, Hepatology, Pond St, London, United Kingdom
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Vyas S, Puri Y, John B, Yu D, Watkins J, Imber C, Fusai G, Arjun S, Sharma D, Davidson B, Malago M, Rahman S. Radiological tumor density and lymph node size correlate with survival in resectable adenocarcinoma of the pancreatic head: A retrospective cohort study. J Cancer Res Ther 2018. [DOI: 10.4103/0973-1482.170938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Laskaratos FM, Walker M, Wilkins D, Tuck A, Ramakrishnan S, Phillips E, Gertner J, Megapanou M, Papantoniou D, Shah R, Banks J, Vlachou E, Garcia-Hernandez J, Woodbridge L, Papadopoulou A, Grant L, Theocharidou E, Watkins J, Luong TV, Mandair D, Caplin M, Toumpanakis C. Evaluation of Clinical Prognostic Factors and Further Delineation of the Effect of Mesenteric Fibrosis on Survival in Advanced Midgut Neuroendocrine Tumours. Neuroendocrinology 2018; 107:292-304. [PMID: 30153671 DOI: 10.1159/000493317] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Small intestinal neuroendocrine tumours (SI NETs) represent 30-50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. AIM The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. RESULTS The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. CONCLUSIONS This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.
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Affiliation(s)
- Faidon-Marios Laskaratos
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United
| | - Martin Walker
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Dominic Wilkins
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alexander Tuck
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Shashank Ramakrishnan
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Edward Phillips
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Julian Gertner
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maria Megapanou
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dimitrios Papantoniou
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Ruchir Shah
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jamie Banks
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Erasmia Vlachou
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jorge Garcia-Hernandez
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Lorna Woodbridge
- Department of Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Anthie Papadopoulou
- Department of Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Lee Grant
- Department of Radiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Eleni Theocharidou
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jennifer Watkins
- Academic Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tu Vinh Luong
- Academic Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dalvinder Mandair
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Martyn Caplin
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Centre for Gastroenterology, ENETS Centre of Excellence, Royal Free London NHS Foundation Trust, London, United Kingdom
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Singh S, Siriwardana PN, Johnston EW, Watkins J, Bandula S, Illing R, Davidson BR. Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model<sup/>. Int J Hyperthermia 2017; 34:1114-1120. [PMID: 29096566 DOI: 10.1080/02656736.2017.1400119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 12/22/2022] Open
Abstract
Microwave ablation (MWA) has been proposed to suffer less from the heat sink effect compared to radiofrequency ablation but has been reported to cause extension of the ablation zone along intrahepatic vessels in clinical practice. To study this effect in detail, eight fresh porcine livers were perfused in an ex vivo organ perfusion system. Livers were perfused with oxygenated, O-positive human blood at 37 °C. Perfusion was discontinued immediately before ablation in the non-perfused group (n = 4) whilst in the perfused group (n = 4) perfusion was maintained during MWA (140 W X 2 min). Large intrahepatic vessels (> 6 mm) were avoided using ultrasound. MWA zones were bisected within 30 min of perfusion termination and sections were fixed in formalin and stained with H&E and NADH to assess cell viability. Magnetic resonance imaging (MRI) was performed on two livers (one perfused, one non-perfused) to provide imaging correlation before sectioning. Twenty-one out of a total of 30 MW ablation zones (70%) showed extension of the ablation zone along a vessel. There was no statistically significant difference (p = 1) in the incidence of ablation zone extension between perfused (9/13, 69%) and non-perfused organs (12/17, 71%). MRI also demonstrated ablation zone extension along blood vessels correlating with macroscopy in two livers. NADH staining also confirmed extension of the ablation zone. Liver MWA appears to be commonly associated with propagated thermal injury along adjacent vessels and occurs independent of active blood flow. In order to avoid possible complications through non-target tissue injury, this effect requires further investigation.
