1
|
Guy D, Wootten JC, Wong M, Turski D, Lukewich M, Alboog A, Kandasamy AR, Gregory J, Poolacherla R. Pharmacodynamic effects following co-administration of cannabinoids and opioids: A scoping review of human experimental studies. Pain Med 2024:pnae024. [PMID: 38561178 DOI: 10.1093/pm/pnae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cannabinoids are increasingly used in the management of chronic pain. Although analgesic potential has been demonstrated, cannabinoids interact with a range of bodily functions that are also influenced by chronic pain medications, including opioids. OBJECTIVE We performed a scoping review of literature on the pharmacodynamic effects following co-administration of cannabinoids and opioids. METHODS We systematically searched EMBASE, PubMed, and PsycINFO for studies that experimentally investigated the co-effects of cannabinoids and opioids in human-subjects. Available evidence was summarized by clinical population and organ system. A risk of bias assessment was performed. RESULTS A total of sixteen studies met inclusion criteria. Study populations included patients with chronic non-cancer and cancer pain on long-term opioid regimens and healthy young adults without prior exposure to opioids who were subject to experimental nociceptive stimuli. Commonly administered cannabinoid agents included Δ9-tetrahydrocannabinol and/or cannabidiol. Co-administration of cannabinoids and opioids did not consistently improve pain outcomes; however, sleep and mood benefits were observed in chronic pain patients. Increased somnolence, memory and attention impairment, dizziness, gait disturbance, and nauseousness and vomiting were noted with co-administration of cannabinoids and opioids. Cardiorespiratory effects following co-administration appeared to vary according to duration of exposure, population type, and prior exposure to cannabinoids and opioids. CONCLUSIONS The available evidence directly investigating the pharmacodynamic effects following co-administration of cannabinoids and opioids for non-analgesic outcomes is scarce and suffers from a lack of methodological reporting. As such, further research in this area with comprehensive methodologic reporting is warranted.
Collapse
Affiliation(s)
- David Guy
- Northern Ontario School of Medicine, Laurentian University, Sudbury, ON
| | - Jared C Wootten
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Michael Wong
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daniel Turski
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mark Lukewich
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Abdulrahman Alboog
- University of Jeddah, College of Medicine, Department of Anesthesia and ICU, Jeddah, Saudi Arabia
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Abirami R Kandasamy
- Clinical & Health Psychologist, Children's Hospital-LHSC; Associate Scientist, Children's Health Research Institute; Adjunct Clinical Professor-Dept of Anesthesia, Schulich School of Medicine & Dentistry
| | - Jonathan Gregory
- Assistant Professor, Consultant at First Episode Mood & Anxiety Program, Emergency Diversion Clinic for Children's Hospital, and Ambulatory Child & Adolescent Mental Health Care Program
| | - Raju Poolacherla
- Director Pediatric Anesthesia, Consultant Pediatric Anesthetist and Medical Director - Pediatric Chronic Pain Program, London Health Sciences Centre
- Assistant Professor of Anesthesia and Pediatrics - Schulich School of Medicine & Dentistry, London, Ontario, Canada
| |
Collapse
|
2
|
Heinzerling JH, Mileham K, Robinson M, Symanowski JT, Induru R, Corso CD, Brouse G, Prabhu RS, Haggstrom D, Moeller BJ, Bobo WE, Fasola C, Thakkar VV, Gregory J, Burri SH, Simone CB. Prospective Phase II Trial of Primary Lung Tumor Stereotactic Body Radiation Therapy (SBRT) Followed By Concurrent Mediastinal Chemoradiation and Adjuvant Immunotherapy for Locally-Advanced Non-Small Cell Lung Cancer (LA NSCLC). Int J Radiat Oncol Biol Phys 2023; 117:S27-S28. [PMID: 37784465 DOI: 10.1016/j.ijrobp.2023.06.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To report the efficacy and toxicity outcomes of a prospective phase II trial of primary tumor SBRT followed by conventional chemoradiation to the lymph nodes and adjuvant immunotherapy in patients (pts) with unresectable LA NSCLC. MATERIALS/METHODS Eligible pts included stage II-III LA NSCLC with peripheral primary tumors ≤ 7cm or centrally based tumors that had at least 2 cm separation from involved nodal disease. Pts received SBRT to the primary tumor (50-54 Gy in 3-5 fractions) followed by standard radiation to 60 Gy in 30 fractions to the involved lymph nodes with concurrent platinum doublet chemotherapy. The trial was amended to allow pts without disease progression after chemoradiation to receive adjuvant durvalumab per the PACIFIC trial. The primary endpoint was 1 year progression free survival (PFS), evaluated as a binary variable. Frequencies and proportions were used for reporting this primary endpoint, in addition to adverse events and patterns of failure. Median PFS and OS were estimated using Kaplan Meier methods. RESULTS Safety and efficacy is reported on the first 50 pts enrolled in the trial with a median follow-up of 24 months (mos) (range, 1-54 mos). Pts were primarily stage IIIA (60%) or stage IIIB (34%), with 6% of pts stage IIB. Overall grade 3 or higher toxicity related to SBRT and/or mediastinal radiation was 8% with two pts (4%) developing grade 3 pneumonitis and one pt having a grade 5 lung infection possibly related to radiation. Overall grade 2 pneumonitis related to SBRT or mediastinal radiation was 20%. Only one pt (2%) developed grade 3 esophagitis. No late cardiac events have been observed. The one-year PFS for all pts was 62% with a median PFS of 26.3 mos and median overall survival of 40.8 mos. Of the 50 pts enrolled, 37 received at least one dose of adjuvant durvalumab. The one-year PFS for pts who received at least one dose of durvalumab was 70.3% with a median PFS not yet reached in this group (median follow-up 24 mos). Patterns of failure were mostly distant with 26% of pts experiencing distant failure, 6% regional, and 2% distant and regional. There was only one local failure (2%) after SBRT in all 50 pts. CONCLUSION SBRT to the primary tumor followed by conventional chemoradiation to the involved lymph nodes and adjuvant immunotherapy was well tolerated and showed improved 1-year PFS compared to prior conventional chemoradiation trials for locally advanced NSCLC. The results of this trial will be further evaluated in a randomized phase III study, NRG LU-008. Pts will receive either conventional chemoradiation vs. SBRT to the primary tumor followed by chemoradiation to the involved lymph nodes followed by consolidative immunotherapy to evaluate the possibility of utilization of SBRT as a new standard of care for LA NSCLC.
Collapse
Affiliation(s)
- J H Heinzerling
- Levine Cancer Institute, Atrium Health/Wake Forest School of Medicine and Southeast Radiation Oncology Group, Charlotte, NC
| | - K Mileham
- Levine Cancer Institute, Atrium Health/Wake Forest School of Medicine, Charlotte, NC
| | - M Robinson
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - R Induru
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - C D Corso
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - G Brouse
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - R S Prabhu
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - D Haggstrom
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - B J Moeller
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - W E Bobo
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - C Fasola
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - V V Thakkar
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | - J Gregory
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - S H Burri
- Levine Cancer Institute, Atrium Health and Southeast Radiation Oncology Group, Charlotte, NC
| | | |
Collapse
|
3
|
Mauricaite R, Le Calvez K, Brodbelt A, Bottle A, Gregory J, Booth T, Williams M. Gliocova: Predictors of Post-Operative Complications, 30 Day Mortality and Readmission After First Surgical Intervention in Brain Tumour Patients in England Between 2013-2018. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
AIMS
The Gliocova dataset uses linked English national cancer data on all 51,775 adult primary brain tumour patients diagnosed between 2013-2018. Here we investigate patient safety and post-operative complications after first surgical intervention.
METHOD
We identified patients undergoing first surgical intervention (surgical debulking or biopsy) and used a modified Delphi approach to identify diagnosis codes indicating potential post-surgical complications. We calculated Elixhauer Comorbidity Index (ECI) weights based on our data and developed regression models to link patient characteristics and ECI with 30-day mortality, readmission and chance of complication.
