1
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McLeod CJ, Thomas JM. Does social-norm messaging influence expected satiety and ideal portion-size selection? Appetite 2024; 193:107157. [PMID: 38081543 DOI: 10.1016/j.appet.2023.107157] [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: 08/07/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
A person's perception of how long a food will stave off hunger (expected satiety) and the ideal amount to consume (ideal portion size) are both influenced by food-to-mealtime norms. Here, we examine whether social norms can modulate this effect, in three experimental studies. In study 1 (n = 235) participants were exposed to a social norm suggesting most people enjoyed consuming pasta for breakfast. There was a main effect of food-to-mealtime congruence for expected satiety and ideal portion size (p < 0.001) - participants selected a smaller portion of pasta for breakfast (vs. lunch) - but there were no other main effects/interactions (p ≥ 0.15). Study 2 (n = 200) followed the same approach as study 1, but sought to examine whether the typical volume of food consumed at breakfast and lunch needed to be controlled. Again, there was a main effect of congruence (the same pattern) (p ≤ 0.02) but no other main effects/interactions (p ≥ 0.73). Study 3 (n = 208) followed the same approach as study 2, but the social-norm message was changed to suggest that most people who eat pasta for breakfast found it effectively reduced their hunger. Again, there was a main effect of congruence (the same pattern) (p < 0.001) but no other main effects/interaction (p ≥ 0.26). These studies provide further evidence for the food-to-mealtime effect, but do not provide any evidence that a single, simple social-norm statement can modulate expected satiety or ideal portion size, or interact with the food-to-mealtime effect.
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Affiliation(s)
- C J McLeod
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK.
| | - J M Thomas
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
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2
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Beutler BD, Moody AE, Thomas JM, Sugar BP, Ulanja MB, Antwi-Amoabeng D, Tsikitas LA. Anti-N-methyl-D-aspartate receptor-associated encephalitis: A review of clinicopathologic hallmarks and multimodal imaging manifestations. World J Radiol 2024; 16:1-8. [PMID: 38312349 PMCID: PMC10835429 DOI: 10.4329/wjr.v16.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Anti-N-methyl-D-aspartate receptor-associated encephalitis (NMDARE) is a rare immune-mediated neuroinflammatory condition characterized by the rapid onset of neuropsychiatric symptoms and autonomic dysfunction. The mechanism of pathogenesis remains incompletely understood, but is thought to be related to antibodies targeting the GluN1 subunit of the NMDA receptor with resultant downstream dysregulation of dopaminergic pathways. Young adults are most frequently affected; the median age at diagnosis is 21 years. There is a strong female predilection with a female sex predominance of 4:1. NMDARE often develops as a paraneoplastic process and is most commonly associated with ovarian teratoma. However, NMDARE has also been described in patients with small cell lung cancer, clear cell renal carcinoma, and other benign and malignant neoplasms. Diagnosis is based on correlation of the clinical presentation, electroencephalography, laboratory studies, and imaging. Computed tomography, positron emission tomography, and magnetic resonance imaging are essential to identify an underlying tumor, exclude clinicopathologic mimics, and predict the likelihood of long-term functional impairment. Nuclear imaging may be of value for prognostication and to assess the response to therapy. Treatment may involve high-dose corticosteroids, intravenous immunoglobulin, and plasma exchange. Herein, we review the hallmark clinicopathologic features and imaging findings of this rare but potentially devastating condition and summarize diagnostic criteria, treatment regimens, and proposed pathogenetic mechanisms.
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Affiliation(s)
- Bryce David Beutler
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT 84132, United States
| | - Jerry Mathew Thomas
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Benjamin Phillip Sugar
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Mark B Ulanja
- Department of Internal Medicine, Christus Ochsner St. Patrick Hospital, Lake Charles, LA 70601, United States
| | - Daniel Antwi-Amoabeng
- Department of Internal Medicine, Christus Ochsner St. Patrick Hospital, Lake Charles, LA 70601, United States
| | - Lucas Anthony Tsikitas
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
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3
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Dixon A, Steinman HK, Kyrgidis A, Smith H, Sladden M, Zouboulis C, Argenziano G, Apalla Z, Lallas A, Longo C, Nirenberg A, Popescu C, Tzellos T, Cleaver L, Zachary C, Anderson S, Thomas JM. Online prediction tools for melanoma survival: A comparison. J Eur Acad Dermatol Venereol 2023; 37:1999-2003. [PMID: 37210649 DOI: 10.1111/jdv.19219] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. OBJECTIVE To compare online melanoma survival prediction tools that request user input on clinical and pathological features. METHODS Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. RESULTS Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. LIMITATIONS The authors did not have access to the base data used to compile various prediction tools. CONCLUSION The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.
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Affiliation(s)
- A Dixon
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - H K Steinman
- Campbell University, Buies Creek, North Carolina, USA
| | - A Kyrgidis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Smith
- Oxford Dermatology, Western Australia, Perth, Australia
| | - M Sladden
- University of Tasmania, Tasmania, Launceston, Australia
| | - C Zouboulis
- Staedtisches Klinikum Dessau, Brandenburg Medical School, Dessau, Germany
| | - G Argenziano
- Dermatology, University of Campania, Naples, Italy
| | - Z Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Longo
- University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unita Sanitaria Locale, IRCCS di Reggio Emilia, Skin Cancer Center, Regio Emilia, Italy
| | - A Nirenberg
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - C Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - T Tzellos
- Arctic University of Norway, Tromsø, Norway
| | - L Cleaver
- AT Still University, Missouri, Kirksville, USA
| | - C Zachary
- University of California Irvine, California, Irvine, USA
| | - S Anderson
- Australasian College of Cutaneous Oncology, Victoria, Melbourne, Australia
| | - J M Thomas
- Formerly of Royal Marsden Hospital, Chelsea, London, UK
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4
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Dixon AJ, Steinman HK, Kyrgidis A, Smith H, Sladden M, Zouboulis C, Argenziano G, Apalla Z, Lallas A, Longo C, Nirenberg A, Popescu C, Dixon JB, Tzellos T, Zachary C, Cleaver L, Anderson S, Zagarella S, Thomas JM. Improved methodology in determining melanoma mortality and selecting patients for immunotherapy. J Eur Acad Dermatol Venereol 2023. [PMID: 36785984 DOI: 10.1111/jdv.18951] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Affiliation(s)
- A J Dixon
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - H K Steinman
- Campbell University, Buies Creek, North Carolina, USA
| | - A Kyrgidis
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Smith
- Oxford Dermatology, Perth, Western Australia, Australia
| | - M Sladden
- University of Tasmania, Launceston, Tasmania, Australia
| | - C Zouboulis
- Dessau Medical Center, Brandenburg Medical School, Dessau, Germany
| | | | - Z Apalla
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Lallas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Longo
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Nirenberg
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - C Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - J B Dixon
- Swinburne University of Technology, Melbourne, Victoria, Australia
| | - T Tzellos
- Arctic University of Norway, Tromsø, Norway
| | - C Zachary
- University of California, Irvine, California, USA
| | - L Cleaver
- A.T. Still University, Kirksville, Missouri, USA
| | - S Anderson
- Australasian College of Cutaneous Oncology, Melbourne, Victoria, Australia
| | - S Zagarella
- University of Sydney, Sydney, New South Wales, Australia
| | - J M Thomas
- Formerly of Royal Marsden Hospital, London, UK
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Veenstra MMK, Smithers BM, Visser E, Edholm D, Brosda S, Thomas JM, Gotley DC, Thomson IG, Wijnhoven BPL, Barbour AP. Complications and survival after hybrid and fully minimally invasive oesophagectomy. BJS Open 2021; 5:6133613. [PMID: 33609389 PMCID: PMC7893474 DOI: 10.1093/bjsopen/zraa033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 12/31/2022] Open
Abstract
Background Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes. Methods Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival. Results There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach. Conclusion MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.
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Affiliation(s)
- M M K Veenstra
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - B M Smithers
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
| | - E Visser
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - D Edholm
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - S Brosda
- Diamantina Institute, Translational Research Institute, The University of Queensland, Queensland, Australia
| | - J M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, Brisbane, Queensland, Australia
| | - D C Gotley
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - I G Thomson
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - A P Barbour
- Academy of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Diamantina Institute, Translational Research Institute, The University of Queensland, Queensland, Australia
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Ketchum JN, Bonacker RC, Andersen CM, Smith EG, Stoecklein KS, Spinka CM, Thomas JM. Evaluation of later timepoints for split-time artificial insemination when using sex-sorted semen among beef heifers following the 14-d CIDR®-PG protocol. Anim Reprod Sci 2020; 224:106649. [PMID: 33302141 DOI: 10.1016/j.anireprosci.2020.106649] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
An experiment was designed to evaluate later timepoints for Split-Time AI (STAI), with the hypothesis that delaying AI may improve estrous response and pregnancy per AI when using sex-sorted semen. Timing of estrus was synchronized among 794 heifers using the 14-d CIDR®-PG protocol (1.38 g progesterone intravaginal insert from Day 0-14, followed by 25 mg dinoprost tromethamine on Day 30) with STAI performed based on estrous status. Heifers were blocked based on breed, source, sire, reproductive tract score (RTS), and BW and assigned within block to one of two approaches. In Approach 66, heifers that were estrual by 66 h after PG administration were inseminated at 66 h, and remaining heifers were inseminated 24 h later (90 h). In Approach 72, heifers that were estrual by 72 h were inseminated at 72 h, and remaining heifers were inseminated 24 h later (96 h). With both approaches, heifers that were non-estrual by the final timepoint were administered 100 μg gonadorelin acetate (GnRH). Within approach, heifers were pre-assigned to receive SexedULTRA 4M™ sex-sorted or conventional semen. The proportion of heifers estrual by the first timepoint was greater (P < 0.0001) with Approach 72 (76 %; 302/395) compared to Approach 66 (61 %; 242/399). The proportion of heifers pregnant as a result of AI differed (P = 0.0005) by semen type (59 % [240/404] for conventional compared with 48 % [187/390] for sex-sorted) but was not affected by approach or approach × semen type. In summary, pregnancy per AI of heifers receiving sex-sorted or conventional semen following the 14-d CIDR®-PG protocol did not differ when STAI was delayed 6 h. The proportion of estrual heifers prior to the first timepoint, however, was greater with later STAI.
