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Diana G, Donnelly R, Steele P, McCaul J, McMahon J, Subramaniam S. Incidence of cerebrovascular accident following head and neck free tissue transfer surgery. Int J Oral Maxillofac Surg 2023; 52:328-333. [PMID: 35791995 DOI: 10.1016/j.ijom.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
The aim of this study was to determine the incidence of postoperative cerebrovascular accident (CVA) following head and neck free tissue transfer and to identify predictive risk factors. A retrospective audit was performed of patients who underwent head and neck reconstructive surgery at Queen Elizabeth University Hospital between 2009 and 2020. The patient records were analysed to identify those who developed CVA within 30 days after surgery. A total of 1109 patients underwent head and neck free tissue transfer surgery, including 1048 neck dissection procedures. Of these, 78.6% had one or more identified risk factors for perioperative stroke. Five patients (0.45%) developed postoperative CVA. The results showed that CVA correlated to patients with hypercholesterolemia (P = 0.007). This study demonstrates the safety of free tissue transfer. Despite underlying co-morbidities and risk factors, the incidence of CVA is low following surgery and manipulation of the major vasculature of the neck.
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Affiliation(s)
- G Diana
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK.
| | - R Donnelly
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - P Steele
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - J McCaul
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - J McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - S Subramaniam
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital, Glasgow, UK
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Mario Capanni P, Mario Capanni P, Tengku S, Steele P, Craven H, Neytchev O, McMahon J, Shiels P, Anthony McCaul J. 48. Evaluation of microbiotal changes in head and neck cancer. Br J Oral Maxillofac Surg 2022. [DOI: 10.1016/j.bjoms.2022.11.122] [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: 12/24/2022]
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Sutton E, Killian N, Perry B, Stas J, Opie J, Toepritz A, Ransley B, Toms J, Steele P. Coventry University telehealth coaching – A pilot. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.086] [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: 11/24/2022]
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Steele P, Cheng N, Phillips LJ, Bryce S, Alvarez-Jimenez M, Allott K. Cognitive strengths in first episode psychosis: a thematic analysis of clinicians' perspectives. BMC Psychiatry 2021; 21:612. [PMID: 34876068 PMCID: PMC8653580 DOI: 10.1186/s12888-021-03627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive deficits are associated with poor functional outcomes in individuals recovering from a first episode of psychosis (FEP). Existing treatments that target cognitive deficits in FEP may enhance cognitive function, but improvements to real-world functioning are less consistent. Furthermore, these treatments may not adequately address the personal recovery goals of young people attending FEP services. A novel cognitive strengths-based approach may overcome these shortcomings. METHODS This qualitative study used semi-structured interviews to explore clinicians' (N = 12) perspectives toward the potential development of a cognitive strengths-based assessment or treatment in FEP. The interviews were analysed using thematic analysis. RESULTS Five higher-order themes emerged: (1) pro-strengths attitude despite unfamiliarity and minimal use, (2) default to a cognitive deficit lens, (3) potential benefits of a cognitive strengths approach, (4) potential risks and barriers, and (5) considerations for successful implementation. While clinicians acknowledged their current deficit approach, they supported implementing a cognitive strengths assessment or treatment and highlighted their potential benefits for the personal recovery needs of young people with FEP. CONCLUSIONS These findings suggest that a deficit-focused approach to cognitive function amongst clinicians may be common practice in FEP services. Nevertheless, a cognitive strengths approach was viewed favourably by clinicians and may represent a novel method of supporting personal recovery. Thus, the design and implementation of a cognitive strengths approach may be worthwhile. Future exploration of other stakeholder perspectives, such as young people with FEP, is essential.
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Affiliation(s)
- Peter Steele
- grid.1008.90000 0001 2179 088XMelbourne School of Psychological Sciences, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Nicholas Cheng
- grid.488501.0Orygen, Parkville, Victoria Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lisa J. Phillips
- grid.1008.90000 0001 2179 088XMelbourne School of Psychological Sciences, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052 Australia
| | - Shayden Bryce
- grid.488501.0Orygen, Parkville, Victoria Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- grid.488501.0Orygen, Parkville, Victoria Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
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Steele P, McMahon J, Dickson K, Zubair F, Puglia F, McMahon G, Wales C, McCaul J, Ansell M, Hislop S, Thomson E, Subramaniam S. Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a UK oncology and reconstructive surgery service - benchmarking the data. Br J Oral Maxillofac Surg 2021; 59:1079-1084. [PMID: 34275677 DOI: 10.1016/j.bjoms.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022]
Abstract
The British Association of Oral and Maxillofacial Surgery is soon to implement the Quality Outcomes in Oral in Maxillofacial Surgery (QOMS) to provide a platform for quality management across the specialty in the UK. The initial oncology and reconstruction audits for QOMS involves data collection on specific procedures and metrics. The aim of this report is to determine their appropriateness using extant audit datasets in our institution that overlap substantially with the QOMS audits. Pre-existing datasets comprising information on patients treated for oral cavity SCC with curative intent were analysed. Data on surgical margins, lymphadenectomy lymph node yield, delay between surgery and adjuvant radiotherapy, duration of hospital stay, and complications including flap failures were analysed. All statistical analyses were performed with SPSS 25. Run charts describing longitudinal data were generated using SPC for Excel version 6. Twenty three patients (3.1%) of 701 resections had a positive surgical margin reported. Seventeen (4.3%) of patients had less than 18 LNs in the ND specimen analysed. Mean time to start date of adjuvant therapy was 62 days. Only 9% of patients commenced adjuvant therapy within 6 weeks. The median duration of stay was 18 days. In 1153 free flaps a failure rate of 4.3% was identified. A total of 1349 complications (CD I-V) were recorded in the 1111 patients undergoing major surgery with free flap reconstruction. The QOMS selected metrics for oncology and reconstruction are clinically relevant, readily measurable, and likely to be actionable by the surgical team.