RESULTS
29,258 out of 51,775 patients underwent a surgical intervention (28,173 surgical debulking; and 1,207 biopsy). 11,959 (40.9\%) patients had at least one comorbidity during first intervention admission. In hospital mortality was 0.99\% (N = 289), 30-day mortality was 2.3\% (N = 677) and 30-day readmission was 12.7\% (N = 3,725). 13,137 patients (44.9\%) had at least one complication code from our defined list, either during their first surgical intervention or during a 30-day readmission. Predictors of 30-day mortality, readmission, and risk of complications included age, ECI score, number of complications, type of intervention (biopsy vs surgical debulking), income quintile, and tumour type (i.e., Glioblastoma versus other types of brain tumours).
CONCLUSION
To our knowledge this is the first study in England to assess post-surgical complications in a large brain tumour patient cohort. Our further work will focus on variation in outcomes between different centres/ centre volumes/ regions and the cost of complications. More information: https://blogs.imperial.ac.uk/gliocova/about-gliocova/.
Collapse
Affiliation(s)
- Radvile Mauricaite
- Computational Oncology Laboratory, Institute of Global Health Innovation, Imperial College London , London , UK
| | - Kerlann Le Calvez
- Department of Radiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust , London
| | | | - Alex Bottle
- Dr Foster Unit, School of Public Health, Imperial College London , London , UK
| | - Jonathan Gregory
- Computational Oncology Laboratory, Institute of Global Health Innovation, Imperial College London , London , UK
| | | | - Matt Williams
- Computational Oncology Group, Department of Surgery and Cancer, Imperial College London , London , UK
| |
Collapse
|
4
|
Harrison C, Stow J, Ge X, Gregory J, Gibson H, Monk A. At the limit? Using operational data to estimate train driver human reliability. Appl Ergon 2022; 104:103795. [PMID: 35635943 DOI: 10.1016/j.apergo.2022.103795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 03/24/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Human reliability analysis plays an important role in the safety assessment and management of rail operations. This paper discusses how the increasing availability of operational data can be used to develop an understanding of train driver reliability. The paper derives human reliability data for two driving tasks, stopping at red signals and controlling speed on approach to buffer stops. In the first of these cases, a tool has been developed that can estimate the number of times a signal is approached at red by trains on the Great Britain (GB) rail network. The tool has been developed using big data techniques and ideas, recording and analysing millions of pieces of data from live operational feeds to update and summarise statistics from thousands of signal locations in GB on a daily basis. The resulting driver reliability data are compared to similar analyses of other train driving tasks. This shows human reliability approaching the currently accepted limits of human performance. It also shows higher error rates amongst freight train drivers than passenger train drivers for these tasks. The paper highlights the importance of understanding the task specific performance limits if further improvements in human reliability are sought. It also provides a practical example of how big data could play an increasingly important role in system error management, whether from the perspective of understanding normal performance and the limits of performance for specific tasks or as the basis for dynamic safety indicators which, if not leading, could at least become closer to real time.
Collapse
Affiliation(s)
- Chris Harrison
- RSSB, The Helicon, One South Place, London, EC2M 2RB, UK.
| | - Julian Stow
- Institute of Railway Research, University of Huddersfield, UK
| | - Xiaocheng Ge
- RSSB, The Helicon, One South Place, London, EC2M 2RB, UK
| | | | - Huw Gibson
- RSSB, The Helicon, One South Place, London, EC2M 2RB, UK
| | - Alice Monk
- RSSB, The Helicon, One South Place, London, EC2M 2RB, UK
| |
Collapse
|
5
|
Bloch-Johnson J, Rugenstein M, Gregory J, Cael BB, Andrews T. Climate impact assessments should not discount 'hot' models. Nature 2022; 608:667. [PMID: 35999296 DOI: 10.1038/d41586-022-02241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
6
|
Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
7
|
Gregory J, Kilvert H, Williams T, Cooper M, Polli A, Iadeluca L, Ou S. P08.02 Lorlatinib in First Line Treatment of Patients With ALK-Positive NSCLC: A Network Meta-Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer RJ, Abudu S. Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system : what has been the impact of national policies in the UK? Bone Joint J 2021; 103-B:1541-1549. [PMID: 34465152 DOI: 10.1302/0301-620x.103b9.bjj-2020-2554.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 11/05/2022]
Abstract
AIMS While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Birmingham, UK
| | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert J Grimer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Seggy Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
9
|
Sharma PR, Brech H, Pérez-Pachón L, Gregory J, Lowe T, Poyade M, Gröning F. O49 The use of augmented reality for surgical guidance: an assessment of the human error. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Microsoft HoloLens® is an augmented-reality headset which is increasingly used for surgical guidance. This headset allows the overlay of patient-specific virtual models obtained from medical images onto the patient’s body surface using automatic marker-based alignment. This can guide surgeons during certain surgical tasks, e.g. determining biopsy needle entry points. This study aims to measure the human error in the localisation of virtual models with the headset and discuss its surgical implications.
Method
59 adults were recruited between the ages of 20–59 years. A 12 cm2 digital marker was displayed on a monitor in 9 different positions, one at a time. This was repeated 3 times, resulting in 27 markers shown to each participant. Once a marker was detected by the headset’s camera, a virtual hexagon was rendered on the headset’s transparent lenses. Participants were tasked to click on the hexagon’s vertices using a mouse. The clicks’ coordinates were recorded by the system and compared to the predicted coordinates. This allowed for the calculation of the vertex localisation error.
Result
The mean vertex localisation error was found to be 5.19 mm (±3.56) with a range from 0.08 to 29.77 mm. There was a significant difference between marker positions as determined by a one-way ANOVA (P < 0.001).
Conclusion
This study suggests that the error in the localisation of virtual models depends on the position of the markers relative to the user wearing the headset. Further research is required to explore whether training can reduce the human error with this headset.
Take-home Message
The range of the human error in localising virtual models via the Microsoft HoloLens® headset is large and may be dependent on the position of the marker relative to the user of the headset. Further research is needed to investigate whether training with the headset can improve human performance.