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Affiliation(s)
- J N Ketchum
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - R C Bonacker
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - C M Andersen
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - E G Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - K S Stoecklein
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - C M Spinka
- Division of Plant Sciences, University of Missouri, Columbia, MO 65211, United States
| | - J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States.
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7
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Bonacker RC, Gray KR, Breiner CA, Anderson JM, Patterson DJ, Spinka CM, Thomas JM. Comparison of the 7 & 7 Synch protocol and the 7-day CO-Synch + CIDR protocol among recipient beef cows in an embryo transfer program. Theriogenology 2020; 158:490-496. [PMID: 33080452 DOI: 10.1016/j.theriogenology.2020.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/16/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
An experiment was designed to evaluate the effectiveness of the recently developed 7 & 7 Synch protocol to synchronize estrus among recipients prior to embryo transfer (ET). Postpartum beef cows (n = 1358) across thirteen locations were assigned to either the 7-d CO-Synch + CIDR protocol or the 7 & 7 Synch protocol prior to ET. Cows were preassigned to balanced treatments within location based on age and days postpartum, with body condition score recorded at ET. Cows assigned to the 7-d CO-Synch + CIDR protocol were administered gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin acetate) on Day 7, an intravaginal controlled internal drug release (CIDR; 1.38 g progesterone) from Day 7 to Day 14, and prostaglandin F2α (PGF2α; 25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows assigned to the 7 & 7 Synch protocol were administered PGF2α (25 mg dinoprost tromethamine) coincident with CIDR insertion on Day 0, GnRH (100 μg gonadorelin acetate) on Day 7, and PGF2α (25 mg dinoprost tromethamine) coincident with CIDR removal on Day 14. Cows were observed for visible signs of estrus, with GnRH (100 μg gonadorelin acetate) administered to cows failing to express estrus during the detection period. Embryo transfer was performed approximately seven days after estrus or GnRH administration. Presence of corpora lutea (CL) was determined via transrectal palpation by a single veterinarian blinded to treatment, and embryos were transferred only to cows with palpable CL. Embryo transfer was performed using either fresh or frozen embryos, with embryo stage and grade recorded for each recipient. The proportion of cows expressing estrus was increased (P < 0.0001) among cows assigned to the 7 & 7 Synch protocol (86% [529/615] vs 76% [488/640]). The proportion of cows expressing estrus and presenting with palpable CL at ET was greater (P < 0.0001) among cows following treatment with the 7 & 7 Synch protocol compared to the 7-d CO-Synch + CIDR protocol (76% [466/615] vs 65% [418/640]). Consequently, the proportion pregnant to ET was greater (P < 0.03) following the 7 & 7 Synch protocol (40% [263/653]) compared to the 7-d CO-Synch + CIDR protocol (34% [228/664]). In summary, the 7 & 7 Synch protocol involving administration of PGF2α and treatment with a CIDR for 7 days prior to GnRH improved the likelihood of estrus expression in recipients, increased the proportion of cows eligible to receive an embryo, which resulted in a greater pregnancy rate to ET.
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Affiliation(s)
- R C Bonacker
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - K R Gray
- Cross Country Genetics, Westmoreland, KS, 66549, USA
| | - C A Breiner
- Cross Country Genetics, Westmoreland, KS, 66549, USA
| | - J M Anderson
- Cross Country Genetics, Westmoreland, KS, 66549, USA
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - C M Spinka
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA.
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8
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Bonacker RC, Stoecklein KS, Locke JWC, Ketchum JN, Knickmeyer ER, Spinka CM, Poock SE, Thomas JM. Treatment with prostaglandin F 2α and an intravaginal progesterone insert promotes follicular maturity in advance of gonadotropin-releasing hormone among postpartum beef cows. Theriogenology 2020; 157:350-359. [PMID: 32858443 DOI: 10.1016/j.theriogenology.2020.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
An experiment was designed to evaluate treatments to promote ovarian follicular maturity in advance of administration of exogenous gonadotropin-releasing hormone (GnRH; 100 μg gonadorelin) for control of the bovine estrous cycle. We hypothesized prostaglandin F2α (PGF2α; 500 μg cloprostenol) followed by an intravaginal progesterone-releasing insert (CIDR; 1.38 g progesterone) would induce greater follicle size and serum estradiol at the time of GnRH administration. Postpartum cows (n = 194) in two locations were assigned to one of five treatments based on age, days postpartum, and body condition score. Cows in Treatment 1 were treated with the standard 7-d CO-Synch + CIDR protocol: administration of GnRH and CIDR insertion on Day -10, and administration of PGF2α and CIDR removal on Day -3. Treatments 2-5 were designed in a 2 × 2 factorial arrangement, with Treatment 1 included as an additional reference. On Day -17, cows in Treatments 2-5 received a CIDR insert, either with (Treatments 2 and 3) or without (Treatments 4 and 5) administration of PGF2α at CIDR insertion. On Day -10, all cows were administered GnRH, and CIDR inserts were either removed (Treatments 2 and 4) or remained in place until Day -3 (Treatments 3 and 5). Treatment with PGF2α and CIDR in advance of GnRH (Treatments 2 and 3) resulted in increased diameter of the largest ovarian follicle (P < 0.001) and increased serum concentrations of estradiol (P < 0.0005) on Day -10. In addition, variation among cows in CL status (no CL vs. a single CL vs. multiple CL) on Day -3 tended to be decreased (P = 0.08), with cows more likely to have a single CL rather than no CL or multiple CL. Lastly, the proportion of cows expressing estrus prior to fixed-time artificial insemination tended (P = 0.08) to be improved. Results support the hypothesis that administration of PGF2α and treatment with a CIDR for 7 days prior to GnRH promotes follicular maturity in advance of GnRH administration and may provide an approach by which to enhance response of postpartum beef cows to GnRH-based estrus synchronization programs.
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Affiliation(s)
- R C Bonacker
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - K S Stoecklein
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - J N Ketchum
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - E R Knickmeyer
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - C M Spinka
- Division of Plant Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - S E Poock
- College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA.
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9
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van Hootegem SJM, Smithers BM, Gotley DC, Brosda S, Thomson IG, Thomas JM, Gartside M, Barbour AP. Baseline neutrophil-lymphocyte ratio holds no prognostic value for esophageal and junctional adenocarcinoma in patients treated with neoadjuvant chemotherapy. Dis Esophagus 2020; 33:5610875. [PMID: 31676907 DOI: 10.1093/dote/doz082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several studies have reported that neutrophil-lymphocyte ratio (NLR) can predict survival in esophageal and gastroesophageal junction adenocarcinoma, as it reflects systemic inflammation. Hence, we aimed to determine whether baseline NLR holds prognostic value for esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy (nCT) followed by surgery. METHODS We studied the data of 139 patients that received nCT before undergoing esophagectomy with curative intent, all identified from a prospectively maintained database (1998-2016). Pretreatment hematology reports were used to calculate the baseline NLR. A receiver operating characteristic curve (ROC-curve) was plotted to determine an optimal cutoff value. NLR quartiles were used to display possible differences between groups in relation to overall survival (OS) and disease-free survival (DFS) using the method of Kaplan-Meier. Cox regression analysis was performed to assess the prognostic value of NLR. RESULTS The median OS and DFS times were 46 months (interquartile range [IQR]: 19-166) and 30 months (IQR: 13-166], respectively, for the entire cohort. The ROC-curve showed that NLR has no discriminating power for survival status (area under the curve = 0.462) and therefore no optimal cutoff value could be determined. There were no statistically significant differences in median OS times for NLR quartiles: 65 (Q1), 32 (Q2), 45 (Q3), and 46 months (Q4) (P = 0.926). Similarly, DFS showed no difference between quartile groups, with median survival times of 27 (Q1), 19 (Q2), 36 (Q3), and 20 months (Q4) (P = 0.973). Age, pN, pM, and resection margin were independent prognostic factors for both OS and DFS. On the contrary, NLR was not associated with OS or DFS in univariable and multivariable analyses. CONCLUSION Baseline NLR holds no prognostic value for esophageal and gastroesophageal junction adenocarcinoma patients treated with nCT in this study, in contrast to other recently published papers. This result questions the validity of NLR as a reliable prognostic indicator and its clinical usefulness in these patients.
