1
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Hintze J, Lang B, Subramaniam T, Kruseman N, O'Regan E, Brennan S, Lennon P. Factors influencing nodal yield in neck dissections for head and neck malignancies. J Laryngol Otol 2023; 137:925-929. [PMID: 36651334 DOI: 10.1017/s0022215122002687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A standard lateral neck dissection should yield at least 18 lymph nodes. The goal of the present study was to examine what factors might influence the number of lymph nodes retrieved during a neck dissection. METHODS This was a retrospective cohort study in a tertiary academic referral centre for head and neck oncology. Two hundred and nineteen consecutive neck dissections were examined. Age of the patient and primary site were recorded, along with tumour histology, previous radiotherapy and final nodal count. RESULTS The mean age was 62.2 ± 13.0 years. The most common primary site was the oral cavity (38.8 per cent). The mean number of lymph nodes was 30.63 ± 13.9. In total, 17.8 per cent had undergone previous radiotherapy. The mean number of lymph nodes was 33.26 ± 13.27 in patients with no previous radiation exposure and 18.47 ± 9.46 in those with previous radiation treatment. CONCLUSION Lymph node yield from a neck dissection is likely multi-factorial in nature. Previous radiotherapy, the only significant contributor, led to a mean reduction of lymph node yield from 33.3 to 18.5.
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Affiliation(s)
- J Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - T Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - N Kruseman
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - E O'Regan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - S Brennan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Radiation Oncology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
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2
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McInerney N, Nae A, Brennan S, Kennedy S, Mackle T. Pilomatricoma of the external auditory canal. Otolaryngology Case Reports 2023. [DOI: 10.1016/j.xocr.2023.100530] [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: 03/31/2023] Open
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3
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Fitzpatrick P, Bhardwaj N, Masalkhi M, Lyons A, Frazer K, McCann A, Syed S, Niranjan V, Kelleher CC, Brennan S, Kavanagh P, Fox P. Provision of smoking cessation support for patients following a diagnosis of cancer in Ireland. Prev Med Rep 2023; 32:102158. [PMID: 36875512 PMCID: PMC9982599 DOI: 10.1016/j.pmedr.2023.102158] [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: 11/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
There is growing evidence that smoking cessation (SC) improves outcomes following diagnosis of cancer. Notwithstanding adverse outcomes, a significant number of those diagnosed with cancer continue to smoke. Our objective was to document the SC services provided for patients with cancer by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. A cross-sectional survey based on recent national clinical guidelines was used to determine SC care delivery across eight adult cancer specialist hospitals, and one specialist radiotherapy centre. Qualtrics was used. The response rate was 88.9% with data reported from seven cancer hospitals and one specialist radiotherapy centre, all indicating they had some SC related provision (100%). Stop smoking medications were provided to cancer inpatients in two hospitals, at outpatients and attending day ward services in one hospital. Smokers with cancer were referred automatically to the SC service in two hospitals at diagnosis. While stop smoking medications were available 24 h a day in five hospitals, most did not stock all three (Nicotine Replacement Therapy, Bupropion, Varenicline). One hospital advised they had data on uptake of SC services for smokers with cancer but were unable to provide detail. There is considerable variation in SC information and services provided to cancer patients across adult cancer specialist centres in Ireland, reflecting the suboptimal practice of smoking cessation for patients with cancer found in the limited international audits. Such audits are essential to demonstrate service gaps and provide a baseline for service improvement.
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Affiliation(s)
- P Fitzpatrick
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - M Masalkhi
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland
| | - A Lyons
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - K Frazer
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - A McCann
- School of Medicine, University College Dublin, Belfield Dublin 4, Ireland.,UCD Conway Institute of Biomolecular and Biomedical Research and UCD School of Medicine, Ireland
| | - S Syed
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield Dublin 4, Ireland
| | - C C Kelleher
- Dept. of Preventive Medicine and Health Promotion, St Vincent's University Hospital, D04 T6F4, Elm Park Dublin 4, Ireland.,College of Health and Agricultural Science (CHAS), University College Dublin, Belfield Dublin 4, Ireland
| | - S Brennan
- St Luke's Hospital, Rathgar Dublin 6, Ireland
| | - P Kavanagh
- Health Service Executive Tobacco Free Ireland Programme, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, D01 W596, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
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4
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Fitzpatrick P, Bhardwaj N, Syed S, Fox P, Frazer K, Niranjan V, Lyons A, McCann A, Brennan S, Guerin S. Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions. Eur J Public Health 2022. [PMCID: PMC9594757 DOI: 10.1093/eurpub/ckac131.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.