Collapse
Affiliation(s)
- P R Sharma
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - H Brech
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - L Pérez-Pachón
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - J Gregory
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| | - T Lowe
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
- Head and Neck Oncology Unit, Aberdeen Royal Infirmary (NHS Grampian), Aberdeen, UK
| | - M Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, UK
| | - F Gröning
- The School of Medicine, Medical Sciences and Nutrition, Aberdeen University, Aberdeen, UK
| |
Collapse
|
10
|
Tsoi KM, Lowe M, Tsuda Y, Lex JR, Fujiwara T, Almeer G, Gregory J, Stevenson J, Evans SE, Botchu R, Jeys LM. How Are Indeterminate Pulmonary Nodules at Diagnosis Associated with Survival in Patients with High-Grade Osteosarcoma? Clin Orthop Relat Res 2021; 479:298-308. [PMID: 32956141 PMCID: PMC7899536 DOI: 10.1097/corr.0000000000001491] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pulmonary metastases are a poor prognostic factor in patients with osteosarcoma; however, the clinical significance of subcentimeter lung nodules and whether they represent a tumor is not fully known. Because the clinician is faced with decisions regarding biopsy, resection, or observation of lung nodules and the potential impact they have on decisions about resection of the primary tumor, this remains an area of uncertainty in patient treatment. Surgical management of the primary tumor is tailored to prognosis, and it is unclear how aggressively patients with indeterminate pulmonary nodules (IPNs), defined as nodules smaller than 1 cm at presentation, should be treated. There is a clear need to better understand the clinical importance of these nodules. QUESTIONS/PURPOSES (1) What percentage of patients with high-grade osteosarcoma and spindle cell sarcoma of bone have IPNs at diagnosis? (2) Are IPNs at diagnosis associated with worse metastasis-free and overall survival? (3) Are there any clinical or radiologic factors associated with worse overall survival in patients with IPN? METHODS Between 2008 and 2016, 484 patients with a first presentation of osteosarcoma or spindle cell sarcoma of bone were retrospectively identified from an institutional database. Patients with the following were excluded: treatment at another institution (6%, 27 of 484), death related to complications of neoadjuvant chemotherapy (1%, 3 of 484), Grade 1 or 2 on final pathology (4%, 21 of 484) and lack of staging chest CT available for review (0.4%, 2 of 484). All patients with abnormalities on their staging chest CT underwent imaging re-review by a senior radiology consultant and were divided into three groups for comparison: no metastases (70%, 302 of 431), IPN (16%, 68 of 431), and metastases (14%, 61 of 431) at the time of diagnosis. A random subset of CT scans was reviewed by a senior radiology registrar and there was very good agreement between the two reviewers (κ = 0.88). Demographic and oncologic variables as well as treatment details and clinical course were gleaned from a longitudinally maintained institutional database. The three groups did not differ with regard to age, gender, subtype, presence of pathological fracture, tumor site, or chemotherapy-induced necrosis. They differed according to local control strategy and tumor size, with a larger proportion of patients in the metastases group presenting with larger tumor size and undergoing nonoperative treatment. There was no differential loss to follow-up among the three groups. Two percent (6 of 302) of patients with no metastases, no patients with IPN, and 2% (1 of 61) of patients with metastases were lost to follow-up at 1 year postdiagnosis but were not known to have died. Individual treatment decisions were determined as part of a multidisciplinary conference, but in general, patients without obvious metastases received (neo)adjuvant chemotherapy and surgical resection for local control. Patients in the no metastases and IPN groups did not differ in local control strategy. For patients in the IPN group, staging CT images were inspected for IPN characteristics including number, distribution, size, location, presence of mineralization, and shape. Subsequent chest CT images were examined by the same radiologist to reevaluate known nodules for interval change in size and to identify the presence of new nodules. A random subset of chest CT scans were re-reviewed by a senior radiology resident (κ = 0.62). The association of demographic and oncologic variables with metastasis-free and overall survival was first explored using the Kaplan-Meier method (log-rank test) in univariable analyses. All variables that were statistically significant (p < 0.05) in univariable analyses were entered into Cox regression multivariable analyses. RESULTS Following re-review of staging chest CTs, IPNs were found in 16% (68 of 431) of patients, while an additional 14% (61 of 431) of patients had lung metastases (parenchymal nodules 10 mm or larger). After controlling for potential confounding variables like local control strategy, tumor size, and chemotherapy-induced necrosis, we found that the presence of an IPN was associated with worse overall survival and a higher incidence of metastases (hazard ratio 1.9 [95% CI 1.3 to 2.8]; p = 0.001 and HR 3.6 [95% CI 2.5 to 5.2]; p < 0.001, respectively). Two-year overall survival for patients with no metastases, IPN, or metastases was 83% [95% CI 78 to 87], 65% [95% CI 52 to 75] and 45% [95% CI 32 to 57], respectively (p = 0.001). In 74% (50 of 68) of patients with IPNs, it became apparent that they were true metastatic lesions at a median of 5.3 months. Eighty-six percent (43 of 50) of these patients had disease progression by 2 years after diagnosis. In multivariable analysis, local control strategy and tumor subtype correlated with overall survival for patients with IPNs. Patients who were treated nonoperatively and who had a secondary sarcoma had worse outcomes (HR 3.6 [95% CI 1.5 to 8.3]; p = 0.003 and HR 3.4 [95% CI 1.1 to 10.0]; p = 0.03). The presence of nodule mineralization was associated with improved overall survival in the univariable analysis (87% [95% CI 39 to 98] versus 57% [95% CI 43 to 69]; p = 0.008), however, because we could not control for other factors in a multivariable analysis, the relationship between mineralization and survival could not be determined. We were unable to detect an association between any other nodule radiologic features and survival. CONCLUSION The findings show that the presence of IPNs at diagnosis is associated with poorer survival of affected patients compared with those with normal staging chest CTs. IPNs noted at presentation in patients with high-grade osteosarcoma and spindle cell sarcoma of bone should be discussed with the patient and be considered when making treatment decisions. Further work is required to elucidate how the nodules should be managed. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
Affiliation(s)
- Kim M Tsoi
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Martin Lowe
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Yusuke Tsuda
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Johnathan R Lex
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Tomohiro Fujiwara
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Ghassan Almeer
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Gregory
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Jonathan Stevenson
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Scott E Evans
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Rajesh Botchu
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| | - Lee M Jeys
- K. M. Tsoi, M. Lowe, Y. Tsuda, J. R. Lex, T. Fujiwara, J. Gregory, J. Stevenson, S. E. Evans, L. M. Jeys, Oncology Department, Royal Orthopaedic Hospital, Birmingham, UK
- K. M. Tsoi, Mount Sinai Hospital, Toronto, ON, Canada
- G. Almeer, R. Botchu, Department of Diagnostic Imaging, Royal Orthopaedic Hospital, Birmingham, UK
- J. Stevenson, L. M. Jeys, Aston University Medical School, Birmingham, UK
| |
Collapse
|
11
|
Abstract
AIMS Malignancy and surgery are risk factors for venous thromboembolism (VTE). We undertook a systematic review of the literature concerning the prophylactic management of VTE in orthopaedic oncology patients. METHODS MEDLINE (PubMed), EMBASE (Ovid), Cochrane, and CINAHL databases were searched focusing on VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, or wound complication rates. RESULTS In all, 17 studies published from 1998 to 2018 met the inclusion criteria for the systematic review. The mean incidence of all VTE events in orthopaedic oncology patients was 10.7% (1.1% to 27.7%). The rate of PE was 2.4% (0.1% to 10.6%) while the rate of lethal PE was 0.6% (0.0% to 4.3%). The overall rate of DVT was 8.8% (1.1% to 22.3%) and the rate of symptomatic DVT was 2.9% (0.0% to 6.2%). From the studies that screened all patients prior to hospital discharge, the rate of asymptomatic DVT was 10.9% (2.0% to 20.2%). The most common risk factors identified for VTE were endoprosthetic replacements, hip and pelvic resections, presence of metastases, surgical procedures taking longer than three hours, and patients having chemotherapy. Mean incidence of VTE with and without chemical prophylaxis was 7.9% (1.1% to 21.8%) and 8.7% (2.0% to 23.4%; p = 0.11), respectively. No difference in the incidence of bleeding or wound complications between prophylaxis groups was reported. CONCLUSION Current evidence is limited to guide clinicians. It is our consensus opinion, based upon logic and deduction, that all patients be considered for both mechanical and chemical VTE prophylaxis, particularly in high-risk patients (pelvic or hip resections, prosthetic reconstruction, malignant diagnosis, presence of metastases, or surgical procedures longer than three hours). Additionally, the surgeon must determine, in each patient, if the risk of haemorrhage outweighs the risk of VTE. No individual pharmacological agent has been identified as being superior in the prevention of VTE events. Cite this article: Bone Joint J 2020;102-B(12)1743:-1751.