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Affiliation(s)
- P Steele
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - K Dickson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - F Zubair
- University of Glasgow Medical School, Faculty of Life Sciences, United Kingdom.
| | - F Puglia
- BAOMS Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London, United Kingdom.
| | - G McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - C Wales
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McCaul
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - M Ansell
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Hislop
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - E Thomson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Subramaniam
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
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Muir H, Cowan K, Steele P, Downie JJ. Presentation and surgical management of a superficial temporal artery pseudoaneurysm: A case report. Int J Surg Case Rep 2021; 79:368-370. [PMID: 33516052 PMCID: PMC7847816 DOI: 10.1016/j.ijscr.2021.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/21/2022] Open
Abstract
Raise awareness of pseudoaneurysms as an uncommon but important differential diagnosis for masses in the head and neck region. Highlight the importance of excluding pseudoaneurysm prior to diagnosing a simple post traumatic haematoma. Discuss treatment strategies for superficial temporal artery pseudoaneurysms.
Introduction and Importance A Superficial Temporal Artery Pseudoaneurysm is an uncommon, but important, differential diagnosis for masses in the head and neck region. This work has been reported in line with SCARE 2020 criteria [1]. Case Presentation An 81-year-old male presented to the Oral and Maxillofacial Department with a facial swelling that had been present for a duration of three weeks. A provisional diagnosis of a haematoma was made and an ultrasound carried out to confirm diagnosis. Ultrasonography and CT Angiography confirmed a pseudoaneurysm arising from the left superficial temporal artery. Clinical Discussion Although this is a relatively uncommon diagnosis it is important to be aware of the key diagnostic tools used to identify a pseudoaneurysm. Specifically, their potential to exclude a pseudoaneurysm prior to diagnosing a simple post-traumatic haematoma. This is important as the treatment strategies for the two pathologies differ considerably. Useful learning points from this case include diagnostic aids such as the unique pulsatile nature of the mass and the role of ultrasonography and CT Angiography in confirming diagnosis and guiding surgical management. Conclusion Pseudoaneurysms are an important consideration as a differential diagnosis of masses in the head and neck region. This case report may impact upon management of future similar cases by highlighting significant aspects of their clinical diagnosis and surgical management, enabling early identification and appropriate management.
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Affiliation(s)
- Hannah Muir
- Forth Valley Royal Hospital, Larbert, FK5 4WR, United Kingdom.
| | - Kirsty Cowan
- Forth Valley Royal Hospital, Larbert, FK5 4WR, United Kingdom
| | - Peter Steele
- Forth Valley Royal Hospital, Larbert, FK5 4WR, United Kingdom
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McMahon J, Steele P, Kyzas P, Pollard C, Jampana R, MacIver C, Subramaniam S, Devine J, Wales C, McCaul J. Operative tactics in floor of mouth and tongue cancer resection - the importance of imaging and planning. Br J Oral Maxillofac Surg 2020; 59:5-15. [PMID: 33143945 DOI: 10.1016/j.bjoms.2020.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
Complete tumour resection (R0 margin) is an axiom of surgical oncology. Oral cancer ablation is challenging, due to anatomical, functional, and aesthetic considerations. R0 margin is strongly linked to better survival outcomes with great variation in the R0 % across units. This is commonly attributed to disease biology. Without disputing the importance of biological characteristics, we contend that image-based anatomical surgical planning has an important role to play in achieving complete resection. Here, we present our approach utilising cross-sectional imaging, anatomical characteristics and spatial awareness in planning resections for floor of mouth (FOM) and oral tongue cancers. We highlight the challenge of controlling the deep tumour margin lingual to mandible due to anterior vector constraints and emphasise the importance of resecting the genial muscles in a planned fashion and that any rim resection should be obliquely sagittal. In resecting lateral FOM tumours, assessing extension to the parapharyngeal fat is crucial; and mandibular rim resection at a sagittal plane below the mylohyoid line is often required. Assessing the proximity of the contralateral neurovascular pedicle, pre-epiglottic space and hyoid bone are crucial parameters to determine the extent of tongue tumour resection. Our cohort included 173 patients with FOM SCC and 299 patients with tongue SCC. Six patients (3.5%) from the FOM group and eight patients (3%) from the tongue group had involved (R1) margins following surgery. This was associated with local relapse (p<0.05). In conclusion, we demonstrate that image-based planning can aid achieving R0 resections and reduce disease relapse.