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Affiliation(s)
- S J M van Hootegem
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - B M Smithers
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - D C Gotley
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - S Brosda
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - I G Thomson
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - J M Thomas
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,Mater Research Institute, Mater Health Services, South Brisbane, Australia
| | - M Gartside
- The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - A P Barbour
- Upper Gastrointestinal/Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Queensland, Australia
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Locke JWC, Thomas JM, Knickmeyer ER, Ellersieck MR, Yelich JV, Poock SE, Smith MF, Patterson DJ. Comparison of long-term progestin-based protocols to synchronize estrus prior to natural service or fixed-time artificial insemination in Bos indicus-influenced beef heifers. Anim Reprod Sci 2020; 218:106475. [PMID: 32507258 DOI: 10.1016/j.anireprosci.2020.106475] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
This experiment was designed to evaluate breeding strategies involving natural service or fixed-time artificial insemination (FTAI) in Bos indicus-influenced beef heifers (n = 1456) when there were field-type management conditions. Body weights and reproductive tract scores (RTS; Scale 1-5) were obtained for heifers before assignment to one of five treatments: 1) Non-synchronized control exposed for natural service (NS), n = 299; 2) melengestrol acetate + natural service (MGA + NS; 0.5 mg/heifer/d), n = 295; 3) 14-d controlled internal drug release insert + natural service (CIDR + NS), n = 289; 4) 14-d MGA-prostaglandin F2α (PG) + FTAI, n = 295; or 5) 14-d CIDR-PG + FTAI, n = 278. Fertile bulls were placed in pastures with heifers of the three NS treatment groups for a 65-day period which began 10 days after progestin treatments (MGA or CIDR) ended. Heifers in FTAI treatment groups were administered PG (25 mg, IM) 16 days after CIDR removal or 19 days following MGA withdrawal, respectively, and FTAI was performed at 66 (CIDR-PG) or 72 h (MGA-PG) after PG. Gonadotropin-releasing hormone (GnRH; 100 μg, i.m.) was administered at FTAI. Pregnancy status was determined at the end of a 65-day breeding period. Pregnancy rates on Days 21 and 65 of the breeding period differed among treatment groups based on pre-treatment pubertal status (P ≤ 0.02) and body weight (P ≤ 0.05) but did not differ by group. These data highlight the need for continued research efforts to improve reproductive management of Bos indicus-influenced females.
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Affiliation(s)
- J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - E R Knickmeyer
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - M R Ellersieck
- Agriculture Experiment Station Statistician, University of Missouri, Columbia, MO 65211, United States
| | - J V Yelich
- Department of Animal Sciences, Institute of Food and Agriculture Sciences, University of Florida, Gainesville, FL 32611, United States
| | - S E Poock
- College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States.
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11
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Hayes AJ, Moskovic E, O'Meara K, Smith HG, Pope RJE, Larkin J, Thomas JM. Prospective cohort study of ultrasound surveillance of regional lymph nodes in patients with intermediate-risk cutaneous melanoma. Br J Surg 2019; 106:729-734. [PMID: 30816996 PMCID: PMC6593779 DOI: 10.1002/bjs.11112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/24/2018] [Revised: 10/26/2018] [Accepted: 12/11/2018] [Indexed: 02/05/2023]
Abstract
Background For patients with intermediate‐thickness melanoma, surveillance of regional lymph node basins by clinical examination alone has been reported to result in a larger number of lymph nodes involved by melanoma than if patients had initial sentinel node biopsy and completion dissection. This may result in worse regional control. A prospective study of both regular clinical examination and ultrasound surveillance was conducted to assess the effectiveness of these modalities. Methods Between 2010 and 2014, patients with melanoma of thickness 1·2–3·5 mm who had under‐gone wide local excision but not sentinel node biopsy were recruited to a prospective observational study of regular clinical and ultrasound nodal surveillance. The primary endpoint was nodal burden within a dissected regional lymph node basin. Secondary endpoints included locoregional or distant relapse, progression‐free and overall survival. Results Ninety patients were included in the study. After a median follow‐up of 52 months, ten patients had developed nodal relapse as first recurrence, four had locoregional disease outside of an anatomical nodal basin as the first site of relapse and six had relapse with distant disease. None of the patients who developed relapse within a nodal basin presented with unresectable nodal disease. The median number of involved lymph nodes in patients undergoing lymphadenectomy for nodal relapse was 1 (range 1–2; mean 1·2). Conclusion This study suggests that ultrasound surveillance of regional lymph node basins is safe for patients with melanoma who undergo a policy of nodal surveillance.
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Affiliation(s)
- A J Hayes
- Skin Cancer Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - E Moskovic
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - K O'Meara
- Skin Cancer Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - H G Smith
- Skin Cancer Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R J E Pope
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J Larkin
- Skin Cancer Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J M Thomas
- Skin Cancer Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
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12
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Thomas JM, Locke JWC, Bonacker RC, Knickmeyer ER, Wilson DJ, Vishwanath R, Arnett AM, Smith MF, Patterson DJ. Evaluation of SexedULTRA 4M™ sex-sorted semen in timed artificial insemination programs for mature beef cows. Theriogenology 2018; 123:100-107. [PMID: 30296650 DOI: 10.1016/j.theriogenology.2018.09.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/12/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
An experiment was designed to compare fertility of SexedULTRA 4M™ sex-sorted semen and conventional, non-sex-sorted semen following either fixed-time artificial insemination (FTAI) or split-time artificial insemination (STAI) of mature suckled beef cows. Units of sex-sorted and conventional semen were produced using contemporaneous ejaculates from three commercially available sires. Units of conventional semen were generated with 25.0 × 106 live cells per 0.25 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRATM Genesis III sorting technology with 4.0 × 106 live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Cows (n = 1620) across four herds were treated with the 7-d CO-Synch + CIDR protocol [administration of gonadotropin-releasing hormone (GnRH) and insertion of a progesterone insert (CIDR) on Day -10, followed by administration of prostaglandin F2α (PG) and removal of CIDR inserts on Day -3]. Cows were preassigned based on age, body condition score, and days postpartum to one of the following four treatments: FTAI with SexedULTRA 4M™ sex-sorted semen, FTAI with conventional semen, STAI with SexedULTRA 4M™ sex-sorted semen, or STAI with conventional semen. On Day -3, estrus detection aids (Estrotect®) were applied. For cows in FTAI treatments, AI was performed on Day 0 at 66 h after PG administration and CIDR removal, and 100 μg GnRH was administered concurrent with AI. For cows in STAI treatments, AI was performed on either Day 0 or 1, at 66 or 90 h after PG administration and CIDR removal, based on timing of estrus expression. On Day 1 at 90 h after PG administration and CIDR removal, 100 μg GnRH was administered concurrent with AI to any STAI-treated cows that had failed to express estrus. Pregnancy rates to AI were affected (P = 0.04) by the interaction of bull and semen type. Greater pregnancy rates were obtained with conventional semen versus SexedULTRA 4M™ sex-sorted semen when using semen from Bull A (64% [176/277] versus 36% [100/278]; P < 0.0001) and Bull B (72% [200/277] versus 57% [156/276]; P < 0.01), whereas pregnancy rates to AI did not differ between conventional and SexedULTRA 4M™ sex-sorted semen when using semen from Bull C (58% [149/258] versus 52% [131/254]). Pregnancy rates did not differ significantly between cows inseminated using a STAI versus FTAI approach, regardless of whether insemination was performed with conventional semen (65% [265/409] versus 65% [260/403] or SexedULTRA 4M™ sex-sorted semen (50% [200/403] versus 48% [187/405]). However, due to the additional 24 h for potential estrus expression when performing STAI, total estrous response prior to AI was greater (P < 0.001) among cows receiving STAI (84%; 686/812) compared to FTAI (72%; 585/808), and greater pregnancy rates (P < 0.0001) were obtained among cows that expressed estrus prior to AI. In summary, the relative fertility of SexedULTRA 4M™ sex-sorted semen and conventional semen varied across bulls. Although overall pregnancy rates to timed AI did not differ between STAI and FTAI approaches, use of a STAI approach allowed for greater total estrous response prior to AI. Therefore, to achieve acceptable conception rates per unit and service the maximum number of cows with sex-sorted semen, one viable approach may be to use STAI to maximize total estrous response and restrict use of SexedULTRA 4M™ sex-sorted to only those cows expressing estrus.
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Affiliation(s)
- J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA.
| | - J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - R C Bonacker
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - E R Knickmeyer
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA; College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - D J Wilson
- Wilson Veterinary Services, Dittmer, MO, 63050, USA
| | | | - A M Arnett
- Sexing Technologies, Navasota, TX, 77868, USA
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO, 65211, USA
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13
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Thomas JM, Locke JWC, Ellersieck MR, Smith MF, Patterson DJ. 375 The 9-d CIDR-PG Protocol: Evaluation of Synchrony of Estrus, Endocrine Parameters, Ovarian Dynamics, and Pregnancy Rates to AI in Comparison to the 7-d CO-Synch + CIDR Protocol. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - M F Smith
- University of Missouri, Columbia, MO
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14
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Thomas JM, Locke JWC, Bishop BE, Abel JM, Ellersieck MR, Poock SE, Smith MF, Patterson DJ. The 9-d CIDR-PG protocol II: Characterization of endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time AI following use of long-term CIDR-based estrus synchronization among mature beef cows. Theriogenology 2017; 103:185-190. [PMID: 28802241 DOI: 10.1016/j.theriogenology.2017.07.046] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 12/01/2022]
Abstract
An experiment was designed to evaluate endocrine parameters, ovarian dynamics, and pregnancy rates to fixed-time artificial insemination (FTAI) following the 9-d CIDR-PG protocol in comparison to the 14-d CIDR-PG protocol. While both are long-term protocols using CIDR treatment for presynchronization, the 9-d CIDR-PG protocol differs from the 14-d CIDR-PG protocol in that prostaglandin F2α (PG) is administered at CIDR insertion and removal to facilitate a decreased length of progestin treatment and potentially enhance response to the presynchronization treatment. Estrus was synchronized for 393 mature beef cows across five locations. Treatments were represented in each location, and cows within each location were randomly assigned to one of the two protocols based on age, days postpartum (DPP), and body condition score (BCS). Cows assigned to the 14-d CIDR-PG treatment received a CIDR insert (1.38 g progesterone) on Day 0 with removal of CIDR on Day 14, and 25 mg PG 16 d after CIDR removal on Day 30. Cows assigned the 9-d CIDR-PG treatment received 25 mg PG and a CIDR insert (1.38 g progesterone) on Day 5; 25 mg PG and removal of CIDR on Day 14; and 25 mg PG 16 d after CIDR removal on Day 30. In both treatments, cows received FTAI on Day 33, 72 h after PG. All cows were administered 100 μg gonadotropin-releasing hormone (GnRH) concurrent with insemination. For a subset of animals in each treatment, ovarian ultrasound was performed and blood samples were collected for determination of serum estradiol concentrations at CIDR removal, PG administration, and FTAI. Protocols were compared on the basis of estrous response and pregnancy rate resulting from FTAI. Serum estradiol concentrations, follicle size, and estrous response did not differ based on treatment. However, cows assigned to the 9-d CIDR-PG protocol tended to achieve greater FTAI pregnancy rates than cows assigned to the 14-d CIDR-PG protocol (62% versus 52%; P = 0.07). Across treatments, greater pregnancy rates tended (P = 0.10) to be achieved by cows that expressed estrus prior to FTAI (69% for 9-d CIDR-PG, 58% for 14-d CIDR-PG) than by cows that failed to express estrus (55% for 9-d CIDR-PG, 47% for 14-d CIDR-PG). In summary, the 9-d CIDR-PG protocol is an effective protocol for synchronization of estrus among mature beef cows, and pregnancy rates to FTAI tended to be improved through use of the 9-d CIDR-PG compared to the 14-d CIDR-PG protocol.