Collapse
Affiliation(s)
- Johnathan R Lex
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada.,Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Scott Evans
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.,Medical School, Keele University, Keele, UK
| | - Jonathan Gregory
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert U Ashford
- Joint Reconstruction and Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Kenneth S Rankin
- Translational and Clinical Sciences Institute, Newcastle University, Newcastle, UK.,North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals NHS Foundation Trust, Newcastle, UK
| | - Tom Cosker
- Orthopaedic Oncology, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Amit Kumar
- Orthopaedics Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Craig Gerrand
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Jonathan Stevenson
- Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Medical School, Aston University, Birmingham, UK
| | | |
Collapse
|
12
|
Abstract
AIMS The existing clinical guidelines do not describe a clear indication for adjuvant radiotherapy (RT) in the treatment of superficial soft tissue sarcomas (STSs). We aimed to determine the efficacy of adjuvant RT for superficial STSs. METHODS We retrospectively studied 304 patients with superficial STS of the limbs and trunk who underwent surgical resection at a tertiary sarcoma centre. The efficacy of RT was investigated according to the tumour size and grade: group 1, ≤ 5 cm, low grade; group 2, ≤ 5cm, high grade; group 3, > 5 cm, low grade; group 4, > 5 cm, high grade. RESULTS The five- and ten-year local recurrence-free survival (LRFS) for all patients was 88% and 81%, respectively. While the efficacy of adjuvant RT was not proven in local control of all patients (five-year LRFS; RT+, 90% versus RT-, 83%; p = 0.074), the LRFS was significantly improved by adjuvant RT in group 2 (five-year LRFS; RT+, 96% versus RT-, 82%; p = 0.019), and group 4 (five-year LRFS; RT+, 87% versus RT-, 73%; p = 0.027). In groups 2 and 4, adjuvant RT significantly reduced the LR risk if the resection margin was clear but less than 5 mm; the LR rate was 7% with adjuvant RT compared with 26% with surgery alone (p = 0.003). There was no statistical relationship with the use of adjuvant RT and survival in every group. CONCLUSION Adjuvant RT reduces the risk of local recurrence in patients with superficial high-grade STS regardless of tumour size, especially when resection margin is less than 5 mm. Cite this article: Bone Joint J 2020;102-B(8):1088-1094.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Roger Tillman
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
13
|
Hartley A, Hardcastle SA, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Granell R, Gregory J, Williams M, Tobias JH, Gregson CL. Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1180-1190. [PMID: 32417557 DOI: 10.1016/j.joca.2020.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
Collapse
Affiliation(s)
- A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - S A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK; Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Integrated Research Into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - K E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - K Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - R Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Gregory
- Institute of Medical Science, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - M Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol UK
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Faber BG, Bredbenner TL, Baird D, Gregory J, Saunders F, Giuraniuc CV, Aspden RM, Lane NE, Orwoll E, Tobias JH. Subregional statistical shape modelling identifies lesser trochanter size as a possible risk factor for radiographic hip osteoarthritis, a cross-sectional analysis from the Osteoporotic Fractures in Men Study. Osteoarthritis Cartilage 2020; 28:1071-1078. [PMID: 32387760 PMCID: PMC7387228 DOI: 10.1016/j.joca.2020.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/17/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Statistical shape modelling (SSM) of hip dual-energy X-ray absorptiometry (DXA) scans has identified relationships between hip shape and radiographic hip OA (rHOA). We aimed to further elucidate shape characteristics related to rHOA by focusing on subregions identified from whole-hip shape models. METHOD SSM was applied to hip DXAs obtained in the Osteoporotic Fractures in Men Study. Whole-hip shape modes (HSMs) associated with rHOA were combined to form a composite at-risk-shape. Subsequently, subregional HSMs (cam-type and lesser trochanter modes) were built, and associations with rHOA were examined by logistic regression. Subregional HSMs were further characterised, by examining associations with 3D-HSMs derived from concurrent hip CT scans. RESULTS 4,098 participants were identified with hip DXAs and radiographs. Composite shapes from whole-hip HSMs revealed that lesser trochanter size and cam-type femoral head are related to rHOA. From sub-regional models, lesser trochanter mode (LTM)1 [OR 0.74; 95%CI 0.63.0.87] and cam-type mode (CTM)3 [OR 1.27; 1.13.1.42] were associated with rHOA, associations being similar to those for whole hip HSMs. 515 MrOS participants had hip DXAs and 3D-HSMs derived from hip CT scans. LTM1 was associated with 3D-HSMs that also represented a larger lesser trochanter [3D-HSM7 (beta (β)-0.23;-0.33,-0.14) and 3D-HSM9 (β0.36; 0.27.0.45)], and CTM3 with 3D-HSMs describing cam morphology [3D-HSM3 (β-0.16;-0.25,-0.07) and 3D-HSM6 (β 0.19; 0.10.0.28)]. CONCLUSION Subregional SSM of hip DXA scans suggested larger lesser trochanter and cam morphology underlie associations between overall hip shape and rHOA. 3D hip modelling suggests our subregional SSMs represent true anatomical variations in hip shape, warranting further investigation.
Collapse
Affiliation(s)
- B G Faber
- Medical Research Council Clinical Research Fellow, Musculoskeletal Research Unit, University of Bristol, Bristol, UK.
| | - T L Bredbenner
- Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado, USA
| | - D Baird
- Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - F Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - C V Giuraniuc
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - N E Lane
- Center for Musculoskeletal Health, U.C. Davis School of Medicine, Sacramento, CA 95817, USA
| | - E Orwoll
- Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| |
Collapse
|
15
|
Howard EL, Gregory J, Tsoi K, Evans S, Flanagan A, Cool P. Comorbidities and Pregnancy Do Not Affect Local Recurrence in Patients With Giant Cell Tumour of Bone. Cureus 2020; 12:e9164. [PMID: 32802601 PMCID: PMC7419151 DOI: 10.7759/cureus.9164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study evaluates the relationship between pregnancy, comorbid conditions and giant cell tumour of bone. Furthermore, it examines if pregnancy and comorbid conditions affect the outcome following treatment for this tumour. A multi-centre retrospective review was conducted of consecutive patients with a confirmed histological diagnosis of giant cell tumour of bone between June 2012 and May 2017. A total of 195 patients were identified from two centres. Of these, 168 patients were treated with curative intent and had more than six months follow-up. Data were collected on pregnancy status, comorbid conditions, site of disease, surgical management and local recurrence rates. Statistical analysis included the Fisher exact test and Kaplan-Meier survival analysis. There were 72 females of childbearing age, of which 15 (21%) were currently pregnant or had been pregnant within the last six months. The pregnancy rate is higher than the highest reported pregnancy rate over the last 10 years (8.4%; Fisher test, p = 0.033). Women were more likely to have a comorbid condition than men (Fisher test, p < 0.002) and had a higher rate of autoimmune disease than the normal population (p = 0.015). Men were older than women (Wilcoxon test, p = 0.046) and had less risk of local recurrence (logrank test, p = 0.014). Pregnancy or comorbid conditions did not increase the local recurrence rate. Predictors for local recurrence included location in the distal radius (logrank test, p < 0.001), intralesional treatment (logrank test, p = 0.008) and age less than 40 (logrank test, p = 0.043). In conclusion, giant cell tumour of bone is more common in pregnant females and patients with immune disease. Comorbidities and pregnancy do not affect the local recurrence rate. Male patients over 40 years of age have a lower risk of local recurrence, and patients with disease in the distal radius have a high risk of recurrence.
Collapse
Affiliation(s)
- Emma L Howard
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Jonathan Gregory
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Kim Tsoi
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Scott Evans
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Adrienne Flanagan
- Pathology, The Royal Orthopaedic Hospital NHS Foundation Trust, Stanmore, GBR
| | - Paul Cool
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR.,Medical Sciences, Keele University, Keele, GBR
| |
Collapse
|
16
|
Abstract
Introduction The aim of this study was to evaluate radiological measurements to establish the origin of giant cell tumours of bone. Methods A multi-centre retrospective review was conducted of patients with histologically confirmed giant cell tumours of bone. Images were analysed to estimate the centre of the tumour. Measured from the joint line, the ratio between the distance of the centre of the tumour and the physeal scar was calculated. Results Ninety-five patients were included in the study. Two observers found the tumour to be arising from the metaphyseal area in 94% - 97% of the cases. There was good agreement between the measurements of observers (interclass correlation coefficient 0.71). Conclusion Giant cell tumours of bone appear to be arising from the metaphyseal region.