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Affiliation(s)
- J McMahon
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Steele
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Kyzas
- Dept of OMFS/H&N Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals Trust, BB2 3HH.
| | - C Pollard
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - R Jampana
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - C MacIver
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - S Subramaniam
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J Devine
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - C Wales
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J McCaul
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
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Allott K, Steele P, Boyer F, de Winter A, Bryce S, Alvarez-Jimenez M, Phillips L. Cognitive strengths-based assessment and intervention in first-episode psychosis: A complementary approach to addressing functional recovery? Clin Psychol Rev 2020; 79:101871. [DOI: 10.1016/j.cpr.2020.101871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
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Anderson J, Lavender M, Lau E, Celermajer D, Collins N, Dwyer N, Feenstra J, Horrigan M, Keating D, Keogh A, Kotlyar E, Ng B, Proudman S, Steele P, Thakkar V, Weintraub R, Whitford H, Williams T, Wrobel J, Strange G. Pharmacological Treatment of Pulmonary Arterial Hypertension in Australia: Current Trends and Challenges. Heart Lung Circ 2020; 29:1459-1468. [PMID: 32280014 DOI: 10.1016/j.hlc.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/25/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Combination drug therapy for pulmonary arterial hypertension (PAH) is the international standard of care for most patients, however in Australia there are barriers to drug access. This study evaluates current treatment of PAH patients in Australia and the consistency of therapy with international guidelines. METHODS Cross-sectional analysis of patients with Group 1 PAH enrolled in the Pulmonary Hypertension Society of Australia and New Zealand Registry (PHSANZ) at 31 December 2017. Drug treatment was classified as monotherapy or combination therapy and adequacy of treatment was determined by risk status assessment using the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0 risk calculator. Predictors of monotherapy were assessed using a generalised linear model with Poisson distribution and logarithmic link function. RESULTS 1,046 patients met the criteria for analysis. Treatment was classified as monotherapy in 536 (51%) and combination therapy in 510 (49%) cases. Based on REVEAL 2.0, 184 (34%) patients on monotherapy failed to meet low-risk criteria and should be considered inadequately treated. Independent predictors of monotherapy included age greater than 60 years (risk ratio [RR] 1.23, 95% confidence interval [CI] 1.09-1.38; p=0.001), prevalent enrolment in the registry (RR 1.21 [95%CI 1.08-1.36]; p=0.001) and comorbid systemic hypertension (RR 1.17 [95%CI 1.03-1.32]; p=0.014), while idiopathic/heritable/drug-induced PAH subtype (RR 0.85 [95%CI 0.76-0.96]; p=0.006), functional class IV (RR 0.50 [95%CI 0.29-0.86]; p=0.012), increased right ventricular systolic pressure (RR 0.99 [95%CI 0.99-1.00]; p<0.001) and increased pulmonary vascular resistance (RR 0.96 [95%CI 0.95-0.98]; p<0.001) were less likely to be associated with monotherapy. CONCLUSIONS Most Australian PAH patients are treated with monotherapy and a significant proportion remain at risk of poor outcomes. This is below the standard of care recommended by international guidelines and at risk patients should be escalated to combination therapy.
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Affiliation(s)
- James Anderson
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; Respiratory Department, Sunshine Coast University Hospital, Birtinya, Qld, Australia.
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Edmund Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - David Celermajer
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Nathan Dwyer
- Cardiology Department, Royal Hobart Hospital, Hobart, Tas, Australia
| | - John Feenstra
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Qld, Australia
| | | | - Dominic Keating
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Anne Keogh
- Heart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Eugene Kotlyar
- Heart and Lung Transplant Unit and Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | | | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter Steele
- Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vivek Thakkar
- Macquarie University, Department of Clinical Medicine, Macquarie Park, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Robert Weintraub
- Royal Children's Hospital, Melbourne, Vic, Australia; Murdoch Children's Research Institute, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Helen Whitford
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Trevor Williams
- Respiratory Department, Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; University of Notre Dame, Perth, WA, Australia
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10
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Khou V, Anderson JJ, Strange G, Corrigan C, Collins N, Celermajer DS, Dwyer N, Feenstra J, Horrigan M, Keating D, Kotlyar E, Lavender M, McWilliams TJ, Steele P, Weintraub R, Whitford H, Whyte K, Williams TJ, Wrobel JP, Keogh A, Lau EM. Diagnostic delay in pulmonary arterial hypertension: Insights from the Australian and New Zealand pulmonary hypertension registry. Respirology 2020; 25:863-871. [PMID: 31997504 DOI: 10.1111/resp.13768] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/09/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Early diagnosis of PAH is clinically challenging. Patterns of diagnostic delay in Australian and New Zealand PAH populations have not been explored in large-scale studies. We aimed to evaluate the magnitude, risk factors and survival impact of diagnostic delay in Australian and New Zealand PAH patients. METHODS A cohort study of PAH patients from the PHSANZ Registry diagnosed from 2004 to 2017 was performed. Diagnostic interval was the time from symptom onset to diagnostic right heart catheterization as recorded in the registry. Factors associated with diagnostic delay were analysed in a multivariate logistic regression model. Survival rates were compared across patients based on the time to diagnosis using Kaplan-Meier method and Cox regression. RESULTS A total of 2044 patients were included in analysis. At diagnosis, median age was 58 years (IQR: 43-69), female-to-male ratio was 2.8:1 and majority of patients were in NYHA FC III-IV (82%). Median diagnostic interval was 1.2 years (IQR: 0.6-2.7). Age, CHD-PAH, obstructive sleep apnoea and peripheral vascular disease were independently associated with diagnostic interval of ≥1 year. No improvement in diagnostic interval was seen during the study period. Longer diagnostic interval was associated with decreased 5-year survival. CONCLUSION PAH patients experience significant diagnostic interval, which has not improved despite increased community awareness. Age, cardiovascular and respiratory comorbidities are significantly associated with longer time to diagnosis. Mortality rates appear higher in patients who experience longer diagnostic interval.