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Affiliation(s)
- P Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - N Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - S Syed
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - K Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin , Dublin, Ireland
| | - V Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin , Dublin, Ireland
| | - A Lyons
- Department of Preventive Medicine and Health Promotion, St. Vincent’s University Hospital , Dublin, Ireland
| | - A McCann
- Biomolecular & Biomedical Research Institute, University College Dublin , Dublin, Ireland
| | - S Brennan
- Department of Radiation Oncology, St. Luke’s Radiation Oncology Network , Dublin, Ireland
| | - S Guerin
- School of Psychology, University College Dublin , Dublin, Ireland
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5
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Brennan S, Costigan O, McEvoy JW. Impact of antihypertensive medication regimens on blood pressure control in individuals with established coronary heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2326] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Hypertension is a major risk factor for coronary heart disease (CHD) development and progression, with pharmacological control of blood pressure reducing the risk of CHD events and death [1].
Treatment and control of blood pressure in CHD is suboptimal, with many patients failing to achieve guideline-directed targets [1,2]. This study aims to assess the relationship between antihypertensive medication regimens and blood pressure control in patients with hypertension and established coronary heart disease.
Methods
The iASPIRE study recently evaluated secondary prevention in an Irish cohort with coronary heart disease [2]. Based on a method used in a similar study [3], we calculated the average percentage daily dose of each prescribed antihypertensive agent. We then assessed the relationship between dose and number of antihypertensive agents with blood pressure control.
Results
540 (75.5%) of iASPIRE participants had an underlying diagnosis of hypertension, and at the study examination, 56% of these had a blood pressure ≥140/90 mmHg, while 83% had a blood pressure ≥130/80 mmHg. The median number of antihypertensive agents prescribed was 2 (IQR 1–2), with 88% of those with hypertension on at least one blood pressure medication. In participants with hypertension on treatment, the median percentage daily medication dose was 29% (IQR 14–50). After adjustment for age and sex, the addition of further antihypertensive medications increased the odds of achieving a blood pressure target of <130/80 mmHg (OR 1.3, 95% CI 1.07–1.69, p=0.012). The average percentage daily dose of each antihypertensive agent was lower in both participants with a medication-controlled blood pressure of <130/80 mmHg and <140/90 mmHg compared to those without blood pressure control (30% versus 37% p=0.006 and 33% versus 38% p=0.028 respectively).
Conclusion
Many patients with hypertension and coronary heart disease currently fail to achieve blood pressure control. This analysis found that an increasing number of antihypertensive medications but not increasing dose was associated with better blood pressure control. Combination therapy is superior to sequential monotherapy in the treatment of hypertension [1], and an approach that emphasises the initiation of several antihypertensive agents would likely lead to better blood pressure control in individuals with coronary heart disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Brennan
- Royal Perth Hospital , Perth , Australia
| | - O Costigan
- Royal Perth Hospital , Perth , Australia
| | - J W McEvoy
- National Institute of Preventive Cardiology , Galway , Ireland
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6
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Brennan S, Avalos G, Mc Evoy JW. The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.164] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD.
Methods
In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland.
Results
An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p<0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control.
Conclusion
Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.