Collapse
Affiliation(s)
- Emma L Howard
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Jonathan Gregory
- Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Naomi Winn
- Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | | | - Paul Cool
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR.,Medical Sciences, Keele University, Keele, GBR
| |
Collapse
|
17
|
Boo SL, Botchu R, McLoughlin E, Patel A, James SL, Gregory J, Davies AM. Sarcoma multidisciplinary team meeting: past, present, and future. Clin Radiol 2020; 75:316-318. [PMID: 31973939 DOI: 10.1016/j.crad.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S L Boo
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
18
|
Hartley L, Evans S, Davies M, Kelly S, Gregory J. A Daily Diagnostic Multidisciplinary Team Meeting to Reduce Time to Definitive Diagnosis in the Context of Bone and Soft Tissue Sarcoma. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
19
|
Fujiwara T, Medellin MR, Sambri A, Tsuda Y, Balko J, Sumathi V, Gregory J, Jeys L, Abudu A. Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels. Bone Joint J 2019; 101-B:1024-1031. [DOI: 10.1302/0301-620x.101b8.bjj-2018-0963.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.
Collapse
Affiliation(s)
- T. Fujiwara
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - M. R. Medellin
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Oncology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - A. Sambri
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
- Istituto Ortopedico Rizzoli/University of Bologna, Bologna, Italy
| | - Y. Tsuda
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Balko
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - V. Sumathi
- Department of Musculoskeletal Pathology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Gregory
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - L. Jeys
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Abudu
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
20
|
Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101:405-410. [PMID: 31155889 DOI: 10.1308/rcsann.2019.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. MATERIALS AND METHODS A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. RESULTS Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. CONCLUSIONS This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.
Collapse
Affiliation(s)
- J R Lex
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J Gregory
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - C Allen
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J P Reid
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| | - J D Stevenson
- Royal Orthopaedic Hospital Oncology Service , Birmingham , UK
| |
Collapse
|
21
|
Henney K, Hayers L, Dick K, Gregory J, Francis J, Murray N, Dixon E. P398 Cystic fibrosis education for schools and nurseries. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Seddon L, Dick K, Balfour-Lynn I, Carr S, Gregory J, Henney K, Francis J. WS20-3 Newborn screening - telling parents that their baby might have cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Goelzer H, Nowicki S, Edwards T, Beckley M, Abe-Ouchi A, Aschwanden A, Calov R, Gagliardini O, Gillet-Chaulet F, Golledge NR, Gregory J, Greve R, Humbert A, Huybrechts P, Kennedy JH, Larour E, Lipscomb WH, clećh SL, Lee V, Morlighem M, Pattyn F, Payne AJ, Rodehacke C, Rückamp M, Saito F, Schlegel N, Seroussi H, Shepherd A, Sun S, van de Wal R, Ziemen FA. Design and results of the ice sheet model initialisation experiments initMIP-Greenland: an ISMIP6 intercomparison. Cryosphere 2019; 12:1433-1460. [PMID: 32676174 PMCID: PMC7365265 DOI: 10.5194/tc-12-1433-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Earlier large-scale Greenland ice sheet sea-level projections (e.g., those run during the ice2sea and SeaRISE initiatives) have shown that ice sheet initial conditions have a large effect on the projections and give rise to important uncertainties. The goal of the initMIP-Greenland intercomparison exercise is to compare, evaluate and improve the initialisation techniques used in the ice sheet modelling community and to estimate the associated uncertainties in modelled mass changes. initMIP-Greenland is the first in a series of ice sheet model intercomparison activities within ISMIP6 (the Ice Sheet Model Intercomparison Project for CMIP6), which is the primary activity within the Coupled Model Intercomparison Project - phase 6 (CMIP6) focusing on the ice sheets. Two experiments for the large-scale Greenland ice sheet have been designed to allow intercomparison between participating models of 1) the initial present-day state of the ice sheet and 2) the response in two idealised forward experiments. The forward experiments serve to evaluate the initialisation in terms of model drift (forward run without additional forcing) and in response to a large perturbation (prescribed surface mass balance anomaly), and should not be interpreted as sea-level projections. We present and discuss results that highlight the diversity of data sets, boundary conditions and initialisation techniques used in the community to generate initial states of the Greenland ice sheet. We find good agreement across the ensemble for the dynamic response to surface mass balance changes in areas where the simulated ice sheets overlap, but differences arising from the initial size of the ice sheet. The model drift in the control experiment is reduced for models that participated in earlier intercomparison exercises.
Collapse
Affiliation(s)
- Heiko Goelzer
- Utrecht University, Institute for Marine and Atmospheric Research (IMAU), Utrecht, Netherlands
- Laboratoire de Glaciologie, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Tamsin Edwards
- School of Environment, Earth & Ecosystem Sciences, The Open University, Milton Keynes, United Kingdom
| | | | - Ayako Abe-Ouchi
- Atmosphere Ocean Research Institute, University of Tokyo, Kashiwa, Japan
| | | | - Reinhard Calov
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Olivier Gagliardini
- Univ. Grenoble Alpes, CNRS, IRD, Grenoble INP, IGE, F-38000 Grenoble, France
| | | | - Nicholas R. Golledge
- Antarctic Research Centre, Victoria University of Wellington, Wellington, New Zealand
| | - Jonathan Gregory
- Department of Meteorology, University of Reading, Reading, United Kingdom
- Met Office Hadley Center, Exeter, United Kingdom
| | - Ralf Greve
- Institute of Low Temperature Science, Hokkaido University, Sapporo, Japan
| | - Angelika Humbert
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
- University of Bremen, Bremen, Germany
| | | | - Joseph H. Kennedy
- Climate Change Science Institute, Oak Ridge National Laboratory, Oak Ridge, USA
- Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, USA
| | - Eric Larour
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, USA
| | - William H. Lipscomb
- Los Alamos National Laboratory, Los Alamos, USA
- National Center for Atmospheric Research, Boulder, USA
| | - Sébastien Le clećh
- LSCE/IPSL, Laboratoire des Sciences du Climat et de l’Environnement, CEA-CNRS-UVSQ, Gif-sur-Yvette, France
| | | | | | - Frank Pattyn
- Laboratoire de Glaciologie, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Christian Rodehacke
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
- Danish Meteorological Institute, Copenhagen, Denmark
| | - Martin Rückamp
- Alfred Wegener Institute for Polar and Marine Research, Bremerhaven, Germany
| | - Fuyuki Saito
- Japan Agency for Marine-Earth Science and Technology, Yokohama, Japan
| | - Nicole Schlegel
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, USA
| | - Helene Seroussi
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, USA
| | - Andrew Shepherd
- School of Earth and Environment, University of Leeds, United Kingdom
| | - Sainan Sun
- Laboratoire de Glaciologie, Université Libre de Bruxelles, Brussels, Belgium
| | - Roderik van de Wal
- Utrecht University, Institute for Marine and Atmospheric Research (IMAU), Utrecht, Netherlands
| | | |
Collapse
|
24
|
Outani H, Nakamura T, Murata H, Stevenson J, Parry M, Gregory J, Tillman R, Jeys L, Abudu A. Localized synovial sarcoma: A single institutional study of 191 patients with a minimum follow-up of 5 years for survivors. J Surg Oncol 2019; 119:850-855. [PMID: 30786036 DOI: 10.1002/jso.25417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/03/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Factors affecting long-term outcomes of synovial sarcoma (SS) remain unknown. Here, we aimed to investigate the long-term oncological outcomes and prognostic factors in a large group of patients with surgically-treated localized SS. PATIENTS AND METHODS Between 1980 and 2011, 191 patients (94 males and 97 females) were treated at a single hospital with a minimum follow-up of 5 years for survivors. The median age was 35 years (range, 3-80 years), and the median follow-up period was 83 months (range, 3-235 months). RESULTS Disease-specific survival was 76.4% and 60.4% at 5 and 10 years, respectively. Local recurrence occurred in 23 patients at a median of 33 months (range, 6-158 months), and metastasis occurred in 73 patients at a median of 20 months (range, 2-166 months). In multivariate analysis, grade 3 tumors sized ≥5 cm were significantly associated with worse survival. Ten patients (5.2%) developed metastasis more than 5 years after surgery. CONCLUSION Tumor size and grade govern prognosis in surgically-treated localized SS in long-term settings. If adequately treated patients have not developed metastases for 5 years after surgery, the risk of subsequently developing metastases was lower than previously reported.