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Affiliation(s)
- Victor Khou
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - James J Anderson
- Respiratory Department, Sunshine Coast University Hospital, Sunshine Coast Region, QLD, Australia
| | - Geoff Strange
- School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Carolyn Corrigan
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nicholas Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nathan Dwyer
- Cardiology Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - John Feenstra
- Department of Thoracic Medicine, Prince Charles Hospital, Brisbane, QLD, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
| | - Dominic Keating
- Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department Allergy Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Eugene Kotlyar
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Tanya J McWilliams
- Greenlane Respiratory Services, Auckland City Hospital, Auckland, New Zealand
| | - Peter Steele
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert Weintraub
- Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Helen Whitford
- Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department Allergy Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Ken Whyte
- Greenlane Respiratory Services, Auckland City Hospital, Auckland, New Zealand
| | - Trevor J Williams
- Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department Allergy Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Jeremy P Wrobel
- School of Medicine, University of Notre Dame, Perth, WA, Australia.,Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Anne Keogh
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Edmund M Lau
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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11
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Anderson JJ, Lau EM, Lavender M, Benza R, Celermajer DS, Collins N, Corrigan C, Dwyer N, Feenstra J, Horrigan M, Keating D, Kermeen F, Kotlyar E, McWilliams T, Rhodes B, Steele P, Thakkar V, Williams T, Whitford H, Whyte K, Weintraub R, Wrobel JP, Keogh A, Strange G. Retrospective Validation of the REVEAL 2.0 Risk Score With the Australian and New Zealand Pulmonary Hypertension Registry Cohort. Chest 2019; 157:162-172. [PMID: 31563497 DOI: 10.1016/j.chest.2019.08.2203] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/13/2019] [Accepted: 08/31/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) prognosis has improved with targeted therapies; however, the long-term outlook remains poor. Objective multiparametric risk assessment is recommended to identify patients at risk of early morbidity and mortality, and for optimization of treatment. The US Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0 risk score is a new model proposed for the follow-up of patients with PAH but has not been externally validated. METHODS The REVEAL 2.0 risk score was applied to a mixed prevalent and incident cohort of patients with PAH (n = 1,011) from the Pulmonary Hypertension Society of Australia and New Zealand (PHSANZ) Registry. Kaplan-Meier survival was estimated for each REVEAL 2.0 risk score strata and for a simplified three-category (low, intermediate, and high risk) model. Sensitivity analysis was performed on an incident-only cohort. RESULTS The REVEAL 2.0 model effectively discriminated risk in the large external PHSANZ Registry cohort, with a C statistic of 0.74 (both for full eight-tier and three-category models). When applied to incident cases only, the C statistic was 0.73. The three-category REVEAL 2.0 model demonstrated robust separation of 12- and 60-month survival estimates (all risk category comparisons P < .001). Although the full eight-tier REVEAL 2.0 model separated patients at low, intermediate, and high risk, survival estimates overlapped within some of the intermediate- and high-risk strata. CONCLUSIONS The REVEAL 2.0 risk score was validated in a large external cohort from the PHSANZ Registry. The REVEAL 2.0 model can be applied for risk assessment of patients with PAH at follow-up. The simplified three-category model may be preferred for clinical use and for future comparison with other prognostic models.
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Affiliation(s)
- James J Anderson
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; Respiratory Department, Sunshine Coast University Hospital, Birtinya, QLD, Australia.