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Affiliation(s)
- S Brennan
- Royal Perth Hospital, Perth, Australia
| | - G Avalos
- National University of Ireland Galway, Galway, Ireland
| | - J W Mc Evoy
- National University of Ireland Galway, Galway, Ireland
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7
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Brennan S, Mc Evoy JW. Bempedoic acid and PCSK9 inhibitor eligibility in a contemporary population with atherosclerotic cardiovascular disease. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.165] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Purpose
The reduction of low-density lipoprotein cholesterol (LDL-C) in patients with established coronary heart disease (CHD) reduces the risk of atherosclerotic cardiovascular disease (ASCVD) events.(1) Many CHD patients fail to achieve guideline-recommended LDL-C targets without prohibitively expensive proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 inhibitors).(2, 3, 4) This study aims to assess the impact that bempedoic acid may have on PCSK9 inhibitor eligibility in a population with CHD and ascertain whether its universal adoption would lead to overall cost-savings and a cost-effective reduction in ASCVD events.
Methods and Results
This retrospective analysis included 635 participants from the iASPIRE study, which recently assessed secondary prevention in an Irish cohort of CHD patients. We applied the 2019 ESC/EAS dyslipidaemia guideline LDL-C target of <1.4mmol/L and simulated the average treatment effect of improved lipid-lowering therapy with statins, ezetimibe and bempedoic acid. 86.3% of iASPIRE participants did not have LDL-C control and qualified for treatment intensification. Optimisation of statin therapy would allow 24.4% of patients to achieve their LDL-C goal, while the addition of ezetimibe would improve this to 55.7% leaving 44.3% eligible for a PCSK9 inhibitor. Utilising bempedoic acid would further reduce the proportion eligible to 18.7%. Based on current market prices and the universal application of ESC/EAS recommendations,(1, 5) the adoption of bempedoic acid would reduce the annual treatment costs associated with PCSK9 inhibitor use by almost 50% and result in cost savings per prevented CVD event.
Conclusions
The vast majority of CHD patients currently fail to achieve the recommended LDL-C target in everyday clinical practice. Ezetimibe and optimised statin therapy would enable most patients to meet their LDL-C goal. Employing bempedoic acid in patients with poor LDL-C control would significantly reduce the requirement for PCSK9 inhibitors and lead to cost savings per prevented CVD event.
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Affiliation(s)
- S Brennan
- Royal Perth Hospital, Perth, Australia
| | - J W Mc Evoy
- National University of Ireland Galway, Galway, Ireland
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8
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Mc Garry J, Sri Paran T, Brennan S, Gallagher T. Paediatric pancreatoduodenectomy – A video vignette. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102274] [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] Open
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9
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Boyle S, Hussain M, Kirby C, Brennan S, Clarke L, Mullan R, Halpenny D, Conlon N, Little MA, Conlon BJ, Abdulrahman S. Oro-Naso-Sino-Orbital-Cutaneous Fistula From Prolonged Cocaine Use. Ir Med J 2022; 115:544. [PMID: 35420004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presentation We present the case of a 48-year-old man with nasal cellulitis and subsequent oro-naso-sino-orbital-cutaneous fistula from prolonged cocaine use. Diagnosis Initial laboratory investigations reported a raised white cell count (WBC) and C-Reactive Protein (CRP) and subsequently a positive atypical anti-neutrophil cytoplasm antibodies (ANCA) and positive anti-proteinase (PR3). Perihilar lung nodularity on chest imaging raised the possibility of a systemic autoimmune response. His urinalysis was positive for cocaine. Treatment He was commenced on Augmentin, Amphotericin B and Prednisolone. An obturator was created to manage the oro-nasal fistula. A subsequent naso-cutaneous defect was re-approximated. Daily nasal saline douche and abstinence of cocaine were recommended. Discussion Cocaine use in the community is rising and poses a challenge to multiple facets of our health care system.