Collapse
Affiliation(s)
- Hidetatsu Outani
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom.,Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroaki Murata
- Department of Orthopaedic Surgery, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | - Jonathan Stevenson
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Michael Parry
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Jonathan Gregory
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Roger Tillman
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Lee Jeys
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Adesegun Abudu
- Oncology Service, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| |
Collapse
|
25
|
Hewitt L, Powell R, Zenginer K, Coyle C, Murray H, Cooper L, Gregory J. Patient Perceptions of the Impact of Treatment (Surgery and Radiotherapy) for Soft Tissue Sarcoma. Sarcoma 2019; 2019:9581781. [PMID: 31049021 PMCID: PMC6462335 DOI: 10.1155/2019/9581781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment for soft tissue sarcoma (STS) is challenging for patients. This study aimed to gain an in-depth understanding of patients' experiences of STS treatment, including whether the sequence of treatment (preoperative or postoperative radiotherapy) influences patient perceptions. METHODS Face-to-face semi-structured interviews were conducted with nineteen patients who had been treated for STS with surgery and radiotherapy between 2011 and 2016. Topics discussed included perceptions of treatment, social support, and coping mechanisms. Qualitative, inductive, thematic analysis was conducted and structured using the Framework approach. RESULTS Treatment sequence itself did not appear to cause concern, but uncertainty regarding treatment and side effects could negatively impact participants. Social relationships and individual coping strategies influenced participants' experiences of treatment. CONCLUSIONS Participants' perceptions of the treatment process varied; the experience was highly individual. It is important to ensure individual psychosocial and information needs are met. In particular, the removal of uncertainty regarding treatment is important in supporting patients undergoing treatment for soft tissue sarcoma.
Collapse
Affiliation(s)
- Lauren Hewitt
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Rachael Powell
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Kaan Zenginer
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | | | - Helen Murray
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa Cooper
- The Christie NHS Foundation Trust, Manchester, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Molecular and Clinical Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
26
|
Medellin MR, Fujiwara T, Tillman RM, Jeys LM, Gregory J, Stevenson JD, Parry M, Abudu A. Prognostic factors for local recurrence in extremity-located giant cell tumours of bone with pathological fracture. Bone Joint J 2018; 100-B:1626-1632. [PMID: 30499317 DOI: 10.1302/0301-620x.100b12.bjj-2018-0189.r2] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this paper was to investigate the prognostic factors for local recurrence in patients with pathological fracture through giant cell tumours of bone (GCTB). PATIENTS AND METHODS A total of 107 patients presenting with fractures through GCTB treated at our institution (Royal Orthopaedic Hospital, Birmingham, United Kingdom) between 1995 and 2016 were retrospectively studied. Of these patients, 57 were female (53%) and 50 were male (47%).The mean age at diagnosis was 33 years (14 to 86). A univariate analysis was performed, followed by multivariate analysis to identify risk factors based on the treatment and clinical characteristics. RESULTS The initial surgical treatment was curettage with or without adjuvants in 55 patients (51%), en bloc resection with or without reconstruction in 45 patients (42%), and neoadjuvant denosumab, followed by resection (n = 3, 3%) or curettage (n = 4, 4%). The choice of treatment depended on tumour location, Campanacci tumour staging, intra-articular involvement, and fracture displacement. Neoadjuvant denosumab was used only in fractures through Campanacci stage 3 tumours. Local recurrence occurred in 28 patients (25%). Surgery more than six weeks after the fracture did not affect the risk of recurrence in any of the groups. In Campanacci stage 3 tumours not treated with denosumab, en bloc resection had lower local recurrences (13%), compared with curettage (39%). In tumours classified as Campanacci 2, intralesional curettage and en bloc resections had similar recurrence rates (21% and 24%, respectively). After univariate analysis, the type of surgical intervention, location, and the use of denosumab were independent factors predicting local recurrence. Further surgery was required 33% more often after intralesional curettage in comparison with resections (mean 1.59, 0 to 5 vs 1.06, 0 to 3 operations). All patients treated with denosumab followed by intralesional curettage developed local recurrence. CONCLUSION In patients with pathological fractures through GCTB not treated with denosumab, en bloc resection offers lower risks of local recurrence in tumours classified as Campanacci stage 3. Curettage or resections are both similar options in terms of the risk of local recurrence for tumours classified as Campanacci stage 2. The benefits of denosumab followed by intralesional curettage in these patients still remains unclear.
Collapse
Affiliation(s)
| | - T Fujiwara
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - L M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J D Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK; Honorary Senior Lecturer, Aston University Medical School, Birmingham, UK
| | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - A Abudu
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
27
|
Estes-Doetsch H, Rusnak S, Gilmore D, Gregory J, Ritchey K, Nahikian-Nelms M. Dietetic Education: The Value of an Experiential Workshop Using Patient Simulation in Teaching Assessment of Malnutrition. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Dhinsa BS, DeLisa M, Pollock R, Flanagan AM, Whelan J, Gregory J. Dedifferentiated Chondrosarcoma Demonstrating Osteosarcomatous Differentiation. Oncol Res Treat 2018; 41:456-460. [DOI: 10.1159/000487803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/20/2018] [Indexed: 11/19/2022]
|
29
|
Abstract
Abstract:To practice medicine in the near future, health care providers in the USA need an information infrastructure they do not yet have. We offer a contribution from social science research to discussions of current medical records practices and how health care activity systems may be transformed by the advent of electronic health records. The goal of the paper is to set forth a framework that connects over-arching questions concerning medical informatics systems development with the practical, cultural and conceptual issues involved in transitions from handwritten and other free text documentation to structured entry of medical records to build patient profiles. The research is broadly framed by an interest in how reciprocal modifications of the design and use of an electronic health record are negotiated in an iterative prototyping project. It is conducted as part of a complex multi-disciplinary research and development effort to create an electronic health record prototype for use in the integrated health care delivery environment of the Southern California Kaiser Permanente Medical Care Program.
Collapse
|
30
|
Gregory J, Barlow R, McGee U, Cole H, Edwards S, Howell G, Lewis W. Incidence and recognition of malnutrition on admission to hospital. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Edwards S, Barlow R, Cole H, Gregory J, McGee U. Does age, gender, smoking and alcohol intake influence nutritional status on admission to an acute hospital? Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Cole H, Barlow R, Edwards S, Gregory J, McGee U, Howell G, Lewis W. Impact of nutritional status on length of hospital stay. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
33
|
Aweid B, Gregory J. Early Analgesic and Anti-Emetic Prescriptions for New Surgical Admissions: A Closed Loop Audit. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Gregory TM, Gregory J, Nicolas E, Pierrart J, Masmejean E. Shoulder Arthroplasty Imaging: What's New. Open Orthop J 2017; 11:1126-1132. [PMID: 29152007 PMCID: PMC5675998 DOI: 10.2174/1874325001711011126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/10/2017] [Accepted: 05/14/2017] [Indexed: 11/22/2022] Open
Abstract
Background Shoulder arthroplasty, in its different forms (hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty) has transformed the clinical outcomes of shoulder disorders. Improvement of general clinical outcome is the result of stronger adequacy of the treatment to the diagnosis, enhanced surgical techniques, specific implanted materials, and more accurate follow up. Imaging is an important tool in each step of these processes. Method This article is a review article declining recent imaging processes for shoulder arthroplasty. Results Shoulder imaging is important for shoulder arthroplasty pre-operative planning but also for post-operative monitoring of the prosthesis and this article has a focus on the validity of plain radiographs for detecting radiolucent line and on new Computed Tomography scan method established to eliminate the prosthesis metallic artefacts that obscure the component fixation visualisation. Conclusion Number of shoulder arthroplasties implanted have grown up rapidly for the past decade, leading to an increase in the number of complications. In parallel, new imaging system have been established to monitor these complications, especially component loosening.