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Affiliation(s)
- J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - B E Bishop
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - J M Abel
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - M R Ellersieck
- Agriculture Experiment Station Statistician, University of Missouri, Columbia, MO 65211, United States
| | - S E Poock
- College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States.
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15
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Smith JP, Kasten-Jolly J, Rebellato L, Haisch CE, Thomas JM. Use of Allogeneic Bone Marrow Labeled with Neomycin Resistance Gene to Examine Bone Marrow-Derived Chimerism in Experimental Organ Transplantation. Cell Transplant 2017; 6:369-76. [PMID: 9258510 DOI: 10.1177/096368979700600403] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Posttransplant infusion of viable donor bone marrow cells (DBMC) has been shown in our previous studies to promote acceptance of incompatible kidney allografts in rhesus monkeys after treatment with polyclonal antithymocyte globulin to deplete peripheral T-lymphocytes. In this nonhuman primate model, the infusion of the DBMC is requisite for the induction of functional graft tolerance and specific MLR and CTLp unresponsiveness, although the relevant role and fate of bone marrow-derived chimeric cells is uncertain. Standard immunological and molecular techniques applied to this monkey model are unable to differentiate between chimeric cells derived from the infused DBMC and those derived from allograft-borne passenger leukocyte emigrants. To distinguish chimerism due to infused DBMC, we transduced DBMC with a functional neomycin resistance gene (Neor) using the retroviral vector pHSG-Neo. Neor-Mransduced BMC were infused into recipients approximately 2 wk after kidney transplantation and treatment with rabbit antithymocyte globulin. No maintenance immunosuppressive drugs were given. Genomic DNA isolated from peripheral blood leukocytes was used to monitor the presence of Neor-positive cells. Tissue samples obtained at necropsy also were assessed for Neor-positive chimeric cells. The presence of DBMC-derived chimerism was assessed by polymerase chain reaction using Neor sequence-specific primers (PCR-SSP). Chimerism was detectable in recipient tissues at various times for up to 6 mo after DBMC infusion. These studies using gene transduction methodology indicate that a stable genetic marker can provide capability to examine DBMC-derived chimerism for prolonged periods in a nonhuman primate model. This approach should facilitate future studies in preclinical models to study the role and type of chimeric cell lineages in relation to functional allograft tolerance.
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Affiliation(s)
- J P Smith
- Department of Anatomy, East Carolina University, Greenville, NC, USA
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16
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Famodu OA, Montgomery-Downs H, Thomas JM, Gilleland DL, Bryner RW, Olfert MD. 0083 IMPACT OF A SINGLE WEEK OF SLEEP EXTENSION ON PERFORMANCE, MOOD, AND NUTRITION AMONG FEMALE COLLEGE TRACK ATHLETES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.082] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Thomas JM, Locke JWC, Vishwanath R, Hall JB, Ellersieck MR, Smith MF, Patterson DJ. Effective use of SexedULTRA™ sex-sorted semen for timed artificial insemination of beef heifers. Theriogenology 2017; 98:88-93. [PMID: 28601161 DOI: 10.1016/j.theriogenology.2017.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 11/30/2016] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
An experiment was designed to evaluate the relative fertility of SexedULTRATM sex-sorted semen compared to conventional, non-sex-sorted semen when used among beef heifers in conjunction with split-time AI following the 14-d CIDR-PG protocol. Units of conventional semen were generated with 25.0 × 106 live cells per 0.5 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRATM Genesis III sorting technology with 4.0 × 106 live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Estrus was synchronized in 851 heifers at four locations using the 14-d CIDR-PG protocol: controlled internal drug release (CIDR) insert (1.38 g progesterone) on Day 0, CIDR removal on Day 14, and administration of prostaglandin F2α (PG; 25 mg im) on Day 30. Estrus detection aids were applied at PG on Day 30 to evaluate estrous response rate, and split-time AI was performed based on estrous response. At 66 h after PG (Day 33), heifers having expressed estrus received timed AI. Heifers failing to express estrus by 66 h received timed AI 24 h later (90 h after PGF2α on Day 34). Heifers failing to express estrus by 90 h were administered gonadotropin-releasing hormone (GnRH; 100 μg im) concurrent with AI. Heifers were preassigned to treatment (insemination with either conventional or SexedULTRATM sex-sorted semen), and treatments were balanced within each location based on source, reproductive tract score, and weight. Heifers were exposed for natural service beginning 14 d after AI for the remainder of a 60 d breeding season. Pregnancy rates to AI across locations tended to be higher (P = 0.09) for heifers inseminated with conventional semen (60%; 257/429) compared to sex-sorted semen (52%; 218/422). Higher pregnancy rates to AI (P < 0.0001) were obtained among heifers that expressed estrus prior to AI than among heifers that failed to express estrus prior to AI at 90 h. Total pregnancy rates at the end of the 60 d breeding season did not differ between heifers that received sex-sorted semen at AI (89%; 376/422) and heifers that received conventional semen at AI (89%; 382/429). In summary, the pregnancy rates observed suggest that SexedULTRATM sex-sorted semen can be used effectively for timed AI of beef heifers when split-time AI is performed following the 14-d CIDR-PG protocol.
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Affiliation(s)
- J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - R Vishwanath
- Sexing Technologies, Navasota, TX 77868, United States
| | - J B Hall
- Department of Animal and Veterinary Science, Nancy M. Cummings Research Extension and Education Center, University of Idaho, Carmen, ID 83462, United States
| | - M R Ellersieck
- Agriculture Experiment Station Statistician, University of Missouri, Columbia, MO 65211, United States
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States.
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18
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Thomas P, Thomas JM. [Specificity of communication in general practice]. Rev Med Brux 2017; 38:377-380. [PMID: 28981244] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Beyond its scientific and ethical competencies, a good doctor is characterized by his communication skills. The ability to listen is fundamental. During an interview, the physician must keep in mind a bio-psycho-social approach while being able to hear the unspeakable and inaudible. Knowledge of patients and their relatives, which seems to be a specific knowledge for general practitioners, offers a lot of information. Among the main sensitive topics that the clinician must identify are: intrafamily violence, domestic violence, substance abuse and anxiety-depressive disorders. In order to improve, the practitioner can use tools such as the Calgary-Cambridge guide and techniques used in Motivational Maintenance.
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Affiliation(s)
- P Thomas
- Département de Médecine générale, Université Libre de Bruxelles, ULB
| | - J M Thomas
- Département de Médecine générale, Université Libre de Bruxelles, ULB
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Thomas JM, Thomas P. [Communicating with elderly patients]. Rev Med Brux 2017; 38:381-384. [PMID: 28981245] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As with other adults, communication with elderly patients will be based on the three pillars of the person-centered approach, on motivational interviewing and on the Calgary Cambridge guide. The particularity of communication with the elderly lies in the consideration of obstacles such as visual, auditory and cognitive deficits. In addition, caregivers who accompany the patient sometimes monopolize the discussion, which could prevent him from expressing himself or even making decisions about his health. Humanity and Validation are a set of tools for communicating more effectively with the very elderly or those suffering from dementia.