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Affiliation(s)
- Saurabh Singh
- a Interventional Oncology Service , University College Hospital , London , UK
| | - Pulathis Nilantha Siriwardana
- b Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery , Royal Free London NHS Foundation Trust and University College London , London , UK
| | | | - Jennifer Watkins
- c Department of Cellular Pathology , Royal Free London NHS Foundation Trust , London , UK
| | - Steven Bandula
- a Interventional Oncology Service , University College Hospital , London , UK
| | - Rowland Illing
- a Interventional Oncology Service , University College Hospital , London , UK
| | - Brian Ritchie Davidson
- b Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery , Royal Free London NHS Foundation Trust and University College London , London , UK
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Anwar S, Tampubolon G, Hutajulu S, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women: A nationwide study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx729.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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37
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Chandran S, Watkins J, Abdul-Aziz A, Calvert P, Bowles K, Flather M, Rushworth S, Ryding A. P1779Differential cytokine expression between the coronary and peripheral circulation in patients with ruptured and intact fibrous caps presenting with ST segment myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mclaren A, Ulahannan D, Keen E, Stewart G, Bell J, Planche K, Power N, Navalkissoor S, Craig R, Luong T, Watkins J, Clark I, Gillmore R. The workload and impact of a dedicated cancer of unknown primary (CUP) service on patients with imaging suggestive of metastatic disease. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nitecki R, Davis M, Watkins J, Wu Y, Muto M, Horowitz N, Berkowitz R, Feltmate C. Extramammary Paget's disease of the vulva: Management, recurrence and malignant transformation. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.486] [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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Finken KH, Reiter D, Denner T, Dippel KH, Hobirk J, Mank G, Kever H, Wolf GH, Noda N, Miyahara A, Shoji T, Sato KN, Akaishi K, Boedo JA, Brooks JN, Conn RW, Corbett WJ, Doerner RP, Goebel D, Gray DS, Hillis DL, Hogan J, Mcgrath RT, Matsunaga M, Moyer R, Nygren RE, Watkins J. The Toroidal Pump Limiter ALT-II in TEXTOR. Fusion Science and Technology 2017. [DOI: 10.13182/fst05-a694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K. H. Finken
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - D. Reiter
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - T. Denner
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - K. H. Dippel
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - J. Hobirk
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - G. Mank
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - H. Kever
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - G. H. Wolf
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - N. Noda
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - A. Miyahara
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - T. Shoji
- Nagoya University, Department of Energy Engineering and Science, 464-8603 Nagoya, Japan
| | - K. N. Sato
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - K. Akaishi
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - J. A. Boedo
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | | | - R. W. Conn
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - W. J. Corbett
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - R. P. Doerner
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. Goebel
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. S. Gray
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. L. Hillis
- Oak Ridge National Laboratory, Building 9201-2, MS-8072, Oak Ridge, Tennessee
| | - J. Hogan
- Oak Ridge National Laboratory, Building 9201-2, MS-8072, Oak Ridge, Tennessee
| | - R. T. Mcgrath
- Sandia National Laboratories, Albuquerque, New Mexico
| | - M. Matsunaga
- Toyama University, Hydrogen Isotope Research Center, Gofuku 3190, Toyama 930-8555, Japan
| | - R. Moyer
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - R. E. Nygren
- Sandia National Laboratories, Albuquerque, New Mexico
| | - J. Watkins
- Sandia National Laboratories, Albuquerque, New Mexico
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Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Abstract P1-05-14: Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Genomic instability is a critical feature of breast cancers, which manifests in genome-wide copy number aberrations (CNA), often causing “gene breakage” and the generation of fusion genes. We aimed to identify aborted transcripts with underlying CNAs and to investigate the molecular landscape of breast cancers harbouring such events.
Methods: A walking student's t-test algorithm was applied to Affymetrix Exon 1.0ST array data of 123 breast cancers to identify regions of aborted transcription and overlaid with DNA breakpoints derived from matched Affymetrix SNP6 ASCAT-segmented copy number. Aborted transcripts were investigated as potential fusion gene partners through RNA-seq analysis of 151 breast cancer samples (TCGA) and 51 breast cancer cell lines (BCCL) using ChimeraScan. Clinical correlates were established for clinicopathological features, genomic instability measures, and gene expression-based molecular classifiers including PAM50, TNBCtype, IntClust subtypes and immune signatures.
