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Giucca A, Morrison H, Wilson T, Cossburn M. Anti-Yo paraneoplastic cerebellar degeneration in a patient with stage IV ovarian adenocarcinoma during bevacizumab maintenance therapy. BMJ Case Rep 2023; 16:16/5/e251277. [PMID: 37137547 PMCID: PMC10163414 DOI: 10.1136/bcr-2022-251277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Anti-Yo paraneoplastic cerebellar degeneration (PCD) is a rare autoimmune neurological syndrome characterised by cerebellar symptoms and frequently associated with gynaecological malignancies. While typically preceding the diagnosis of the malignancy, rarely it may present later in the disease course, heralding a recurrence prior to biochemical or radiological confirmation. Disease management is challenging and prognosis remains poor.We present the case of a woman with stage IV ovarian adenocarcinoma who developed anti-Yo PCD 16 months post malignancy diagnosis while receiving bevacizumab maintenance therapy. We review the literature and outline the difficulties in diagnosis and the frequently refractory nature of PCD to available treatments.
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Affiliation(s)
- Alice Giucca
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Hamish Morrison
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Thomas Wilson
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Mark Cossburn
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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Cleaver J, Morrison H, Renowden SA, Atan D, Cossburn M, Rice CM. An important diagnostic clue for neuro-Behçet's disease: the 'cascade sign'. Rheumatology (Oxford) 2021; 61:e130-e131. [PMID: 34341831 DOI: 10.1093/rheumatology/keab554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jonathan Cleaver
- Department of Neurology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hamish Morrison
- Department of Neurology, North Bristol NHS Trust, Bristol, United Kingdom.,Clinical Neuroscience, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shelley A Renowden
- Department of Neuroradiology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Denize Atan
- Clinical Neuroscience, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Neuro-ophthalmology, Bristol Eye Hospital, Bristol, United Kingdom
| | - Mark Cossburn
- Department of Neurology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Claire M Rice
- Department of Neurology, North Bristol NHS Trust, Bristol, United Kingdom.,Clinical Neuroscience, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Harris M, Cossburn M, Gregory R. Immunoablation and aHSCT for aggressive multiple sclerosis. Lancet 2017; 389:907-908. [PMID: 28271841 DOI: 10.1016/s0140-6736(17)30605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew Harris
- Department of Neurology, Poole Hospital NHS Foundation Trust, Poole BH15 2JB, UK.
| | - Mark Cossburn
- Department of Neurology, Poole Hospital NHS Foundation Trust, Poole BH15 2JB, UK
| | - Ralph Gregory
- Department of Neurology, Poole Hospital NHS Foundation Trust, Poole BH15 2JB, UK
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Willis M, Cossburn M, Ingram G, Pickersgill T, Barry S, Robertson N. HYPERSENSITIVITY PNEUMONITIS FOLLOWING ALEMTUZUMAB TREATMENT FOR MULTIPLE SCLEROSIS. J Neurol Neurosurg Psychiatry 2015. [DOI: 10.1136/jnnp-2015-312379.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Alemtuzumab has recently been licensed in several countries for relapsing multiple sclerosis. Despite its marked clinical efficacy it is associated with acquired autoimmune disease with a particular predilection for the thyroid gland. Despite the recognition and surveillance mechanisms that exist to monitor patients treated with alemtuzumab, vigilance must be maintained to monitor for less common immune-related disorders. We present two patients diagnosed with hypersensitivity pneumonitis following alemtuzumab therapy for multiple sclerosis. Both patients presented with a sub-acute pulmonary illness characterized by cough and breathlessness with interstitial pulmonary infiltrates subsequently demonstrated on chest x-ray and computed tomography of the thorax. Both patients responded well to oral prednisolone and in the case of one patient for whom serum avian precipitins had been strongly positive, removal of a pet parrot. There has been no recurrence of respiratory disease following treatment. Autoimmune disease post-alemtuzumab treatment tends to be due to an aberrant humoral immune response such as that seen in Grave's disease. However, these cases highlight that cell-mediated autoimmunity disorders may also occur and underline the importance of long term surveillance for immune complications in patients treated with this drug.
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Azzopardi L, Thompson SAJ, Harding KE, Cossburn M, Robertson N, Compston A, Coles AJ, Jones JL. Predicting autoimmunity after alemtuzumab treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:795-8. [PMID: 24368840 DOI: 10.1136/jnnp-2013-307042] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We have previously shown that autoimmunity following alemtuzumab treatment of multiple sclerosis can be predicted by high baseline serum interleukin IL-21 (IL-21), as measured using a now 'redundant' enzyme linked immunosorbent assay (ELISA). Here we ask whether currently available ELISAs have similar prognostic value. DESIGN Serum IL-21 from 141 individuals with relapsing remitting multiple sclerosis was measured using the now 'redundant' IL-21 ELISA and five further currently available kits. All patients had been treated with alemtuzumab; 61/141 had developed secondary autoimmunity. RESULTS The 'redundant kit', and one current kit, confirmed higher baseline serum IL-21 in patients with autoimmunity (542 pg/mL vs. 222 pg/mL and 53.1 pg/mL vs. 9.3 pg/mL respectively) and showed positive correlation. However, only the 'redundant' kit had predictive utility. CONCLUSIONS Currently available IL-21 ELISA kits should not be used to counsel individuals with multiple sclerosis considering treatment with alemtuzumab.