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Affiliation(s)
- J M Thomas
- Département de Médecine générale, Université Libre de Bruxelles, ULB
| | - P Thomas
- Département de Médecine générale, Université Libre de Bruxelles, ULB
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Abel JM, Bishop BE, Thomas JM, Ellersieck MR, Poock SE, Smith MF, Patterson DJ. Comparing strategies to synchronize estrus before fixed-time artificial insemination in primiparous 2-year-old beef cows. Theriogenology 2016; 87:306-315. [PMID: 27771115 DOI: 10.1016/j.theriogenology.2016.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 08/23/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
Abstract
Two experiments evaluated controlled internal drug release (CIDR)-based protocols to synchronize estrus in primiparous 2-year-old beef cows. In each experiment, treatments were balanced according to body condition score and days postpartum. Experiment 1 compared the 14-day CIDR-PG (14-d) and 7-day CO-Synch + CIDR (7-d) protocols on the basis of estrous response, pregnancy rates after fixed-time artificial insemination (FTAI), and final pregnancy rate. Cows assigned to 14-d (n = 355) received a CIDR insert on Day 0 with removal on Day 14. Cows assigned to 7-d (n = 349) received gonadotropin releasing hormone (GnRH) and a CIDR insert on Day 23. On Day 30, CIDRs were removed from 7-d cows, and PGF2α was administered to all cows in each treatment. On Day 33, GnRH was administered concurrent with FTAI at 66 and 72 hours after PGF2α for 7-d and 14-d treated cows, respectively. Estrous response before FTAI was higher for 7-d compared with 14-d cows (74% vs. 43%, respectively; P < 0.0001); however, pregnancy rates resulting from FTAI were similar (14-d 63%; 7-d 64%; P = 0.52). Ovarian follicular dynamics and serum estradiol-17β concentrations were evaluated among a subset of cows assigned to each protocol. Dominant follicle diameter was smaller at PGF2α (P = 0.04) and FTAI (P = 0.002) among 14-d cows compared with 7-d cows; however, estradiol-17β at PGF2α (P = 0.06) and FTAI (P = 0.001) was greater for 14-d versus 7-d treated cows. Experiment 2 compared estrous response and pregnancy rates in 2-year-old beef cows after FTAI- or split-time artificial insemination (STAI) following synchronization of estrus with the 14-day protocol. Cows assigned to FTAI (n = 266) were inseminated at a fixed time concurrent with GnRH at 72 hours after PGF2α regardless of estrus expression, whereas cows assigned to STAI (n = 257) were inseminated based on estrus expression as determined by activation of an estrus detection aid. Cows assigned to STAI that exhibited estrus by 72 hours were inseminated; however, AI was delayed until 24 hours after GnRH (96 hours after PGF2α) for nonestrous cows. Total estrous response was increased for STAI- versus FTAI-treated cows (STAI 64%; FTAI 42%; P < 0.0001); pregnancy rates resulting from AI were similar (STAI 55%; FTAI 56%; P = 0.60). In summary, the 14-day CIDR-PG and 7-day CO-Synch + CIDR protocols can be used effectively to synchronize estrus before FTAI in primiparous 2-year-old beef cows. Although expression of estrus was increased using STAI in conjunction with the 14-day protocol, this approach did not increase pregnancy rates compared with FTAI.
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Affiliation(s)
- J M Abel
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, USA; College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - B E Bishop
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, USA; College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, USA
| | - M R Ellersieck
- Agriculture Experiment Station Statistician, University of Missouri, Columbia, Missouri, USA
| | - S E Poock
- College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, USA
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, Missouri, USA.
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Smith HG, Memos N, Thomas JM, Smith MJF, Strauss DC, Hayes AJ. Patterns of disease relapse in primary extremity soft-tissue sarcoma. Br J Surg 2016; 103:1487-96. [DOI: 10.1002/bjs.10227] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/21/2016] [Accepted: 05/09/2016] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Extremity soft-tissue sarcomas comprise a range of distinct histological subtypes. This study aimed to characterize the patterns of disease relapse in patients undergoing resection of primary extremity soft-tissue sarcoma.
Methods
All patients who had resection of primary extremity soft-tissue sarcoma at the Royal Marsden Hospital between January 2004 and January 2014 were identified from an institutional database.
Results
In the period examined, 556 patients underwent resection. The most common histological subtypes were undifferentiated pleomorphic sarcoma (169 patients, 30·4 per cent), well differentiated liposarcoma (63, 11·3 per cent), myxoid liposarcoma (62, 11·2 per cent), myxofibrosarcoma (54, 9·7 per cent) and leiomyosarcoma (39, 7·0 per cent). Local recurrence-free survival (LRFS) did not differ significantly between histological subtypes (P = 0·222). Distant metastasis-free survival (DMFS) and disease-specific survival (DSS) were found to differ significantly between subtypes (P < 0·001 for both DMFS and DSS), with the worst outcomes in patients with undifferentiated pleomorphic sarcoma (5-year survival rate: 56·8 (95 per cent c.i. 52·5 to 61·1) per cent for DMFS; 60·1 (55·6 to 64·6) per cent for DSS). However, on multivariable analysis, histological subtype was not found to be independently prognostic for LRFS, DMFS or DSS. Metastatic disease developed in 149 patients, with the lungs being the most common site of first metastasis (120 patients, 80·5 per cent). The site of first metastasis differed between subtypes, with extrapulmonary metastases predominant in myxoid liposarcoma (11 of 13 patients; P < 0·001).
Conclusion
Although histological subtype was not found to be an independent prognostic factor for oncological outcomes, the site of first metastasis differed significantly between subtypes.
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Affiliation(s)
- H G Smith
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - N Memos
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - J M Thomas
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - M J F Smith
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - D C Strauss
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - A J Hayes
- The Sarcoma Unit, Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
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Smith HG, Panchalingam D, Hannay JAF, Smith MJF, Thomas JM, Hayes AJ, Strauss DC. Outcome following resection of retroperitoneal sarcoma. Br J Surg 2015; 102:1698-709. [DOI: 10.1002/bjs.9934] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Retroperitoneal sarcoma comprises a range of different histological subtypes with dissimilar behaviour and biology. This study sought to characterize the morbidity and mortality associated with multivisceral resection and oncological outcomes according to subtype.
Methods
All patients undergoing resection of primary retroperitoneal sarcoma at the Royal Marsden Hospital between January 2005 and December 2014 were identified from a database.
Results
Some 362 patients underwent resection, with 292 requiring multivisceral resection. The 30-day mortality rate was 1·4 per cent (5 patients), the 30-day morbidity rate was 15·7 per cent (57 patients), and 27 patients required a return to theatre. Age over 75 years was predictive of 30-day mortality (hazard ratio 1·37, 95 per cent c.i. 1·13 to 1·65). The overall disease-specific survival rate at 3 years was 81·2 per cent. For well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma, 3-year local recurrence-free survival rates were 98 (95 per cent c.i. 83 to 99), 56·7 (45·7 to 66·2) and 80 (67 to 89) per cent respectively. At 3 years the distant metastasis-free survival rate was 100, 85·9 (77·4 to 91·4) and 65 (49 to 77) per cent, and the disease-specific survival rate was 97 (89 to 99), 78·5 (74·6 to 82·4) and 79 (63 to 85) per cent for well differentiated liposarcoma, dedifferentiated liposarcoma and leiomyosarcoma respectively.
Conclusion
Resection of retroperitoneal sarcoma was associated with a 30-day mortality rate of less than 2 per cent and a morbidity rate of 15·7 per cent. The overall 3-year disease-specific survival rate was 81·2 per cent.
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Affiliation(s)
- H G Smith
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D Panchalingam
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J A F Hannay
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - M J F Smith
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J M Thomas
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A J Hayes
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D C Strauss
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Thomas JM, Dourish CT, Higgs S. Effects of awareness that food intake is being measured by a universal eating monitor on the consumption of a pasta lunch and a cookie snack in healthy female volunteers. Appetite 2015; 92:247-51. [PMID: 26048004 PMCID: PMC4509509 DOI: 10.1016/j.appet.2015.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 11/17/2022]
Abstract
To date, there have been no studies that have explicitly examined the effect of awareness on the consumption of food from a Universal Eating Monitor (UEM - hidden balance interfaced to a computer which covertly records eating behaviour). We tested whether awareness of a UEM affected consumption of a pasta lunch and a cookie snack. 39 female participants were randomly assigned to either an aware or unaware condition. After being informed of the presence of the UEM (aware) or not being told about its presence (unaware), participants consumed ad-libitum a pasta lunch from the UEM followed by a cookie snack. Awareness of the UEM did not significantly affect the amount of pasta or cookies eaten. However, awareness significantly reduced the rate of cookie consumption. These results suggest that awareness of being monitored by the UEM has no effect on the consumption of a pasta meal, but does influence the consumption of a cookie snack in the absence of hunger. Hence, energy dense snack foods consumed after a meal may be more susceptible to awareness of monitoring than staple food items.
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Affiliation(s)
- J M Thomas
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - C T Dourish
- P1vital, Manor House, Howbery Park, Wallingford, Oxfordshire OX10 8BA, UK
| | - S Higgs
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Wilkinson MJ, Fitzgerald JEF, Strauss DC, Hayes AJ, Thomas JM, Messiou C, Fisher C, Benson C, Tekkis PP, Judson I. Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib. Br J Surg 2015; 102:965-71. [PMID: 25970743 DOI: 10.1002/bjs.9818] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/01/2015] [Accepted: 03/03/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) of the rectum often require radical surgery to achieve complete resection. This study investigated the management and outcome of surgery for rectal GISTs and the role of imatinib. METHODS A cohort study was undertaken of patients identified from a database at one tertiary sarcoma referral centre over a continuous period, from January 2001 to January 2013. RESULTS Over 12 years, 19 patients presented with a primary rectal GIST. Median age was 57 (range 30-77) years. Neoadjuvant imatinib was used in 15 patients, significantly reducing mean tumour size from 7·6 (95 per cent c.i. 6·1 to 9·0) to 4·1 (2·8 to 5·3) cm (P < 0·001). Nine of these patients underwent surgical resection. Imatinib therapy enabled sphincter-preserving surgery to be undertaken in seven patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumour clearance. Neoadjuvant imatinib treatment also led to a significant reduction in mean(s.d.) tumour mitotic count from 16(16) to 4(9) per 50 high-power fields (P = 0·015). Imatinib was used only as adjuvant treatment in two patients. There were three deaths, all from unrelated causes. Eleven of the 13 patients who underwent resection were alive without evidence of recurrence at latest follow-up, with a median disease-free survival of 38 (range 20-129) months and overall survival of 62 (39-162) months. CONCLUSION The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery.