| | - Edmund M Lau
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Melanie Lavender
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | | | - David S Celermajer
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Carolyn Corrigan
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nathan Dwyer
- Cardiology Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - John Feenstra
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | | | - Dominic Keating
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Fiona Kermeen
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Eugene Kotlyar
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Tanya McWilliams
- Greenlane Respiratory Services, Auckland City Hospital, Auckland, New Zealand
| | - Bronwen Rhodes
- Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Peter Steele
- Department of Cardiovascular Services, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vivek Thakkar
- Department of Clinical Medicine, Macquarie University, Macquarie Park, NSW, Australia; Department of Rheumatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Trevor Williams
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Helen Whitford
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Kenneth Whyte
- Greenlane Respiratory Services, Auckland City Hospital, Auckland, New Zealand; NZ Respiratory and Sleep Institute, Auckland, New Zealand
| | - Robert Weintraub
- Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - Anne Keogh
- Heart and Lung Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Geoff Strange
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
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Baumann A, Marathe J, Roberts-Thomson R, Steele P, Teo K. THE ‘BENIGN' PERICARDIAL EFFUSION: NOT ALWAYS WHAT IT SEEMS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Raman KS, Stokes M, Shah R, Walls A, Steele P, Burdeniuk C, De Pasquale C, Celermajer D, Selvanayagam J. Feasibility of Oxygen Sensitive Cardiac Magnetic Resonance in Demonstrating Right Ventricular Myocardial Ischaemia in Patients with Pulmonary Arterial Hypertension. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.270] [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]
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14
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Ratwatte S, Strange G, Corrigan C, Kotlyar E, Kermeen F, Williams T, Celermajer D, Dwyer N, Whitford H, Wrobel J, Feenstra J, Lavendar M, Whyte K, Collins N, Steele P, Proudman S, Thakkar V, Keating D, Keogh A, Lau E. Early Treatment of Pulmonary Arterial Hypertension: Is a PVR > 3 Threshold too High? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.084] [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: 11/25/2022]
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15
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Shanley J, Steele P, Sellars J, Knowles N, Williams N, Wyres M. Responding to a changing population: the need to develop a culturally competent workforce. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.277] [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]
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Strange G, Lau EM, Giannoulatou E, Corrigan C, Kotlyar E, Kermeen F, Williams T, Celermajer DS, Dwyer N, Whitford H, Wrobel JP, Feenstra J, Lavender M, Whyte K, Collins N, Steele P, Proudman S, Thakkar V, Keating D, Keogh A. Survival of Idiopathic Pulmonary Arterial Hypertension Patients in the Modern Era in Australia and New Zealand. Heart Lung Circ 2018; 27:1368-1375. [DOI: 10.1016/j.hlc.2017.08.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
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17
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Steele P, Holland I. Can we rely on emergency department radiographic reports alone to identify maxillofacial trauma patients requiring operative intervention? The Glasgow Experience. Br J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.bjoms.2017.08.167] [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: 11/24/2022]
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18
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Chung K, Strange G, Scalia G, Codde J, Celermajer D, Marwick T, Prior D, Keogh A, Steele P, Ilton M, Stewart S, Gabbay E, Playford D. The National Echo Database Australia (NEDA) and Pulmonary Hypertension (PHT). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.290] [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: 10/21/2022]
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19
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Wong G, Nelson A, Roberts-Thomson R, Parvar S, Scherer D, Pisaniello A, Shirazi M, Roberts-Thomson K, Worthley M, Yeend R, Steele P. Percutaneous Pericardiocentesis: A Contemporary Tertiary Hospital Experience. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strange G, Playford D, Scalia G, Stewart S, Marwick T, Keogh A, Prior D, Steele P, Ilton M, Gabbay E, Codde J, Sheehan B, Celermajer D. Disparity Between Severe Aortic Stenosis Prevalence and Aortic Valve Replacement Using the National Echo Database of Australia (NEDA). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.530] [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: 11/25/2022]
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21
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Bujtár P, Steele P, Holland I, Halsnad M. Buttress guide: direct positioning splint to align a complex fracture of the zygoma. Br J Oral Maxillofac Surg 2016; 55:97-99. [PMID: 27443807 DOI: 10.1016/j.bjoms.2016.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Affiliation(s)
- P Bujtár
- Great Ormond Street Hospital for Children, Department of Plastic Surgery, WC1N 3JH London, UK.
| | - P Steele
- Southern General Hospital, Department of Oral and Maxillofacial Surgery, Glasgow, UK
| | - I Holland
- Southern General Hospital, Department of Oral and Maxillofacial Surgery, Glasgow, UK
| | - M Halsnad
- Southern General Hospital, Department of Oral and Maxillofacial Surgery, Glasgow, UK
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Boucek RJ, Steele J, Jacobs JP, Steele P, Asante-Korang A, Quintessenza J, Steele A. Ex vivo paracrine properties of cardiac tissue: Effects of chronic heart failure. J Heart Lung Transplant 2015; 34:839-48. [DOI: 10.1016/j.healun.2014.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/11/2014] [Accepted: 07/10/2014] [Indexed: 12/15/2022] Open
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Baillie T, Teo K, Sidharta S, Worthley S, Sanders P, Steele P, Nicholls S, Worthley M. A novel non-invasive pulmonary vasoreactive challenge utilising cardiac magnetic resonance imaging: comparison of subjects with and without pulmonary arterial hypertension. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Steele P, Curran J, Sturrock H, Mountain R. Improved retraction for tracheostomy using elasticated retractors: Comparing surgical exposure in cadaveric models. Int J Surg 2013. [DOI: 10.1016/j.ijsu.2013.06.277] [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]
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Steele A, Uckan D, Chamizo W, Ferre P, Thomas B, Edwards T, Steele P, Koutsonikolis A, Good RA. An Optimized Immunohistochemical Protocol for Both Manual and Automated Staining of Formalin Fixed, Paraffin Embedded Human Placenta for Demonstration and Analyses of FAS, FAS-L, and Bcl-2. J Histotechnol 2013. [DOI: 10.1179/his.1998.21.4.285] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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27
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Chianini F, Sisó S, Ricci E, Eaton SL, Finlayson J, Pang Y, Hamilton S, Steele P, Reid HW, Cantile C, Sales J, Jeffrey M, Dagleish MP, González L. Pathogenesis of scrapie in ARQ/ARQ sheep after subcutaneous infection: effect of lymphadenectomy and immune cell subset changes in relation to prion protein accumulation. Vet Immunol Immunopathol 2013; 152:348-58. [PMID: 23398720 DOI: 10.1016/j.vetimm.2013.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
It is well established that the infectious agent of scrapie can replicate in the lymphoreticular system (LRS). However, the effects of removal of LRS target tissues on the pathogenesis of the infection and the accumulation of disease-associated prion protein (PrP(d)) in LRS tissues on specific immune cell subsets are poorly understood aspects. To address these questions 16 ARQ/ARQ sheep were subcutaneously inoculated in the drainage area of the prefemoral lymph node with brain homogenate derived from Suffolk sheep naturally infected with scrapie. Fourteen sheep were then subjected to either early (14-17 days post-inoculation [dpi]) or late (175-201 dpi) lymphadenectomy and culled at preclinical or clinical stages of infection. Neither late nor even early lymphadenectomy prevented infection or had any effect on the accumulation of PrP(d) in the LRS or CNS suggesting a rapid organic dissemination of the infectious agent after inoculation. Lymph nodes from eight scrapie inoculated sheep selected on the basis of the amount of PrP(d) in their LRS tissues (negative, low or high) were examined for six different immune cell markers. The PrP(d) negative lymph nodes from two sheep with no evidence of scrapie infection showed lower numbers of cluster of determination (CD) 21 positive cells than PrP(d) positive nodes, irrespective of their location (hind leg or head). However, quantitative differences in the expression of this marker were not detected when comparing lymph nodes with low and high levels of PrP(d) accumulation, suggesting that proliferation of CD21 positive cells is related to scrapie infection, but not directly linked to the magnitude of PrP(d) accumulation. An additional observation of the study was that sheep that were methionin-threonine at codon 112 of the prion protein gene showed lower attack rates than methionine homozygotes (67% and 100%, respectively) and also generally lower levels of PrP(d) accumulation in the LRS and brain and increased survival times, suggesting an influence of such polymorphism in the susceptibility to scrapie.