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Affiliation(s)
- Laura Azzopardi
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sara A J Thompson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Katherine E Harding
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Mark Cossburn
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil Robertson
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Alastair Compston
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Phizacklea J, Koecher S, Kobialka K, Davis G, Cossburn M. STUDENT LED DEVELOPMENT AND EVALUATION OF UNDERGRADUATE NEUROLOGY VIRTUAL PATIENT E-LEARNING MODULES. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Luppe S, Harding KA, Cossburn M, Ingram G, Palace J, Kitley J, Leite MI, Jacob A, Robertson NP. NEUROMYELITIS OPTICA IN SOUTH WALES AND THE SOUTH WEST OF ENGLAND. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Harding K, Ingram G, Cossburn M, Hirst C, Pickersgill T, Ben-Shlomo Y, Robertson N. Genotype-phenotype correlation for non-HLA disease associated risk alleles in multiple sclerosis. Neurosci Lett 2012; 526:15-9. [PMID: 22732448 DOI: 10.1016/j.neulet.2012.06.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recent advances in MS genetics have led to the successful identification of a number of novel disease associated non-HLA genes. It is now becoming possible to begin to analyse the possible effects of these genes on aspects of disease phenotype where longitudinal clinical data is available. OBJECTIVE We examined phenotypic impact of 10 non-HLA disease associated single nucleotide polymorphisms (SNPs) in 1003 patients with MS followed for an average of 14.1 years. METHODS Association of SNPs with time to established disability milestones (Expanded Disability Status Scale (EDSS) 4.0, 6.0, 8.0), onset of secondary progression and cross-sectional aspects of early phenotype were tested using survival analysis. RESULTS No SNP was associated with systematic deflection in time to disability milestones, age at onset or time to secondary progression. CONCLUSIONS Genotypic information from non-HLA associated SNPs is unlikely to inform individual patient prognosis in the clinical setting although minor phenotypic effects operative at specific phases of disease cannot be excluded. This preliminary study provides a framework for future genotype-phenotype analysis in MS and will need to be replicated in independent patient cohorts.
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Affiliation(s)
- Katharine Harding
- Department of Psychological Medicine and Neurology, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
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Cossburn M, Moore P, Baker KE, Pickersgill TP, Robertson NP. 130 A pilot study of a timed short addition test as a tool for the longitudinal study of cognitive dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cossburn M, Robertson NP, Smith PEM. 025 What are exams for? The many uses formative assessment in neurology. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cossburn M, Baker KE, Ingram G, Pickersgill TP, Robertson NP. 129 Serum IL-21 as a biomarker in multiple sclerosis. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cossburn M, Tackley G, Baker K, Ingram G, Burtonwood M, Malik G, Pickersgill T, te Water Naudé J, Robertson N. The prevalence of neuromyelitis optica in South East Wales. Eur J Neurol 2011; 19:655-9. [PMID: 21967235 DOI: 10.1111/j.1468-1331.2011.03529.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyeltis optica (NMO) is a neuroinflammatory disorder considered rare in Caucasian populations. However, accurate population-based epidemiological data for NMO and NMO spectrum disorder (NMO-SD) from Western populations employing validated diagnostic criteria remain limited. We sought therefore to estimate the prevalence and clinical features of NMO in a north European Caucasian population in South East Wales. METHODS Patients were identified by a comprehensive, multistage ascertainment strategy employing a regional neuroinflammatory disease register, hospital diagnostic databases personal physician referrals and regional requests for anti-aquaporin-4 antibodies (anti-AQP4). RESULTS Fourteen Caucasian patients (11 patients with NMO and three with NMO-SD) were identified in a population of 712,572 (19.6/million; 95% CIs: 12.2-29.7). There was an excess of females (female:male 12:2), 11/14 were anti-AQP4 positive and 5/14 had disease onset under the age of 20 years. CONCLUSION This study suggests that NMO and related spectrum disorders are at least as frequent in Northern European populations as in non-Caucasian populations and that the demographic profile of prevalent patients differs from clinic-based cohorts.