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Affiliation(s)
- S Boyle
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - M Hussain
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - C Kirby
- Rheumatology Department Tallaght University Hospital, Dublin 24, Ireland
| | - S Brennan
- Pathology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - L Clarke
- Pathology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - R Mullan
- Rheumatology Department Tallaght University Hospital, Dublin 24, Ireland
| | - D Halpenny
- Radiology Department, Tallaght University Hospital, Dublin 24, Ireland
| | - N Conlon
- Autoimmune Department, St James Hospital, Dublin 8, Ireland
| | - M A Little
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin 24, Ireland
| | - B J Conlon
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
| | - S Abdulrahman
- ENT Department Tallaght University Hospital, Dublin 24, Ireland
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10
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Cassidy C, Moore L, Ryan J, Brennan S. Audit on Oral Health Examinations in an Approved Psychiatric Centre. Ir Med J 2022; 115:527. [PMID: 35279061] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- C Cassidy
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
| | - L Moore
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
| | - J Ryan
- Suirside Medical Practice, Clonmel, Tipperary
| | - S Brennan
- Department of Psychiatry, South Tipperary Hospital, Clonmel, Tipperary
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11
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Tolia S, Khan M, Khan S, Alexander D, Soltys M, Kamba K, Brennan S, Adhikari S, Hussain S, Joshi A, Sciamanna C, Narang N, Pillarella J, Cotts W, Andrade A. Mortality and long-term outcomes of palliative inotropes in ischemic and non-ischemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0915] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Palliative inotropes are frequently utilized for symptom management in patients with end stage heart failure who are unable to undergo durable advanced heart failure therapies. With the advent of improved medical management and early intervention, palliative inotropes may allow for improved patient outcomes than seen previously. In this study, we aim to investigate the survival and outcomes of palliative inotrope therapy and its impacts on ischemic versus non-ischemic cardiomyopathy.
Methods
We retrospectively analyzed 220 patients with American Heart Association Stage D heart failure who were discharged with palliative inotrope therapy after January 1, 2010. Patients who underwent mechanical circulatory support (MCS) or those who underwent heart transplant were excluded. Those with a history of coronary artery disease, myocardial infarction, history of percutaneous intervention, or coronary artery bypass grafting were assigned to ischemic cardiomyopathy (ICM), while patients without these findings were assigned to non-ischemic cardiomyopathy (NICM). Statistical analysis was completed using Chi-Square and Student's t-tests, wherein p<0.05 was considered statistically significant.
Results
Of the 220 patients, 87 had NICM as opposed to 133 with ICM. Mean age was found to be higher among patients with ICM (70 [62–79]) compared to NICM (65 [55–72], p-value <0.01). No significant difference was seen in total days on inotrope therapy (p=0.6). While more patients in both groups were placed on milrinone as opposed to dobutamine, there was no difference between patients with ischemic and NICM (p=0.66 and 0.51 respectively). Although a greater number of patients with NICM had been lost to follow up, admitted to hospice, or expired at 2 years (p<0.01), survival at 3 months, 1 year, and 2 years showed no difference between both groups. No difference was seen in number of hospitalizations or clinic visits in one year. Both groups had similar complication rates with intravenous-access related PICC line infections and new arrhythmias. (See Table).
Conclusion
Despite more frequent use of durable mechanical support devices, many patients who are deemed unsuitable for invasive measures are treated with palliative inotrope therapy. We have found that there is no significant difference in survival, complications, and outcomes of patients on palliative inotropes among ischemic and NICM. These findings show the versatility of palliative inotrope therapy in end stage heart failure. Further studies with larger populations need to be evaluated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Tolia
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - M Khan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Khan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - D Alexander
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - M Soltys
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - K Kamba
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Brennan
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Adhikari
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - S Hussain
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - A Joshi
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - C Sciamanna
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - N Narang
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - J Pillarella
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - W Cotts