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Affiliation(s)
- M J Wilkinson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J E F Fitzgerald
- Colorectal Surgery Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D C Strauss
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A J Hayes
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J M Thomas
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Messiou
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Fisher
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Benson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - P P Tekkis
- Colorectal Surgery Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - I Judson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
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Minguet C, Aubrege A, Aubart M, Cornuz J, di Patrizio P, Du Boullay D, Farghadani H, Flammang M, Haas N, Kacenelenbogen N, Kopp M, Leners JC, Levêque M, Mbengue M, Paur H, Paur I, Raphaël F, Rausch S, Shetgen M, Tabouring P, Thomas JM, Vignon G. [The flexibility of family medicine]. Bull Soc Sci Med Grand Duche Luxemb 2015:39-50. [PMID: 26946851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We are a European academic group of family doctors and we propose a definition of flexibility in family medicine. A review of the literature shows that flexibility and complexity are emerging concepts in the field of family practice. The outcomes of a workshop at the WONCA-Europe congress in 2014 are discussed. The flexibility is a capability of the general practitioner to deal with complex clinical situations in a biomedical and societal changing world. Flexibility is framed by ethics. It could improve the quality of care, be useful against burnout and used in medical research. In conclusion, family medicine should adopt a specific definition of the flexibility describing its specificity, a useful and teachable capacity.
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26
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Thomas JM. [Euthanasia and general practice in Belgium]. Rev Med Brux 2014; 35:386-393. [PMID: 25675647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors.
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Van Der Walt JJN, Thomas JM, Figaji AA. Intraoperative neurophysiological monitoring for the anaesthetist. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2013.10872924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- JJN Van Der Walt
- Department of Anaesthesia, Red Cross War Memorial Children's Hospital; University of Cape Town, Cape Town
| | - JM Thomas
- Red Cross War Memorial Children's Hospital; University of Cape Town, Cape Town
| | - AA Figaji
- Division of Neurosurgery, University of Cape Town, Cape Town
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Affiliation(s)
| | - JM Thomas
- Red Cross War Memorial Children's Hospital, Cape Town
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Van Der Walt JJN, Thomas JM, Figaji AA. Intraoperative neurophysiological monitoring for the anaesthetist. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2013.10872913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- JJN Van Der Walt
- Department of Anaesthesia, Red Cross War Memorial Children's Hospital; University of Cape Town, Cape Town
| | - JM Thomas
- Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town
| | - AA Figaji
- Paediatric Neurosurgery, Division of Neurosurgery, University of Cape Town, Cape Town
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30
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Timmerman K, Thomas JM. Endotracheal tubes in paediatric anaesthesia: the cuffed versus uncuffed debate. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2010.10872688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Thomas JM, Dourish CT, Tomlinson JW, Hassan-Smith Z, Higgs S. Effects of the 5-HT2C receptor agonist meta-chlorophenylpiperazine on appetite, food intake and emotional processing in healthy volunteers. Psychopharmacology (Berl) 2014; 231:2449-59. [PMID: 24408211 DOI: 10.1007/s00213-013-3409-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/11/2013] [Indexed: 01/28/2023]
Abstract
RATIONALE The treatment of obesity is an increasing global health priority, yet few effective drug treatments are currently available. The discovery of novel anti-obesity therapies could be assisted by the validation of experimental (translational) medicine models in healthy volunteers that assess efficacy and safety at an early stage of drug development. OBJECTIVES The aim of this study was to examine the effects of the 5-HT2C receptor agonist meta-chlorophenylpiperazine (mCPP) in an experimental medicine model assessing both appetite and mood. METHODS Using a between-subjects, double-blind, placebo-controlled design, 24 male and 24 female participants were randomly assigned to either placebo, 15- or 30-mg mCPP treatment groups. Lunch was eaten from a Universal Eating Monitor (UEM) that measured eating rate, and the participants completed the P1vital® Oxford Emotional Test Battery (ETB) and a series of appetite and mood ratings. RESULTS mCPP reduced appetite and, in women, enhanced measures of satiation. The drug also enhanced memory for emotional material in the word recall and recognition memory tasks of the ETB. CONCLUSIONS The results provide new insight into the effects of mCPP on appetite, satiety and memory in humans. In addition, our data provide an illustration of the value of measuring changes in appetite and mood in healthy volunteers to determine the potential efficacy and safety of novel anti-obesity drugs.
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Affiliation(s)
- J M Thomas
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK,
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Glover AR, Allan CP, Wilkinson MJ, Strauss DC, Thomas JM, Hayes AJ. Outcomes of routine ilioinguinal lymph node dissection for palpable inguinal melanoma nodal metastasis. Br J Surg 2014; 101:811-9. [PMID: 24752717 DOI: 10.1002/bjs.9502] [Citation(s) in RCA: 13] [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] [Accepted: 02/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients who present with palpable inguinal melanoma nodal metastasis have two surgical options: inguinal or ilioinguinal lymph node dissection. Indications for either operation remain controversial. This study examined survival and recurrence outcomes following ilioinguinal dissection for patients with palpable inguinal nodal metastasis, and assessed the incidence and preoperative predictors of pelvic nodal metastasis. METHODS This was a retrospective clinicopathological analysis of consecutive surgical patients with stage III malignant melanoma. All patients underwent a standardized ilioinguinal dissection at a specialist tertiary oncology hospital over a 12-year period (1998-2010). RESULTS Some 38.9 per cent of 113 patients had metastatic pelvic nodes. Over a median follow-up of 31 months, the 5-year overall survival rate was 28 per cent for patients with metastatic inguinal and pelvic nodes, and 51 per cent for those with inguinal nodal metastasis only (P = 0.002). The nodal basin control rate was 88.5 per cent. Despite no evidence of pelvic node involvement on preoperative computed tomography (CT), six patients (5.3 per cent) with a single metastatic inguinal lymph node had metastatic pelvic lymph nodes. Logistic regression analysis showed that the number of metastatic inguinal nodes (odds ratio 1.56; P = 0.021) and suspicious CT findings (odds ratio 9.89; P = 0.001) were both significantly associated with metastatic pelvic nodes. The specificity of CT was good (89.2 per cent) in detecting metastatic pelvic nodes, but the sensitivity was limited (57.9 per cent). CONCLUSION Metastatic pelvic nodes are common when palpable metastatic inguinal nodes are present. Long-term survival can be achieved following their resection by ilioinguinal dissection. As metastatic pelvic nodes cannot be diagnosed reliably by preoperative CT, patients presenting with palpable inguinal nodal metastasis should be considered for ilioinguinal dissection.
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Affiliation(s)
- A R Glover
- Kolling Institute of Medical Research, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales
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Thomas JM, Lock SL, Poock SE, Ellersieck MR, Smith MF, Patterson DJ. Delayed insemination of nonestrous cows improves pregnancy rates when using sex-sorted semen in timed artificial insemination of suckled beef cows. J Anim Sci 2014; 92:1747-52. [PMID: 24663169 DOI: 10.2527/jas.2013-7131] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This experiment was designed to test the hypothesis that delayed insemination of nonestrous cows would increase pregnancy rates when using sex-sorted semen in conjunction with fixed-time artificial insemination (FTAI). Estrus was synchronized for 656 suckled beef cows with the 7-d CO-Synch + controlled internal drug release (CIDR) protocol (100 μg GnRH + CIDR [1.38 g progesterone] on d 0, 25 mg PGF2α at CIDR removal on d 7, and 100 μg GnRH on d 10, 66 h after CIDR removal). Estrus detection aids (Estrotect) were applied at PGF2α and CIDR removal on d 7, and estrous expression was recorded at GnRH on d 10. Cows were assigned to 1 of 3 treatments: 1) FTAI (concurrent with GnRH, 66 h after CIDR removal) with conventional semen regardless of estrous expression, 2) FTAI with sex-sorted semen regardless of estrous expression, or 3) FTAI with sex-sorted semen for cows having expressed estrus and delayed AI 20 h after final GnRH for cows failing to express estrus. A treatment × estrous expression interaction was found (P < 0.0001). Higher pregnancy rates (P < 0.0001) were achieved with conventional semen (Treatment 1; 77%) than with sex-sorted semen (Treatments 2 and 3; 51 and 42%, respectively) among cows that expressed estrus. However, among cows that failed to express estrus, delayed insemination with sex-sorted semen yielded higher (P < 0.0001) pregnancy rates than with sex-sorted semen at the standard time (Treatments 2 and 3; 3 versus 36%, respectively). Furthermore, among cows that failed to express estrus, FTAI pregnancy rates when using sex-sorted semen at the delayed time (36%) were comparable (P = 0.9) to those achieved using conventional semen at the standard time (Treatment 1; 37%). These results indicate that delaying AI of nonestrous cows by 20 h from the standard FTAI improves pregnancy rates when sex-sorted semen is used with FTAI.
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Affiliation(s)
- J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia 65211
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Wijesekera NT, Gunaratne MME, Khan N, O'Donovan EJ, Thomas JM, Moskovic EC. Tail-end troubles: imaging of soft-tissue buttock tumours. Clin Radiol 2013; 68:1074-85. [PMID: 23809985 DOI: 10.1016/j.crad.2013.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/04/2013] [Accepted: 05/15/2013] [Indexed: 02/07/2023]
Abstract
Primary soft-tissue buttock tumours are relatively common entities, although they are infrequently reported in the literature. The buttock can be a difficult anatomical site to treat soft-tissue tumours due to the proximity of the sciatic nerve and the propensity of tumours at this site to extend into the pelvis and perineum. Therefore, the radiologist plays an important role in the multidisciplinary assessment of these lesions. Cross-sectional imaging, principally magnetic resonance imaging, is used to determine the exact location and extension of the tumour. Furthermore, certain tumours have characteristic imaging appearances that can help to establish a suitably ordered differential diagnosis. From our prospectively maintained database at The Royal Marsden Hospital, including 225 cases that were treated at the Sarcoma Unit over a 30 year period, we present examples of benign and malignant primary soft-tissue buttock tumours and describe the pertinent imaging characteristics, with emphasis on computed tomography and magnetic resonance imaging findings.