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Affiliation(s)
- M Cossburn
- The Department of Psychological Medicine and Neurology, Cardiff University, Cardiff, UK
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Cossburn M. The Neurological Grand Round: room for updating? Pract Neurol 2011; 11:328; author reply 329. [DOI: 10.1136/practneurol-2011-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cossburn M, Ingram G, Hirst C, Ben-Shlomo Y, Pickersgill TP, Robertson NP. Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis. Mult Scler 2011; 18:45-54. [PMID: 21865412 DOI: 10.1177/1352458511417479] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age at onset modifies prognosis in multiple sclerosis (MS) and may also exert an effect on the characteristics of disease ignition. Understanding how age influences presentation informs disease management and may allow differentiation of distinct clinical sub-groups. OBJECTIVES To determine the nature of age-specific presentations of relapsing-remitting MS (RRMS) with respect to onset symptoms, gender ratios and index event outcomes. METHODS In a prospective, population-based sample of 1424 patients in South-East Wales we examined associations between age at onset, clinical features and outcome of the onset event, making specific comparisons between paediatric, adolescent and late-onset MS. RESULTS Age at onset varied significantly between sexes (Male 31.2, Female 29.3, p = 0.002), 0.7% had paediatric onset, 2.7% adolescent onset and 2.8% late-onset MS (>50 years). Optic neuritis was common in younger patients and declined after age 30. Lower limb motor, facial sensory, sexual and sphincteric symptoms rose with age independent of sex and disease course. F:M ratios were highest <16 years of age and declined with increasing age, with a male excess in those over 50. Probability of complete recovery from index event declined with age from 87.4% in the youngest group to 68% in the eldest (p = 0.009). CONCLUSIONS Age at disease onset in RRMS exerts a significant effect on gender ratios and presenting phenotype, and allows identification of specific clinical sub-groups. In addition, ability to recover from initial relapse declines with age, suggesting accumulation of disability in MS is an age-dependent response to relapse.
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Affiliation(s)
- M Cossburn
- Helen Durham Neuro-inflammatory Centre, Department of Neurology, University Hospital of Wales, Cardiff, UK
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Cossburn M, Pace AA, Jones J, Ali R, Ingram G, Baker K, Hirst C, Zajicek J, Scolding N, Boggild M, Pickersgill T, Ben-Shlomo Y, Coles A, Robertson NP. Autoimmune disease after alemtuzumab treatment for multiple sclerosis in a multicenter cohort. Neurology 2011; 77:573-9. [DOI: 10.1212/wnl.0b013e318228bec5] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baker K, Pickersgill T, Robertson N, Cossburn M, Ben-Shlomo Y, Tilling K, Hirst C, Ingram G. PATU9 Seasonal variation in multiple sclerosis relapse. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ingram G, Colley E, Ben-Shlomo Y, Cossburn M, Hirst CL, Pickersgill TP, Robertson NP. Validity of patient-derived disability and clinical data in multiple sclerosis. Mult Scler 2010; 16:472-9. [DOI: 10.1177/1352458509358902] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient-derived historical data are widely employed to make fundamental management decisions in multiple sclerosis, although the validity of the information provided is unclear. The objectives of this study were to determine validity of patient-derived historical data and to describe the utility of a locally relevant, patient-administered questionnaire designed to ascertain current disability and other important disease milestones. A well-described cohort of 99 patients was identified for whom comparable, detailed, prospective longitudinal clinician-derived data were available. Patient-derived data were collected by completion of a standardized questionnaire or telephone interview for comparison. Reliability analysis for current Expanded Disability Status Scale (EDSS) demonstrated an intraclass correlation coefficient of 0.79 between questionnaire and clinician-derived data in 79 patients, with complete agreement in 75.9%. Intraclass correlation coefficient for year of disease onset, diagnosis and onset of secondary progression was 0.86, 0.91 and 0.78, respectively. Time to EDSS >4.0, 6.0 and 8.0 all had an intraclass correlation coefficient of >0.9. Less robust agreement was observed for current disease course (Kappa coefficient 0.71), initial relapse rate (intraclass correlation coefficient 0.37) and clinical features at disease onset (Kappa 0.25). We conclude that self-reported questionnaires can provide reliable current and retrospective data on time-to-disability milestones with high levels of correlation observed for some additional elements, supporting the use of selected components of patient-derived data in clinical practice and for epidemiological studies.
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Affiliation(s)
- G. Ingram
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - E. Colley
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Y. Ben-Shlomo
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - M. Cossburn
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - CL Hirst
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - TP Pickersgill
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - NP Robertson
- Department of Neurology, University Hospital of Wales, Cardiff, UK,
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Abstract
Relative polycythaemia refers to raised haematocrit with normal red cell mass. Plasma volume may be reduced. This condition is associated with acute hypoxia, smoking, alcohol and diuretics. We describe two life-threatening thrombotic events in two patients with relative polycythaemia under age 40 years. The first had myocardial infarction and on admission haemoglobin was 21.6 g dL-1. The second developed pulmonary embolism and haemoglobin was 19.1 g dL-1. Both patients received antithrombotic measures and isovolumetric venesection. Sixteen patients (age <40 years) who attended our accident and emergency department in 1 year had a haemoglobin level of >18.0 g dL-1. Recognition of relative polycythaemia in at risk-individuals may help reduce thrombotic risk.
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Affiliation(s)
- M Biswas
- Department of Medicine, Prince Charles Hospital, South Glamorgan, UK
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