Collapse
Affiliation(s)
- T M Gregory
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France.,Department of Mechanical Engineering, Imperial College, London, UK
| | - J Gregory
- Department of Radiology, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes Paris, France
| | - E Nicolas
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - J Pierrart
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - E Masmejean
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| |
Collapse
|
35
|
Gregory TM, Boukebous B, Gregory J, Pierrart J, Masemjean E. Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty. Open Orthop J 2017; 11:1133-1141. [PMID: 29152008 PMCID: PMC5676001 DOI: 10.2174/1874325001711011133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/14/2017] [Accepted: 05/14/2017] [Indexed: 12/20/2022] Open
Abstract
Total shoulder arthroplasty (TSA) is an effective approach for the treatment of a variety of clinical conditions affecting the shoulder, including osteoarthritis, inflammatory arthritis and osteonecrosis, and the number of TSA implanted has grown exponentially over the past decade. This review gives an update of the major complications, mainly infections, instability and loosening, encountered after TSA, based on a corpus of recent publications and a dynamic approach: The review focuses on the causes of glenoid loosening, which account for 80% of the complication, and underlines the importance of glenoid positioning in the recovery of early shouder function and in the long term survival rate of TSA.
Collapse
Affiliation(s)
- T M Gregory
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France.,Department of Mechanical Engineering, Imperial College, London, UK
| | - B Boukebous
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| | - J Gregory
- Upper Limb Surgery Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France
| | - J Pierrart
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| | - E Masemjean
- Upper Limb and orthopaedic surgery department, Avicenne Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University Paris 13, Paris, France
| |
Collapse
|
36
|
Morgan-Trimmer S, Gregory J, Townson J, Channon S, Chestnutt I, Chadwick B, Murphy S, Hutchings S. OP86 Understanding intervention acceptability: changing participant views over time and the importance of context. Methods 2017. [DOI: 10.1136/jech-2017-ssmabstracts.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Powell SK, Gregory J, Akbarian S, Brennand KJ. Application of CRISPR/Cas9 to the study of brain development and neuropsychiatric disease. Mol Cell Neurosci 2017; 82:157-166. [PMID: 28549865 DOI: 10.1016/j.mcn.2017.05.007] [Citation(s) in RCA: 23] [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] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022] Open
Abstract
CRISPR/Cas9 technology has transformed our ability to manipulate the genome and epigenome, from efficient genomic editing to targeted localization of effectors to specific loci. Through the manipulation of DNA- and histone-modifying enzyme activities, activation or repression of gene expression, and targeting of transcriptional regulators, the role of gene-regulatory and epigenetic pathways in basic biology and disease processes can be directly queried. Here, we discuss emerging CRISPR-based methodologies, with specific consideration of neurobiological applications of human induced pluripotent stem cell (hiPSC)-based models.
Collapse
Affiliation(s)
- S K Powell
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - J Gregory
- Instructional Technology Group, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - S Akbarian
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - K J Brennand
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| |
Collapse
|
38
|
Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
Collapse
Affiliation(s)
- L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK; School of Health and Life Sciences, Aston University, Birmingham, UK.
| | - G Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
39
|
Gregory J. I72. SUSPECTED SARCOMA: WHAT DOES THE RHEUMATOLOGIST NEED TO KNOW? HOW YOU CAN MAKE A DIFFERENCE TO PATIENTS WITH A RARE CANCER. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex060.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Sampath Kumar V, Tyrrell PNM, Singh J, Gregory J, Cribb GL, Cool P. Surveillance of intramedullary cartilage tumours in long bones. Bone Joint J 2017; 98-B:1542-1547. [PMID: 27803232 DOI: 10.1302/0301-620x.98b11.37864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/10/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. PATIENTS AND METHODS A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients). RESULTS Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025). CONCLUSION Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542-7.
Collapse
Affiliation(s)
- V Sampath Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P N M Tyrrell
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Gregory
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - G L Cribb
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| |
Collapse
|
41
|
Morris O, Gregory J, Kadirvel M, Henderson F, Blykers A, McMahon A, Taylor M, Allsop D, Allan S, Grigg J, Boutin H, Prenant C. Development & automation of a novel [(18)F]F prosthetic group, 2-[(18)F]-fluoro-3-pyridinecarboxaldehyde, and its application to an amino(oxy)-functionalised Aβ peptide. Appl Radiat Isot 2016; 116:120-7. [PMID: 27518217 PMCID: PMC5034901 DOI: 10.1016/j.apradiso.2016.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/07/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
Abstract
2-[(18)F]-Fluoro-3-pyridinecarboxaldehyde ([(18)F]FPCA) is a novel, water-soluble prosthetic group. It's radiochemistry has been developed and fully-automated for application in chemoselective radiolabelling of amino(oxy)-derivatised RI-OR2-TAT peptide, (Aoa-k)-RI-OR2-TAT, using a GE TRACERlab FX-FN. RI-OR2-TAT is a brain-penetrant, retro-inverso peptide that binds to amyloid species associated with Alzheimer's Disease. Radiolabelled (Aoa-k)-RI-OR2-TAT was reproducibly synthesised and the product of the reaction with FPCA has been fully characterised. In-vivo biodistribution of [(18)F]RI-OR2-TAT has been measured in Wistar rats.
Collapse
Affiliation(s)
- Olivia Morris
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK.
| | - J Gregory
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - M Kadirvel
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Fiona Henderson
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - A Blykers
- In-Vivo Cellular and Molecular Imaging Lab, Vrije Universiteit Brussel, Belgium
| | - Adam McMahon
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Mark Taylor
- Division of Biomedical and Life Sciences, The University of Lancaster, UK
| | - David Allsop
- Division of Biomedical and Life Sciences, The University of Lancaster, UK
| | | | - J Grigg
- GE Healthcare, Life Sciences, Imaging R&D, The Grove Centre, Amersham, Bucks, UK
| | - Herve Boutin
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| | - Christian Prenant
- Wolfson Molecular Imaging Centre, CRUK/EPSRC Imaging Centre of Cambridge & Manchester, The University of Manchester, UK
| |
Collapse
|
42
|
Nistor V, Cannell J, Gregory J, Yeghiazarian L. Stimuli-responsive cylindrical hydrogels mimic intestinal peristalsis to propel a solid object. Soft Matter 2016; 12:3582-3588. [PMID: 26971454 DOI: 10.1039/c5sm02553b] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The emerging field of soft robotics relies on soft, stimuli-responsive materials to enable load transport, manipulation, and mobility in complex unconstrained environments. These materials often need to replicate biological functionality such as muscle contractions and flexibility. Here we demonstrate a soft actuator prototype based on thermosensitive PNIPAAM hydrogels that can transport and manipulate objects. A hollow cylindrical hydrogel was selectively heated and cooled with Peltier devices to yield a traveling wave of shrinking and swelling akin to intestinal peristalsis. A 4 mm diameter bead was placed inside the cylinder and propelled 19.5 mm, equal to distance traveled by the peristaltic wave. We derived conditions that enable peristaltic transport as a function of transporter-cargo design parameters. We conclude that hydrogel-based peristaltic manipulators covering 2 orders of magnitude in stiffness (1-10(2) kPa) could transport cargo spanning 4 orders of magnitude in size (μm-m).
Collapse
Affiliation(s)
- V Nistor
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - J Cannell
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - J Gregory
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| | - L Yeghiazarian
- Department of Biomedical Chemical and Environmental Engineering, University of Cincinnati, USA.
| |
Collapse
|
43
|
Nowicki SMJ, Payne T, Larour E, Seroussi H, Goelzer H, Lipscomb W, Gregory J, Abe-Ouchi A, Shepherd A. Ice Sheet Model Intercomparison Project (ISMIP6) contribution to CMIP6. Geosci Model Dev 2016. [PMID: 29697697 DOI: 10.5194/gmd-9-3461-2016] [Citation(s) in RCA: 441] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Reducing the uncertainty in the past, present and future contribution of ice sheets to sea-level change requires a coordinated effort between the climate and glaciology communities. The Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6) is the primary activity within the Coupled Model Intercomparison Project - phase 6 (CMIP6) focusing on the Greenland and Antarctic Ice Sheets. In this paper, we describe the framework for ISMIP6 and its relationship to other activities within CMIP6. The ISMIP6 experimental design relies on CMIP6 climate models and includes, for the first time within CMIP, coupled ice sheet - climate models as well as standalone ice sheet models. To facilitate analysis of the multi-model ensemble and to generate a set of standard climate inputs for standalone ice sheet models, ISMIP6 defines a protocol for all variables related to ice sheets. ISMIP6 will provide a basis for investigating the feedbacks, impacts, and sea-level changes associated with dynamic ice sheets and for quantifying the uncertainty in ice-sheet-sourced global sea-level change.