- Advocate Christ Medical Center, Oak Lawn, United States of America
| | - A Andrade
- Advocate Christ Medical Center, Oak Lawn, United States of America
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12
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Wuitchik DM, Almanzar A, Benson BE, Brennan S, Chavez JD, Liesegang MB, Reavis JL, Reyes CL, Schniedewind MK, Trumble IF, Davies SW. Title: Characterizing environmental stress responses of aposymbiotic Astrangia poculata to divergent thermal challenges. Mol Ecol 2021; 30:5064-5079. [PMID: 34379848 DOI: 10.1111/mec.16108] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022]
Abstract
Anthropogenic climate change threatens corals globally and both high and low temperatures are known to induce coral bleaching. However, coral stress responses across wide thermal breadths remain understudied. Disentangling the role of symbiosis on the stress response in obligately symbiotic corals is challenging because this response is inherently coupled with nutritional stress. Here, we leverage aposymbiotic colonies of the facultatively symbiotic coral, Astrangia poculata, which lives naturally with and without its algal symbionts, to examine how broad thermal challenges influence coral hosts in the absence of symbiosis. A. poculata were collected from their northern range limit and thermally challenged in two independent 16-day common garden experiments (heat and cold challenge) and behavioral responses to food stimuli and genome-wide gene expression profiling (TagSeq) were performed. Both thermal challenges elicited significant reductions in polyp extension. However, there were five times as many differentially expressed genes (DEGs) under cold challenge compared to heat challenge. Despite an overall stronger response to cold challenge, there was significant overlap in DEGs between thermal challenges. We contrasted these responses to a previously identified module of genes associated with the environmental stress response (ESR) in tropical reef-building corals. Cold challenged corals exhibited a pattern consistent with more severe stressors while the heat challenge response was consistent with lower intensity stressors. Given that these responses were observed in aposymbiotic colonies, many genes previously implicated in ESRs in tropical symbiotic species may represent the coral host's stress response in or out of symbiosis.
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Affiliation(s)
- D M Wuitchik
- Department of Biology, Boston University, Boston, MA, USA
| | - A Almanzar
- Department of Biology, Boston University, Boston, MA, USA
| | - B E Benson
- Department of Biology, Boston University, Boston, MA, USA
| | - S Brennan
- Department of Biology, Boston University, Boston, MA, USA
| | - J D Chavez
- Department of Biology, Boston University, Boston, MA, USA
| | - M B Liesegang
- Department of Biology, Boston University, Boston, MA, USA.,Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
| | - J L Reavis
- Department of Biology, Boston University, Boston, MA, USA
| | - C L Reyes
- Department of Biology, Boston University, Boston, MA, USA
| | | | - I F Trumble
- Department of Biology, Boston University, Boston, MA, USA
| | - S W Davies
- Department of Biology, Boston University, Boston, MA, USA
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13
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Monaghan O, O’Dwyer N, Dunne M, Nugent J, Coughlan N, Nolan A, Gilbert F, Glynn A, Duane F, Parkes C, Brennan S. PO-0967 Factors associated with feeding tube requirement in Oropharyngeal Cancer treated with IMRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07418-1] [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: 10/20/2022]
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14
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Crotty T, Brennan S, Cousins G, Kinsella J, Moran T. P3: CASE-CONTROL STUDY OF SEXUAL BEHAVIOUR IN HPV-POSITIVE ORAL CAVITY AND OROPHARYNGEAL CANCER. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.088] [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: 11/15/2022]
Abstract
Abstract
Introduction
HPV infection is recognised as the main aetiological factor responsible for the increased incidence of oropharyngeal squamous cell carcinomas (OPSCC). Currently the epidemiology of oral HPV infection and OPSCC is poorly understood. In this study we aim to define the relationship between sexual behaviours and HPV-positive OPSCC.
Method
We performed a hospital-based, case-control study of 30 patients with HPV-positive and 30 patients with HPV-negative newly diagnosed oral cavity and OPSCC. The participants underwent questionnaire based interviews investigating variables such as age, gender, tobacco use, alcohol intake, and sexual behaviour.
Result
Subjects in the HPV-positive tumour subgroup had significantly less tobacco use then their HPV-negative counterparts (odds ratio, 0.92, 95% CI 0.9-1.17). A history of oral sexual activity was significantly more likely in the HPV-positive tumour subgroup (odds ratio, 5.23, 95% CI, 1.66-16.51), however this association did not remain significant when adjusted for age, gender, smoking and alcohol consumption. Similarly, there was significantly less alcohol consumption overall in the HPV-positive tumour subgroup (odds ratio, 0.107, 95% CI 0.96-1.01), but this association was no longer significant when adjusted for covariables.