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Affiliation(s)
- N T Wijesekera
- Department of Radiology, The Royal Marsden Hospital, London, UK.
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36
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Hii MW, Smithers BM, Gotley DC, Thomas JM, Thomson I, Martin I, Barbour AP. Impact of postoperative morbidity on long-term survival after oesophagectomy. Br J Surg 2012; 100:95-104. [DOI: 10.1002/bjs.8973] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Oesophageal malignancy is a disease with a poor prognosis. Oesophagectomy is the mainstay of curative treatment but associated with substantial morbidity and mortality. Although mortality rates have improved, the incidence of perioperative morbidity remains high. This study assessed the impact of postoperative morbidity on long-term outcomes.
Methods
A prospective database was designed for patients undergoing oesophagectomy for malignancy from 1998 to 2011. An observational cohort study was performed with these data, assessing intraoperative technical complications, postoperative morbidity and effects on overall survival.
Results
Some 618 patients were included, with a median follow-up of 51 months for survivors. The overall complication rate was 64·6 per cent (399 of 618), with technical complications in 124 patients (20·1 per cent) and medical complications in 339 (54·9 per cent). Technical complications were associated with longer duration of surgery (308 min versus 293 min in those with no technical complications; P = 0·017), greater operative blood loss (448 versus 389 ml respectively; P = 0·035) and longer length of stay (22 versus 13 days; P < 0·001). Medical complications were associated with greater intraoperative blood loss (418 ml versus 380 ml in those with no medical complications; P = 0·013) and greater length of stay (16 versus 12 days respectively; P < 0·001). Median overall and disease-free survival were 41 and 43 months. After controlling for age, tumour stage, resection margin, length of tumour, adjuvant therapy, procedure type and co-morbidities, there was no effect of postoperative complications on disease-specific survival.
Conclusion
Technical and medical complications following oesophagectomy were associated with greater intraoperative blood loss and a longer duration of inpatient stay, but did not predict disease-specific survival.
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Affiliation(s)
- M W Hii
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - B M Smithers
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - D C Gotley
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - J M Thomas
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - I Thomson
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - I Martin
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - A P Barbour
- Department of Upper Gastrointestinal and Soft Tissue Tumour Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Surgery, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
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Richard S, Pardoen D, Piquard D, Fostier P, Thomas JM, Vervier JF, Verbanck P. [Perception of training in doctor-patient communication for students at faculty of medicine]. Rev Med Brux 2012; 33:525-530. [PMID: 23373123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Doctor-patient communication is the heart of any medical practice. The technology of medicine today is focused on knowledge, its application and know-how, rather than skills of being, of knowing and of knowing when to do nothing. In 2005, Belgian High Council of Health emphasizes a quantitative and qualitative reduction of communication aspects within the initial medical training. The aim of our study is to investigate Belgian and foreign students perception of how the doctor-patient communication was taught during their studies. A questionnaire was sent by email to 300 Belgian and foreign Universities. We obtained 13.6% of answers of 99 students belonging to 41 Faculties from 22 countries. 55.6% of respondents thought to be well trained in the doctor-patient communication. 85.9% of students received theoretical courses out of which only 64.6% have the opportunity to enhance their apprenticeship by practical work. Majority of respondents required more practical work in learning to communicate. All of them agree on that they would like more applied practical communication incorporated into their curriculum. Like wise the society that calls for doctors with increased communication skills and communication researchers who emphasize the central role of the doctor-patient communication in the clinical and therapeutic approach, students are also seeking longitudinal transdisciplinary learning, including more practical practices.
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Affiliation(s)
- S Richard
- Service Psychiatrique pour Enfants et Adolescents, Secteur Psychiatrique Nord, DP-CHUV, Yverdon-les-Bains, Suisse.
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Wilkinson MJ, Fitzgerald JEF, Thomas JM, Hayes AJ, Strauss DC. Surgical resection for non-familial adenomatous polyposis-related intra-abdominal fibromatosis. Br J Surg 2012; 99:706-13. [PMID: 22359346 DOI: 10.1002/bjs.8703] [Citation(s) in RCA: 16] [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] [Accepted: 01/12/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Intra-abdominal fibromatosis (IAF) in the context of familial adenomatosis polyposis (FAP) is associated with significant morbidity and high recurrence rates after surgical resection. Non-surgical treatments are therefore advocated. This study explored outcomes in patients with IAF not associated with FAP who underwent surgical resection. METHODS Data were analysed from a prospectively collected database at a sarcoma tertiary referral centre. RESULTS From 2001 to 2011, 15 patients without FAP underwent primary curative surgical resection of IAF. Their median (range) age was 42 (19-64) years. Median tumour size was 18 (8.5-25) cm and weight 1306 (236-2228) g. Complete macroscopic clearance was obtained in all patients. There were no deaths in hospital or within 30 days and only one patient developed a major complication. Median follow-up was 40 (6-119) months. During follow-up two patients developed a recurrence after a disease-free interval of 12 and 16 months. CONCLUSION In contrast to FAP-associated IAF, non-FAP-associated IAF has a very low recurrence rate after surgical resection. Surgical resection is therefore advocated as first-line treatment in patients with non-FAP-associated IAF when resection can be performed with low morbidity.
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Affiliation(s)
- M J Wilkinson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
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Qureshi YA, Huddy JR, Miller JD, Strauss DC, Thomas JM, Hayes AJ. Unplanned excision of soft tissue sarcoma results in increased rates of local recurrence despite full further oncological treatment. Ann Surg Oncol 2011; 19:871-7. [PMID: 21792512 DOI: 10.1245/s10434-011-1876-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unplanned excision of soft tissue sarcoma (STS) accounts for up to 40% of all initial operations for STS and is undertaken when the mass is presumed to be benign. The effect this has on outcome has never been fully established. METHODS Patients with extremity or trunk STS between 2001 and 2005 who were treated by an initial inadvertent operation and then referred immediately to our unit were identified. Outcomes were compared with a control group of patients with STS who were stage-matched and had been treated conventionally by core biopsy and definitive surgery. Endpoints were local recurrence, distant metastases and sarcoma-specific survival. RESULTS 134 patients who had undergone unplanned excision of STS were identified. One hundred twenty-one underwent further re-excision, and 51 (48%) of these patients had residual tumour identified after surgical re-excision. Two hundred nine stage-matched controls were identified who were treated conventionally. Median follow-up was 51.6 months. Local recurrence rates were considerably higher in the study group (23.8 vs. 11%, p = 0.0016), despite the control group having more stage 3 tumours. When the tumours were matched by stage, an increase in local recurrence was seen across all stages but was most pronounced for stage 3 tumours (37.5 vs. 14.2%, p = 0.005). Metastasis-free and sarcoma-specific survival were also significantly increased for stage 3 tumours. CONCLUSION Unplanned initial excision of extremity soft tissue sarcoma may compromise long-term local control of extremity STS despite full further oncological management.
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Affiliation(s)
- Y A Qureshi
- Soft Tissue Sarcoma and Melanoma Unit, Department of Academic Surgery, The Royal Marsden Hospital, London, UK
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Abstract
Purpose. To report the phenomenon of infected retroperitoneal sarcoma (RPS). Method. Two case reports. Results. Both patients died soon after laparotomy. Discussion. Infected RPS is identified as an entity not clearly documented in the literature. It should probably be added to the list of poor prognostic factors when planning the management of patients with RPS.
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Affiliation(s)
- A J Spillane
- Melanoma and Sarcoma Unit Royal Marsden Hospital Fulham Road London SW3 6JJ UK
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Abstract
Purpose. Aggressive fibromatosis (AF) is an uncommon locally infiltrating benign disease of soft tissue for which treatment comprises complete surgical resection. Radiotherapy can be given postoperatively if the margin is incompletely resected. If the tumour is inoperable radiotherapy provides an alternative treatment. Hormone therapy and cytotoxic chemotherapy have also been used for unresectable or recurrent disease. All treatment modalities carry an associated morbidity. We believe that the natural history of aggressive fibromatosis may include a period of stable disease without progression, during which time, treatment is not always necessary. Patients and methods. We present a retrospective review of 42 patients referred to the Royal Marsden Hospital between 1988 and 1995 with aggressive fibromatosis. Evidence of periods of stable disease and the relationship to delivered treatment was obtained from the case notes, including the natural history prior to referral to our institution. Stable disease was defined as a period of no objective progression for 6 months or longer. Results. Seventeen patients could be assessed for stable disease and all (100%) experienced at least one episode of stable disease, eight of whom whilst receiving hormonal or cytotoxic therapy. Of the 23 patients who could not be assessed for stable disease, as they underwent surgery at presentation or recurrence of disease, only 2 had persisting disease at last follow-up. Both of these patients had had positive surgical resection margins. Discussion. This study demonstrates the variable natural history of AF, which can include a substantial period of stable disease in a significant number of patients. A less aggressive approach to the management of AF may therefore be appropriate, particularly if a subgroup of patients who are likely to experience a period of stable disease can be identified.