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Affiliation(s)
- F Chianini
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland, UK.
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Shakeel M, Steele P, Kamel M, Hussain A. Temporal bone fibrous dysplasia: presentation, resection, and reconstruction. J Otolaryngol Head Neck Surg 2012; 41:E58-E61. [PMID: 23700593] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Muhammad Shakeel
- Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen AB25 2ZN, Scotland, UK.
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Hathorn I, Steele P, Aldridge L, Montague ML. Adult and paediatric tonsillectomy: a two cycle audit of Scottish Intercollegiate Guidelines Network 117 in a total of one hundred and sixty nine patients. Clin Otolaryngol 2012; 38:81-5. [PMID: 23140421 DOI: 10.1111/coa.12049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
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30
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Keogh A, Strange G, Kotlyar E, Williams T, Kilpatrick D, Macdonald P, Brown K, Pidoux A, Kermeen F, Steele P, Dalton B, Gabbay E. Survival after the initiation of combination therapy in patients with pulmonary arterial hypertension: an Australian collaborative report. Intern Med J 2012; 41:235-44. [PMID: 21118410 DOI: 10.1111/j.1445-5994.2010.02403.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several cellular pathways are implicated in the pathogenesis of pulmonary arterial hypertension (PAH) and attempts to arrest disease progression with a single drug would not be expected to succeed in the medium term. In clinical practice, combination therapy is often used in patients deteriorating on monotherapy, despite the absence of firm evidence from randomized controlled controls. METHODS From January 2005 to August 2009, 112 patients with World Health Organisation Functional Class (FC) II-IV PAH deteriorating on monotherapy received non-parenteral combination therapy at six Australian PAH expert hospitals. Combination therapy included bosentan, sitaxentan, ambrisentan, iloprost and sildenafil. Data were prospectively collected for survival status, 6-min walk distance, FC and echocardiographic parameters at the start of monotherapy through to commencement of combination therapy and at 6-monthly intervals thereafter. RESULTS After varying periods of monotherapy (18.7±13.4onths), survival estimates on combination therapy were 88%, 71% and 61% for the additional 1, 2 and 3years respectively. Survival on dual therapy in patients with idiopathic PAH/familial PAH was 93% at 1year and 79% at 2years, and for scleroderma-related PAH, 72% at 1 year and 48% at year 2 after initiation of combination therapy. In survivors, dual therapy reversed the deterioration in FC, from 3.1±0.6 on monotherapy to 2.2±0.6 at 12months. Similarly, dual therapy improved 6-min walk distance from 316±119m to 406±129m at 12months, and sequential echocardiography demonstrated a fall in pulmonary artery systolic pressure and improved right ventricular function. CONCLUSIONS Dual non-parenteral therapy appears safe and effective and should be considered for PAH patients who are deteriorating on monotherapy to improve long-term outcomes.
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Affiliation(s)
- A Keogh
- St Vincent’s Hospital, Xavier 4, Victoria St, Darlinghurst, NSW 2010, Australia.