Results: One hundred and six genes with recurrent CNA-induced aborted transcription were identified. Aborted transcription showed hormone receptor subtype-specificity for 7 genes (nTNBC=1, nNon-TNBC=6) and was less prevalent in samples of IntClust 2 and IntClust 4 subtypes (p: 0.0043, 0.0011). Aborted transcripts were more frequently observed in samples with greater copy-neutral loss of heterozygosity (p=0.012), while aborted transcription of 54/106 genes significantly affected enrichment of 27 tumor-infiltrating lymphocyte subpopulations.14 aborted transcripts were found as a fusion gene with one partner in RNA-seq of TCGA and BCCL, while 19 were involved in multiple fusion events (range=1-6, median=2). Nine of 106 genes displayed gene breakage and fusion events exclusively in samples with an enriched tandem duplication phenotype. Notably, FOXP1, localised to a tumour suppressor locus at 3p14.1, reported the highest number of fusion configurations (n=6) with concurrent aborted transcription across all RNA-seq datasets (nPRADA=9, nTCGA=38, nBCCL=6).
Conclusion: CNA-induced gene breakage affects the molecular landscape of breast cancers and is linked with many genomic configurations of interest including copy-neutral loss of heterozygosity and tandem duplications. In particular, the role of recurrent gene fusions of the tumour suppressor, FOXP1, in tumourigenesis warrants further investigation.
Citation Format: Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-14.
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Affiliation(s)
- A Mohd Noor
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - S Maguire
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Watkins
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Quist
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - H Mirza
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Tutt
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - C Gillett
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - R Natrajan
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Grigoriadis
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
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Vyas SJ, Puri YS, John BJ, Yu D, Watkins J, Imber C, Fusai G, Arjun S, Sharma D, Davidson BR, Malago M, Rahman S. Radiological tumor density and lymph node size correlate with survival in resectable adenocarcinoma of the pancreatic head: A retrospective cohort study. J Cancer Res Ther 2016; 12:417-21. [PMID: 27072273 DOI: 10.4103/0973-1482.171358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tumors within the pancreatic head show a variable density and enhancement on computerized tomography (CT). The relationship between the radiological appearance of pancreatic adenocarcinoma on CT and survival remains unclear. The aim of this study was to evaluate the relationship between the tumor density on CT and survival. We also evaluated the correlation between lymph node (LN) size and overall survival in patients undergoing pancreaticoduodenectomy for head of pancreas adenocarcinoma. MATERIALS AND METHODS Case records of patients undergoing pancreaticoduodenectomy for the adenocarcinoma of pancreas head, between 2005 and 2009, were evaluated. CT was interpreted to document tumor density - Hounsfield unit (HU) and LN size of enlarged LNs. Histology was analyzed to review tumor differentiation and LN status. Survival was correlated with LN size and tumor density (HU). RESULTS Increasing tumor density was significantly associated with an adverse outcome (P = 0.042, hazard ratio [HR] 1.034, 1.002-1.067 95% confidence interval [95% CI]). Patients with well-differentiated tumors had significantly lower tumor density as compared to moderately differentiated tumors (39.00 ± 26.00 vs. 71.31 ± 21.03 HU, P = 0.005). LN size more than 1 cm irrespective of LN status strongly correlated with the survival and was found to be an important prognostic factor (19.37 ± 2.71 months vs. 27.44 ± 2.74 months; P = 0.025; HR 2.70; 1.09-6.68 95% CI). CONCLUSION Increasing pancreatic tumor density and the lymph nodal size of more than 1 cm are strong predictors of unfavorable overall survival for resectable adenocarcinoma of the pancreatic head. Further studies are required to identify the value of these proposed prognostic factors.