Collapse
Affiliation(s)
| | - Tony Payne
- School of Geographical Sciences, University of Bristol, Bristol, BS8 1SS, UK
| | - Eric Larour
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Helene Seroussi
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Heiko Goelzer
- Institute for Marine and Atmospheric Research, Utrecht University, Utrecht, 3584 CC, NL
- Laboratoire de Glaciologie, Université Libre de Bruxelles, CP160/03, Av. F. Roosevelt 50, 1050 Brussels, BE
| | | | - Jonathan Gregory
- Department of Meteorology, University of Reading, Reading, RG6 6BB, UK
- Met Office Hadley Center, Exeter, EX1 3BP, UK
| | - Ayako Abe-Ouchi
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa-shi, Chiba 277-8564, JP
- Japan Agency for Marine-Earth Science and Technology, Yokohama, JP
| | - Andrew Shepherd
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
44
|
Nowicki SM, Payne T, Larour E, Seroussi H, Goelzer H, Lipscomb W, Gregory J, Abe-Ouchi A, Shepherd A. Ice Sheet Model Intercomparison Project (ISMIP6) contribution to CMIP6. Geosci Model Dev 2016; 9:4521-4545. [PMID: 29697697 PMCID: PMC5911933 DOI: 10.5194/gmd-9-4521-2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Reducing the uncertainty in the past, present and future contribution of ice sheets to sea-level change requires a coordinated effort between the climate and glaciology communities. The Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6) is the primary activity within the Coupled Model Intercomparison Project - phase 6 (CMIP6) focusing on the Greenland and Antarctic Ice Sheets. In this paper, we describe the framework for ISMIP6 and its relationship to other activities within CMIP6. The ISMIP6 experimental design relies on CMIP6 climate models and includes, for the first time within CMIP, coupled ice sheet - climate models as well as standalone ice sheet models. To facilitate analysis of the multi-model ensemble and to generate a set of standard climate inputs for standalone ice sheet models, ISMIP6 defines a protocol for all variables related to ice sheets. ISMIP6 will provide a basis for investigating the feedbacks, impacts, and sea-level changes associated with dynamic ice sheets and for quantifying the uncertainty in ice-sheet-sourced global sea-level change.
Collapse
Affiliation(s)
| | - Tony Payne
- School of Geographical Sciences, University of Bristol, Bristol, BS8 1SS, UK
| | - Eric Larour
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Helene Seroussi
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - Heiko Goelzer
- Institute for Marine and Atmospheric Research, Utrecht University, Utrecht, 3584 CC, NL
- Laboratoire de Glaciologie, Université Libre de Bruxelles, CP160/03, Av. F. Roosevelt 50, 1050 Brussels, BE
| | | | - Jonathan Gregory
- Department of Meteorology, University of Reading, Reading, RG6 6BB, UK
- Met Office Hadley Center, Exeter, EX1 3BP, UK
| | - Ayako Abe-Ouchi
- Atmosphere and Ocean Research Institute, The University of Tokyo, Kashiwa-shi, Chiba 277-8564, JP
- Japan Agency for Marine-Earth Science and Technology, Yokohama, JP
| | - Andrew Shepherd
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
45
|
Gregory J, Larkin A, Nicholas M, Winder J, Borromeo M, MacGregor C. ESTABLISHING A RHYTHM: THE DEVELOPMENT OF AN INTER-PROFESSIONAL COMMUNICATION PRACTICE MODEL IN THE CARDIAC SERVICES INTENSIVE CARE [CSICU]. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
46
|
Trubiano JA, Lee JYH, Valcanis M, Gregory J, Sutton BA, Holmes NE. Non-O1, non-O139 Vibrio cholerae bacteraemia in an Australian population. Intern Med J 2015; 44:508-11. [PMID: 24816311 DOI: 10.1111/imj.12409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 09/12/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022]
Abstract
This retrospective case series identifies the largest cohort of non-O1, non-O139 Vibrio cholerae bacteraemia in an Australian population from 2000 to 2013. We examine the risk factors, epidemiology, clinical presentations and mortality of non-O1, non-O139 V. cholerae bacteraemia in Victoria and compare them with published cases in the literature. This case series highlights the pathogenic potential of non-O1, non-O139 V. cholerae and identifies possible associations with host (underlying chronic liver disease and malignancy) and environmental factors (contaminated water supply and raw seafood). Clinicians should be aware of the morbidity and mortality associated with invasive non-O1, non-O139 V. cholerae infections, particularly in immunocompromised patients.
Collapse
Affiliation(s)
- J A Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia; Communicable Disease Prevention and Control Section, Health Protection Branch, Victorian Government Department of Health, Melbourne, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
47
|
Whitehouse S, Stephenson J, Sinclair V, Gregory J, Tambe A, Verma R, Siddique I, Saeed M. A validation of the Oswestry Spinal Risk Index. Eur Spine J 2014; 25:247-251. [PMID: 25391625 DOI: 10.1007/s00586-014-3665-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to validate the Oswestry Spinal Risk Index (OSRI) in an external population. The OSRI predicts survival in patients with metastatic spinal cord compression (MSCC). METHODS We analysed the data of 100 patients undergoing surgical intervention for MSCC at a tertiary spinal unit and recorded the primary tumour pathology and Karnofsky performance status to calculate the OSRI. Logistic regression models and survival plots were applied to the data in accordance with the original paper. RESULTS Lower OSRI scores predicted longer survival. The OSRI score predicted survival accurately in 74% of cases (p = 0.004). CONCLUSIONS Our study has found that the OSRI is a significant predictor of survival at levels similar to those of the original authors and is a useful and simple tool in aiding complex decision making in patients presenting with MSCC.
Collapse
Affiliation(s)
- S Whitehouse
- ST7 Orthopaedics, North West Deanery, Manchester, UK.
| | - J Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - V Sinclair
- ST7 Orthopaedics, North West Deanery, Manchester, UK
| | - J Gregory
- University of Manchester, Manchester, UK
| | - A Tambe
- Salford Royal Foundation Trust, Salford, UK
| | - R Verma
- Salford Royal Foundation Trust, Salford, UK
| | | | | |
Collapse
|
48
|
Gregory J, Vernon C, Onwudike F, Ainsworth G, Patel E, Barnes S, Ross E, Feilding E. 3 * THE BOLTON PAIN ASSESSMENT TOOL: DEVISING AND IMPLEMENTING A PAIN ASSESSMENT TOOL FOR PATIENTS UNABLE TO COMMUNICATE. Age Ageing 2014. [DOI: 10.1093/ageing/afu124.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Poonai N, Gregory J, Thompson G, Lim R, Van Osch S, Andrusiak T, Mekhaiel S, Sangha G, Seabrook J, Joubert G. Is Pelvic Ultrasound Associated with an Increased Time to Appendectomy in Pediatric Appendicitis? J Emerg Med 2014; 47:51-8. [PMID: 24680102 DOI: 10.1016/j.jemermed.2013.11.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/09/2013] [Accepted: 11/17/2013] [Indexed: 01/05/2023]
|
50
|
Garcia LAD, Brito ELR, Serpa P, Gregory J, Natalini C, Mattos RC, Jobim MIM. Horse Seminal Plasma proteins (HSP-1 and HSP-2) concentration: a possible marker for poor fertility? PFERDEHEILKUNDE 2014. [DOI: 10.21836/pem20140506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|