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Vickery B, Steele P, Kamilaris J, Edie A, Kulis M, Burks A. Early Intervention with Oral Immunotherapy is a Promising Strategy for the Treatment of Peanut Allergy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.763] [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: 11/26/2022]
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32
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Henson M, Edie A, Steele P, Kamilaris J, Kulis M, Thyagarajan A, Vickery B, Burks A. Peanut Oral Immunotherapy and Omalizumab Treatment for Peanut Allergy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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33
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Burks A, Vickery B, Scurlock A, Steele P, Kamilaris J, Hiegel A, Carlisle S, Perry T, Jones S. Development of Clinical Tolerance after Peanut OIT. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.740] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Karlsson T, Shakeel M, Steele P, Ah-See KW, Hussain A, Hurman D. Management of laryngeal cancers: Grampian experience. Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.190] [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: 11/24/2022]
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35
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Hathorn I, Steele P, MacDougall G. Waiting list targets and their impact on training. Clin Otolaryngol 2011; 36:520. [DOI: 10.1111/j.1749-4486.2011.02380.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Lum LG, Rathore R, Al-Kadhimi Z, Davol P, Thakur A, Pray C, Liu Q, Tomaszewski E, Cummings F, Steele P, Wedge J, Kouttab N, Maizel A, Colaiace W, Joyrich R, Ratanatharathorn V, Uberti JP. T-cells targeted with anti-CD3 x anti-HER2 bispecific antibody for treatment of women with stage IV breast cancer (phase I): Clinical and immune function results. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2548] [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: 11/20/2022] Open
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37
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Al-Kadhimi ZS, Thakur A, Tomaszewski E, Abidi MH, Zonder JA, Ratanatharathorn V, Ayash LJ, Deol A, Steele P, Myers K, Uberti JP, Lum LG. Phase I trial: Pretransplant targeting of multiple myeloma stem cell (MMSC) with armed activated T cells (aATC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18570] [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: 11/20/2022] Open
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38
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Ballingall K, Nath M, Holliman A, Laming E, Steele P, Willoughby K. Lack of evidence for an association between MHC diversity and the development of bovine neonatal pancytopenia in Holstein dairy cattle. Vet Immunol Immunopathol 2011; 141:128-32. [DOI: 10.1016/j.vetimm.2011.01.017] [Citation(s) in RCA: 7] [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: 12/02/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
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Steele P, Starritt N, Evans A. Soft tissue damage attributed to the use of tongue depressors as an improvised device to apply pressure to treat epistaxis. Clin Otolaryngol 2011; 36:93. [DOI: 10.1111/j.1749-4486.2010.02237.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Chin S, Kim E, Bird J, Kulis M, Laubach S, Pons L, Shreffler W, Steele P, Kamilaris J, Vickery B. Basophil Suppression in Peanut Allergic Patients Undergoing Sublingual Immunotherapy (SLIT). J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.123] [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]
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Vickery B, Scurlock A, Steele P, Kamilaris J, Hiegel A, Carlisle S, Perry T, Jones S, Burks A. Early and Persistent Gastrointestinal Side Effects Predict Withdrawal from Peanut Oral Immunotherapy (OIT). J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bousquet P, Yver C, Pison I, Li YS, Fortems A, Hauglustaine D, Szopa S, Rayner PJ, Novelli P, Langenfelds R, Steele P, Ramonet M, Schmidt M, Foster P, Morfopoulos C, Ciais P. A three-dimensional synthesis inversion of the molecular hydrogen cycle: Sources and sinks budget and implications for the soil uptake. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2010jd014599] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Steele P, Strange G, Wlodarczyk J, Dalton B, Stewart S, Gabbay E, Keogh A. Hemodynamics in pulmonary arterial hypertension (PAH): do they explain long-term clinical outcomes with PAH-specific therapy? BMC Cardiovasc Disord 2010; 10:9. [PMID: 20170553 PMCID: PMC2841582 DOI: 10.1186/1471-2261-10-9] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 02/22/2010] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) has witnessed dramatic treatment advances over the past decade. However, with the exception of epoprostenol, data from short-term randomized controlled trials (RCTs) have not shown a benefit of these drugs on survival. There remains a need to differentiate between available therapies and current endpoint responses which in turn, could be used to guide treatment selection and provide long-term prognostic information for patients. Methods We performed a systematic literature search of MEDLINE and EMBASE databases for RCTs of PAH-specific therapy published between January 1980 and May 2009. Articles were selected if they contained a placebo comparator and described hemodynamic changes from baseline. We applied the weighted mean change in hemodynamic variables to the equation developed by the National Institutes of Health (NIH) Registry to estimate long-term survival with each therapy. Results Ten RCTs involving 1,635 patients met the inclusion criteria. Suitable hemodynamic data were identified for bosentan, sitaxentan, sildenafil, epoprostenol, beraprost and treprostinil. 77.6% of patients were female and the mean (SD) age was 46.5 ± 4.9 years. 55.5% of patients had idiopathic PAH (iPAH), 23.9% PAH related to connective tissue disease, and 18.2% PAH related to congenital heart disease. Based on the effects observed in short-term trials and, relative to placebo, all analyzed therapies improved survival. The estimated 1-year survival was 78.4%, 77.8%, 76.1%, 75.8%, 75.2%, and 74.1% for epoprostenol, bosentan, treprostinil, sitaxentan, sildenafil, and beraprost, respectively. These estimates are considerably lower than the 1-year observed survival reported in several open-label and registry studies with PAH-specific therapies: 88% - 97%. Conclusion When applied to the NIH Registry equation, hemodynamic changes from baseline appear to underestimate the survival benefits observed with long-term PAH therapy.