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Affiliation(s)
- Soumil J Vyas
- Division of HPB and Liver Transplant Surgery, Royal Free Hospital and Medical School, London, NW3 2QG, UK
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Wulaningsih W, Astuti Y, Matsuguchi T, Anggriyadanny P, Watkins J. 54P Circulating prostate-specific antigen and telomere length in a nationally representative sample of men without history of prostate cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw574.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- A J Swannell
- Department of Rheumatology and Rehabilitation, City Hospital, Nottingham, NG5 1PD
| | - J Watkins
- Protein Reference Unit, Department of Immunology, Hallamshire Hospital, Sheffield S10 2RX
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Childs A, Kirkwood A, Edeline J, Luong TV, Watkins J, Lamarca A, Alrifai D, Nsiah-Sarbeng P, Gillmore R, Mayer A, Thirlwell C, Sarker D, Valle JW, Meyer T. Ki-67 index and response to chemotherapy in patients with neuroendocrine tumours. Endocr Relat Cancer 2016; 23:563-70. [PMID: 27412968 DOI: 10.1530/erc-16-0099] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 05/17/2016] [Accepted: 06/15/2016] [Indexed: 01/23/2023]
Abstract
Chemotherapy (CT) is widely used for neuroendocrine tumours (NETs), but there are no validated biomarkers to predict response. The Ki-67 proliferation index has been proposed as a means of selecting patients for CT, but robust data are lacking. The aim of this study was to investigate the relationship between response to chemotherapy and Ki-67 in NET. We reviewed data from 222 NET patients treated with CT. Tumours were graded according to Ki-67 index: G1 ≤2%, G2 3-20% and G3 >20%. Response was assessed according to RECIST and survival calculated from start of chemotherapy to death. To explore Ki-67 as a marker of response, we calculated the likelihood ratio and performed receiver operating characteristic analysis. Overall, 193 patients had a documented Ki-67 index, of which 173 were also evaluable for radiological response: 10% were G1, 46% G2 and 43% G3; 46% were pancreatic NET (PNET). Median overall survival was 22.1 months. Overall response rate was 30% (39% in PNET vs 22% in non-PNET) and 43% of patients had stable disease. Response rate increased with grade: 6% in G1 tumours, 24% in G2 and 43% in G3. However, maximum likelihood ratio was 2.3 at Ki-67=35%, and the area under the ROC curve was 0.60. As reported previously, a high Ki-67 was an adverse prognostic factor for overall survival. In conclusion, response to CT increases with Ki-67 index, but Ki-67 alone is an unreliable means to select patients for CT. Improved methods to stratify patients for systemic therapy are required.
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Affiliation(s)
- Alexa Childs
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Amy Kirkwood
- Cancer Research UK & UCL Cancer Trials CentreLondon, UK
| | | | - Tu Vinh Luong
- Department of PathologyRoyal Free London NHS Foundation Trust, London, UK
| | - Jennifer Watkins
- Department of PathologyRoyal Free London NHS Foundation Trust, London, UK
| | - Angela Lamarca
- Institute of Cancer SciencesUniversity of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Roopinder Gillmore
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Astrid Mayer
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK
| | - Christina Thirlwell
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK UCL Cancer InstituteUCL, London, UK
| | | | - Juan W Valle
- Institute of Cancer SciencesUniversity of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - Tim Meyer
- Department of OncologyRoyal Free London NHS Foundation Trust, London, UK UCL Cancer InstituteUCL, London, UK
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Noor AM, Maguire S, Watkins J, Quist J, Mirza H, Ougham K, Tutt A, Gillett C, Natrajan R, Grigoriadis A. The characterisation of potential fusion genes in breast cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61097-3] [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: 11/26/2022]
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Siriwardana PN, Singh S, Johnston EW, Watkins J, Bandula S, Illing RO, Davidson BR. Effect of Hepatic Perfusion on Microwave Ablation Zones in an Ex Vivo Porcine Liver Model. J Vasc Interv Radiol 2016; 28:732-739. [PMID: 27266361 DOI: 10.1016/j.jvir.2016.