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Affiliation(s)
- G Mitchell
- Sarcoma Unit Royal Marsden Hospital NHS Trust Fulham Road London SW3 6JJ UK
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Abstract
Patient. A case of peripheral leiomyosarcoma presenting with features of pulmonary thromboembolism is described. Discussion. Persistence of the embolus despite triple-armed thrombolytic therapy and the presence of intravascular tumour invasion suggest the rare entity of pulmonary tumour embolism from a leiomyosarcoma.
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Affiliation(s)
- S Gentle
- Chelsea and Westminster Hospital London UK
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Abstract
STUDY OBJECTIVE To describe the current status of school based sex education and to determine predictors of providing a comprehensive sex education curriculum. DESIGN Cross-sectional mailed survey SETTING Hawaii PARTICIPANTS Seventh and eighth grade health teachers INTERVENTIONS Participants were surveyed regarding the content, quality, and influences on sex education for the 2007 to 2008 academic year. MAIN OUTCOME MEASURES Measures of association (chi-square, ANOVA) and multiple logistic regression were used to determine predictors for teaching comprehensive sex education topics including sexually transmitted infections and pregnancy prevention. RESULTS Approximately 80% of teachers incorporated some form of sex education into their curriculum and 54.4% of teachers incorporated a comprehensive education. Teachers indicated that personal values and the availability of curriculum had the greatest influence on the content of the curriculum. Specific factors which were associated with an increased likelihood of providing a comprehensive curriculum included teaching in a public school (public 66.7% versus private 34.6%, P = 0.01), receiving formal training in sex education (received training 77.8% versus did not receive training 50.0%, P = 0.03) and having contact with a student who became pregnant (contact 72.7% versus no contact 46.7%, P = 0.04). CONCLUSION Although most teachers incorporate some form of sex education, only half incorporate a comprehensive curriculum. Personal values as well as teacher resources play an important role in the content of the curriculum.
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Affiliation(s)
- G W Woo
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
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Debey C, Meert AP, Berghmans T, Thomas JM, Sculier JP. [Febrile neutropenia at the emergency department of a cancer hospital]. Rev Med Brux 2011; 32:74-82. [PMID: 21688591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Febrile neutropenia is an important cause of fever in the cancer patient. When he/she is undergoing chemotherapy, the priority is to exclude that complication because it requires rapid administration of empiric broad-spectrum antibiotics. We have studied the rate and characteristics of febrile neutropenia in cancer patients consulting in a emergency department. We have conducted a retrospective study in the emergency department of a cancer hospital over the year 2008. Every patient with cancer and fever > or = 38 degrees C was included. Over 2.130 consultations, 408 were selected (313 patients) including 21.6% (88) for febrile neutropenia. A focal symptom or physical sign was present in the majority of the cases. 88% were assessed as low risk for severe complications and about half of them received oral antibiotics. There were only a few patients with a nude fever for which it was difficult to make a hypothetical diagnosis in order to administer a probabilistic treatment. The majority of the consultations lead to hospital admission. Over the 80 hospitalisations, 6 deaths occurred. There was no death among the patients who remained ambulatory. In conclusion, our study shows that febrile neutropenia is frequent in ambulatory cancer patients presenting with fever and that in the majority of the cases, it is associated with a low risk. In such a situation, ambulatory management is more and more often considered or, at least, a rapid discharge after a short admission in case of low risk febrile neutropenia. In that context, the role of the general practioner has to be emphasised and to facilitate the outpatient management, we propose an algorithm that requires validation.
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Affiliation(s)
- C Debey
- Unité des Soins Intensifs médico-chirurgicaux et Urgences oncologiques & Oncologie Thoracique, Institut Jules Bordet, Centre des Tumeurs de I'ULB, Bruxelles
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Saffin AP, Thomas JM. Anaesthetic management of laparoscopic assisted bilateral adrenalectomy in a five-year-old child with Cushing's disease. Southern African Journal of Anaesthesia and Analgesia 2011. [DOI: 10.1080/22201173.2011.10872813] [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: 10/24/2022]
Affiliation(s)
| | - JM Thomas
- Red Cross War Memorial Children's Hospital, University of Cape Town
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Amukoa P, Reed A, Thomas JM. Use of the sitting position for pineal tumour surgery in a five-year-old child. Southern African Journal of Anaesthesia and Analgesia 2011. [DOI: 10.1080/22201173.2011.10872811] [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: 10/24/2022]
Affiliation(s)
- P Amukoa
- Kericho District Hospital, Kenya
| | - A Reed
- Metro West Anaesthetic Service, New Somerset Hospital, Greenpoint, Cape Town
| | - JM Thomas
- Red Cross War Memorial Children's Hospital, Rondebosch
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Strauss DC, Qureshi YA, Hayes AJ, Thway K, Fisher C, Thomas JM. The role of core needle biopsy in the diagnosis of suspected soft tissue tumours. J Surg Oncol 2010; 102:523-9. [PMID: 20872955 DOI: 10.1002/jso.21600] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Controversy surrounds the biopsy method of choice for the histological diagnosis of soft tissue sarcoma. The objective of this study was to evaluate the diagnostic accuracy of core needle biopsy (CNB) in patients referred with the suspicion of a soft tissue sarcoma. METHODOLOGY Previously undiagnosed patients (n = 530) with a suspected soft tissue tumour (STT) who underwent CNB at initial presentation were identified. Specific end-points were the ability to differentiate benign from malignant tumours, soft tissue from non-STT, and for sarcomas to define subtype and grade. RESULTS Of the 530 patients, 426 patients (80.4%) with soft tissue tumours were identified, of which 225 (52.8%) were malignant and 201 (47.2%) benign. In the remaining 104 patients, tumours masquerading as STT were diagnosed. CNB could differentiate soft tissue sarcomas from benign soft tissue tumours with an accuracy of 97.6%. High grade were differentiated from low grade sarcomas with an accuracy of 86.3%. Tumour subtype was accurately assigned in 89.5% of benign tumours and 88.0% of sarcomas. CONCLUSION CNB is simple, safe and can accurately diagnose benign and malignant soft tissue tumours. It can reliably identify other tumours masquerading as sarcoma. CNB should be the method of choice to obtain a histological diagnosis in suspected STT.
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Affiliation(s)
- D C Strauss
- Sarcoma Unit, Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London, UK.
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Thomas JM, Pepersack T. [How to avoid the inappropriate prescriptions in nursing homes?]. Rev Med Brux 2010; 31:320-327. [PMID: 21089410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The inappropriate prescription is frequent in the Belgian nursing homes. Which are the better tools to control and improve our prescription? Is it relevant to start or continue medications for prevention in the context of moderate or severe dementia? STOPP-START seems to be a good screening tool for detecting the inappropriate prescriptions by the general practitioner.
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Balkwill DL, Fredrickson JK, Thomas JM. Vertical and horizontal variations in the physiological diversity of the aerobic chemoheterotrophic bacterial microflora in deep southeast coastal plain subsurface sediments. Appl Environ Microbiol 2010; 55:1058-65. [PMID: 16347902 PMCID: PMC184254 DOI: 10.1128/aem.55.5.1058-1065.1989] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aerobic chemoheterotrophic bacteria were isolated from surface soils and coastal plain subsurface (including deep aquifer) sediments (depths to 265 m) at a study site near Aiken, S.C., by plating on concentrated and dilute media. Morphologically distinct colonies were purified, and their responses to 21 selected physiological tests were determined. These isolates were quite diverse; 626 physiologically distinct types (i.e., types with a unique pattern of responses to the 21 tests) were detected among the 1,112 isolates obtained. Physiologically distinct types were isolated on concentrated and dilute media (only 11% overlap between the groups); isolates from surface soils and subsurface sediments were also quite different (only 3% overlap). The surface soil isolates more readily utilized all but 1 of 12 carbon sources offered, and a significantly larger proportion of them hydrolyzed esculin and gelatin. Only 4% of the subsurface isolates fermented glucose, even though 82% of them could use it aerobically. l-Malate and d-gluconate were utilized by at least 75% of the subsurface isolates, and seven other carbon sources were used by at least 40% of them. Subsurface isolates from different geological formations (depths) and, to a lesser extent, from the same geological formation at different boreholes differed distinctly in their group responses to certain physiological tests. Moreover, sediments from different depths and boreholes contained physiologically distinct types of bacteria. Thus, considerable bacterial diversity was observed in coastal plain subsurface sediments, even within defined geological formations.
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Affiliation(s)
- D L Balkwill
- Department of Biological Science, Florida State University, Tallahassee, Florida 32306-2043, and Pacific Northwest Laboratory, Richland, Washington 99352
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Abstract
BACKGROUND Local recurrence after surgical resection is the main cause of disease-related mortality in patients with primary retroperitoneal sarcoma (RPS). This study analysed predictors of local recurrence and disease-specific survival. METHODS A prospective database was reviewed to identify patients who underwent surgery for primary RPS between 1990 and 2009. Patient demographics, operative outcomes and tumour variables were correlated with local recurrence and disease-specific survival. Multivariable analysis was performed to evaluate predictors for local recurrence and disease-free survival. RESULTS Macroscopic clearance was achieved in 170 of 200 patients. The median weight of tumours was 4.0 kg and median maximum diameter 27 cm. Resection of adjacent organs was required in 126 patients. The postoperative mortality rate was 3.0 per cent. Seventy-five patients developed local recurrence during follow-up. At 5 years the local recurrence-free survival rate was 54.6 per cent and the disease-specific survival rate 68.6 per cent. Inability to obtain macroscopic clearance at resection and high-grade tumours were significant predictors for local recurrence and disease-specific survival. CONCLUSION Complete macroscopic excision should be the goal of surgical resection. Ability to resect a RPS completely and tumour grade are the most important predictors of local recurrence and overall survival.
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Affiliation(s)
- D C Strauss
- Melanoma/Sarcoma Unit, Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK.
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