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Affiliation(s)
- Peter Steele
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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Lu W, Seeholzer SH, Han M, Arnold AS, Serrano M, Garita B, Philp NJ, Farthing C, Steele P, Chen J, Linask KK. Cellular nonmuscle myosins NMHC-IIA and NMHC-IIB and vertebrate heart looping. Dev Dyn 2009; 237:3577-90. [PMID: 18697221 DOI: 10.1002/dvdy.21645] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Flectin, a protein previously described to be expressed in a left-dominant manner in the embryonic chick heart during looping, is a member of the nonmuscle myosin II (NMHC-II) protein class. During looping, both NMHC-IIA and NMHC-IIB are expressed in the mouse heart on embryonic day 9.5. The patterns of localization of NMHC-IIB, rather than NMHC-IIA in the mouse looping heart and in neural crest cells, are equivalent to what we reported previously for flectin. Expression of full-length human NMHC-IIA and -IIB in 10 T1/2 cells demonstrated that flectin antibody recognizes both isoforms. Electron microscopy revealed that flectin antibody localizes in short cardiomyocyte cell processes extending from the basal layer of the cardiomyocytes into the cardiac jelly. Flectin antibody also recognizes stress fibrils in the cardiac jelly in the mouse and chick heart; while NMHC-IIB antibody does not. Abnormally looping hearts of the Nodal(Delta 600) homozygous mouse embryos show decreased NMHC-IIB expression on both the mRNA and protein levels. These results document the characterization of flectin and extend the importance of NMHC-II and the cytoskeletal actomyosin complex to the mammalian heart and cardiac looping.
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Affiliation(s)
- Wenge Lu
- Department of Pediatrics, USF/ACH-Children's Research Institute, St. Petersburg, Florida 33701, USA
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Jones S, Scurlock A, Pons L, Kulis M, Perry T, Steele P, Kamilaris J, Henry K, Burks A. Double-Blind, Placebo-Controlled (DBPC) Trial of Oral Immunotherapy (OIT) in Peanut Allergic Children. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Narisety S, Skripak J, Steele P, Hamilton R, Matsui E, Burks A, Wood R. Open Label Maintenance Following Milk Oral Immunotherapy (MOIT) for IgE Mediated Cow's Milk Allergy. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.657] [Citation(s) in RCA: 2] [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: 11/30/2022]
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Huang J, Golombek A, Prinn R, Weiss R, Fraser P, Simmonds P, Dlugokencky EJ, Hall B, Elkins J, Steele P, Langenfelds R, Krummel P, Dutton G, Porter L. Estimation of regional emissions of nitrous oxide from 1997 to 2005 using multinetwork measurements, a chemical transport model, and an inverse method. ACTA ACUST UNITED AC 2008. [DOI: 10.1029/2007jd009381] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sisó S, Jeffrey M, Steele P, McGovern G, Martin S, Finlayson J, Chianini F, González L. Occurrence and cellular localization of PrPd in kidneys of scrapie-affected sheep in the absence of inflammation. J Pathol 2008; 215:126-34. [PMID: 18381605 DOI: 10.1002/path.2336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Following a preliminary description of disease-associated prion protein (PrPd) deposition in the kidneys of scrapie-affected sheep, detailed studies have been undertaken in order to evaluate the factors that could account for such PrPd accumulation and to determine the precise location of PrPd in the renal papillae. Immunohistochemical (IHC) examinations for PrPd were conducted in kidneys collected at post-mortem from 30 naturally and 37 experimentally infected sheep. In addition, PrPd detection by western blot analysis (WB) and ultrastructural examination was carried out in a selection of kidneys. PrPd-specific, multifocal IHC labelling with antibody R145 was achieved in the kidneys of 44% and 51% of the naturally and experimentally infected sheep, respectively. The specificity of these results was confirmed by further IHC and WB using several PrP antibodies raised to different amino acid sequences, and by examination of control tissues. PrPd was shown to accumulate in the interstitium of the renal papillae, in association with the cell membrane and lysosomes of fibroblast-like cells, or extracellularly, in close contact with collagen and basal membranes. These deposits were unrelated to inflammatory changes in the kidney as shown by routine histology and by IHC for different immune cell markers. PrPd accumulated in the kidney of sheep that showed widespread PrPd deposition in the lymphoreticular system and had long incubation periods; these findings argue for a haematogenous origin of renal PrPd, although the precise site and mechanism-glomerular filtration and reabsorption at Henle's loop, or extravasation from vasa recta capillaries, or both-by which PrPd leaves the blood to accumulate in the interstitium of renal papillae remain to be determined. Either of these pathogenetic mechanisms could lead to environmental contamination via urine.
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Affiliation(s)
- S Sisó
- Veterinary Laboratories Agency Lasswade, Pentlands Science Park, Bush Loan, Penicuik, Midlothian EH26 0PZ, UK.
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González L, Dagleish MP, Martin S, Dexter G, Steele P, Finlayson J, Jeffrey M. Diagnosis of preclinical scrapie in live sheep by the immunohistochemical examination of rectal biopsies. Vet Rec 2008; 162:397-403. [DOI: 10.1136/vr.162.13.397] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L. González
- Veterinary Laboratories Agency - Lasswade; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
| | - M. P. Dagleish
- Moredun Research Institute; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
| | - S. Martin
- Veterinary Laboratories Agency - Lasswade; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
| | - G. Dexter
- Veterinary Laboratories Agency - Weybridge; Addlestone Surrey KT15 3NB
| | - P. Steele
- Moredun Research Institute; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
| | - J. Finlayson
- Moredun Research Institute; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
| | - M. Jeffrey
- Veterinary Laboratories Agency - Lasswade; Pentlands Science Park, Bush Loan Midlothian EH26 0PZ
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