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To compare the size of ablation zones derived from nonperfused ex vivo livers with ablation zones created using an ex vivo perfused porcine liver model. MATERIALS AND METHODS Six fresh porcine livers were used to evaluate microwave ablation (MWA). Perfused (n = 3) and nonperfused (n = 3) livers were warmed to 37°C by oxygenated, O-positive human blood reconstituted with Ringer solution, using an organ perfusion circuit. During MWA, perfusion was discontinued in the nonperfused group and maintained in the perfused group. After MWA (140 watts × 2 min at 2.45 GHz) with the Acculis MTA System (AngioDynamics, Latham, New York), ablation zones were bisected sagittally. Sections were stained with nicotinamide adenine dinucleotide (NADH) and hematoxylin-eosin to assess viability of cells in ablation and marginal zones. RESULTS Comparison of 22 MWA zones (9 in perfused group, 13 in nonperfused group) was performed. Ablation zones demonstrated a central "white" and peripheral "red" zone. Cells in the white zone were nonviable with no NADH staining. The red zone showed progressive NADH staining toward the periphery, suggesting incomplete cell death. White and red zones of the perfused group were significantly smaller compared with the nonperfused group (short axis, 17.8 mm ± 2.7 vs 21.1 mm ± 3.2, P = .003; long axis, 40.69 mm ± 3.9 vs 39.63 mm ± 5.2, P = .44; intermediate zone,1.33 mm ± 0.04 vs 2.7 mm ± 0.14, P < .0001; mean ± SD). CONCLUSIONS MWA algorithms provided by this manufacturer are based on nonperfused organ data, which overestimate ablation zone size. Data from perfused liver models may be required for more accurate dosimetry guidelines.
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Affiliation(s)
- Pulathis N Siriwardana
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom.
| | - Saurabh Singh
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Edward W Johnston
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Jennifer Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Rowland O Illing
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Brian R Davidson
- Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery, Royal Free London NHS Foundation Trust and University College London, London, United Kingdom
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Affiliation(s)
- Emma L. Culver
- Sheila Sherlock Liver CentreRoyal Free HospitalLondonUnited Kingdom
| | - Jennifer Watkins
- Department of HistopathologyRoyal Free HospitalLondonUnited Kingdom
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Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz AC, Watkins J, Barrett T, Trushar P, Esser K, Gedaly R. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol 2016; 31:628-33. [PMID: 26399838 PMCID: PMC6615558 DOI: 10.1111/jgh.13166] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [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] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sarcopenia is the most common complication of cirrhosis and adversely affects quality of life and outcomes before, during, and after liver transplantation. We studied predictors of sarcopenia and sarcopenic obesity in patients with cirrhosis undergoing liver transplant (LT) evaluation. METHODS A retrospective analysis of 207 adult cirrhotic patients that underwent LT from January 2008 to December 2013 was performed at our institution. RESULTS Two hundred seven patients were evaluated, 68% were male with a mean age of 54 ± 8 years. The most common etiology of cirrhosis was alcoholic liver disease (38.6%), followed by chronic hepatitis C (38.2%), nonalcoholic steatohepatitis (NASH) (21.7%), and hepatocellular carcinoma (HCC) (24.6%). The mean body mass index of the cohort was of 30.1 ± 5.7 kg/m(2) . Forty-eight percent of these patients were obese. Of the 207 patients, 88% had computed tomographic (CT) scans within 90 days before transplant; of these, 59% had sarcopenia found during LT evaluation. Of the patients with pretransplant sarcopenia, 59 had CT scan at 6 months posttransplant and 56 (95%) remained sarcopenic. Of the 56 patients who had sarcopenia at 6 months, 31 had available CT scans at 1 year, and 100% persisted with sarcopenia. These 31 subjects had a mean skeletal muscle index of 35 at 6 months and 36 at 1 year. SO was found in 41.7% of our patients. On multivariable regression analysis, obesity and age were found to be independently associated with pretransplant sarcopenia after controlling for gender and alcohol liver disease diagnosis (P = 0.00001, odds ratio [OR] 0.22, and P = 0.008, OR 2.0, respectively). A multivariable logistic regression analysis found that NASH as cause of cirrhosis and model of end-stage liver disease score are independent predictors of sarcopenic obesity after controlling for age, gender, alcoholic liver disease diagnosis, and HCC (P = 0.014 and 0.038, respectively; 95% confidence interval, 1.44-25.26 and 1.00-1.15, respectively; OR 6.03, 1.08, respectively). CONCLUSIONS Sarcopenia and sarcopenic obesity is seen in a significant number of patients with cirrhosis undergoing LT evaluation. Sarcopenia progresses after LT initially and does not recover at least within the first year after surgery. Obesity is an independent predictor of pretransplant sarcopenia and NASH was associated with 6-fold increased risk of having sarcopenic obesity in cirrhotic patients in our cohort.
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Affiliation(s)
- Sandra Carias
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ana Lia Castellanos
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Valery Vilchez
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Rashmi Nair
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Anna Christina Dela Cruz
- Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer Watkins
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Terrence Barrett
- Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patel Trushar
- Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Karyn Esser
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Roberto Gedaly
- Department of Surgery, Division of Transplantation, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Siriwardana PN, Luong TV, Watkins J, Turley H, Ghazaley M, Gatter K, Harris AL, Hochhauser D, Davidson BR. Biological and Prognostic Significance of the Morphological Types and Vascular Patterns in Colorectal Liver Metastases (CRLM): Looking Beyond the Tumor Margin. Medicine (Baltimore) 2016; 95:e2924. [PMID: 26937938 PMCID: PMC4779035 DOI: 10.1097/md.0000000000002924] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/29/2016] [Accepted: 01/31/2016] [Indexed: 01/06/2023] Open
Abstract
Patients with encapsulated colorectal liver metastases (CRLM) have a better prognosis than those without a capsule. The reason for the encapsulation is unknown. Hypoxia inducible factor-1α (HIF-1α) increases tumor angiogenesis and tumor tissue expression is associated with reduced survival. Our aim was to determine whether the good prognosis of encapsulated CRLM is associated with reduced HIF-1α expression by the cancer.The study selected only patients who had not undergone neoadjuvant chemotherapy prior to a potentially curative hepatectomy for CRLM. From 30 selected patients, serial sections were cut from a single randomly selected metastasis. Morphology was assessed following H&E staining. Tumor hypoxia, vascular endothelial growth factor (VEGF), proliferation, and microvascular density (MVD) were assessed by immunostaining for HIF-1α and carbonic anhydrase-9 (CA-9), VEGF, Ki67, and cluster of differentiation-31, respectively. MVD was calculated in the vascular hot spots. Pathology was reported without clinical outcome information. Actual long-term survival was recorded.Thirteen (43%) of the cancers were encapsulated CRLM containing glands which were large, complex, and cribriform. Thirteen (43%) were infiltrative CRLM and their glands were small, closely packed, and rounded with vessels in the interglandular fibrous tissue with no capsule; 3 (10%) had a mixed picture. Encapsulated CRLM had a higher expression of HIF-1α (58% vs 8%, P = 0.03), CA-9 (42% vs 0%, P = 0.04), and VEGF (92% vs 25%, P = 0.02). MVD was lower in the encapsulated CRLM group (37 mm vs 143 mm, P < 0.001). The median follow-up was 115 months. The encapsulated CRLM group had a better overall and 5-year survival (relative hazard: 0.58, P = 0.057 and hazard ratio: 0.52, P = 0.044).There are 2 main morphological appearances of CRLM which have very different long-term survival following liver resection surgery. The morphology is associated with differences in expression of HIF-1α, CA-9, VEGF, and angiogenesis.
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Affiliation(s)
- Pulathis N Siriwardana
- From the Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery, Royal Free London NHS Foundation Trust (MG) and University College London Medical School (PNS, BRD); Department of Cellular Pathology, Royal Free London NHS Foundation Trust (TVL, JW); Department of Oncology, UCL Cancer Institute (DH), London, UK; Nuffield Department of Clinical Laboratory Sciences, Tumor Pathology Group (HT) and Nuffield Division of Clinical Laboratory Sciences, Department of Medicine (KG), John Radcliffe Hospital, University of Oxford; and Department of Oncology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford University (ALH), Oxford, UK
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