Conclusion
Significantly less smoking was prevalent in patients with HPV-positive OPSCC. Although patients with HPV-positive tumours had less alcohol consumption and a stronger history of oral sexual activity overall, greater numbers are required in order to show a significant association. This further supports the known association between HPV-infection and OPSCC and the department of health's decision to commence vaccination of boys before the onset of sexual activity.
Take-home message
HPV-positive oropharyngeal cancer can develop without exposure to established risk factors such as tobacco use or excessive alcohol consumption. This change in pathogenesis should lead a change in how we prevent and manage the disease.
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Affiliation(s)
- T Crotty
- Mater Misericordiae University Hospital
| | - S Brennan
- Mater Misericordiae University Hospital
| | - G Cousins
- Mater Misericordiae University Hospital
| | | | - T Moran
- Mater Misericordiae University Hospital
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15
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Roche D, Murray G, Brennan S, Tobin AM. Fleshy friable nodule of the forehead. Clin Exp Dermatol 2021; 46:968-970. [PMID: 33675105 DOI: 10.1111/ced.14560] [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: 10/31/2020] [Revised: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- D Roche
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - G Murray
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - S Brennan
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - A-M Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
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16
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Hintze JM, Fitzgerald C, Lang B, O'Shea J, Barry C, Brennan S, Lennon P. Tracheostomy stomal seeding following oral cavity resection. Oral Oncol 2020; 115:105097. [PMID: 33229202 DOI: 10.1016/j.oraloncology.2020.105097] [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: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheal stoma recurrence following oral cavity surgery is exceedingly rare. Although several different mechanisms for this have been described, the pathogenesis still remains uncertain. METHODS We present the case of a gentleman who presented 6-months following oral cavity SCC resection with a large fungating mass at his previous tracheostomy site, and also review the reported literature on this rare phenomenon. RESULTS Four weeks after diagnosis of his recurrence he underwent a total laryngectomy, wide-local skin excision and reconstruction with a pectoralis major pedicled flap. He recovered well initially following his operation, however unfortunately contracted nosocomial SARS-Cov2 and succumbed from respiratory complications during his post-operative recovery. CONCLUSION Stomal recurrence after temporary tracheostomy for oral cavity malignancies are very rare. Previously reported management of these can vary from surgical to palliative treatment. Methods to prevent these include delaying tracheostomy until after surgical resection, packing the pharynx during resection and adjuvant radiotherapy.
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Affiliation(s)
- J M Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland.
| | - C Fitzgerald
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland
| | - J O'Shea
- Trinity College, University of Dublin, Dublin, Ireland; Department of Radiation Oncology, St James Hospital, Dublin, Ireland
| | - C Barry
- Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland; Department of Maxillofacial Surgery, St James Hospital, Dublin, Ireland
| | - S Brennan
- Trinity College, University of Dublin, Dublin, Ireland; Department of Radiation Oncology, St James Hospital, Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Trinity College, University of Dublin, Dublin, Ireland
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17
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Wesselman LMP, Schild AK, Hooghiemstra AM, Meiberth D, Drijver AJ, Leeuwenstijn-Koopman MV, Prins ND, Brennan S, Scheltens P, Jessen F, van der Flier WM, Sikkes SAM. Targeting Lifestyle Behavior to Improve Brain Health: User-Experiences of an Online Program for Individuals with Subjective Cognitive Decline. J Prev Alzheimers Dis 2020; 7:184-194. [PMID: 32463072 DOI: 10.14283/jpad.2020.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Online programs targeting lifestyle have the potential to benefit brain health. We aimed to develop such a program for individuals with subjective cognitive decline (SCD). These individuals were reported to be at increased risk for dementia, and report both an intrinsic need for brain health information and motivation to participate in prevention strategies. Co-creation and user-evaluation benefits the adherence to and acceptance of online programs. Previously, we developed a prototype of the online program in co-creation with the users . OBJECTIVES We now aimed to evaluate the user-experiences of our online lifestyle program for brain health. DESIGN 30-day user test; multi-method. SETTING Participants were recruited in a memory clinic and (online) research registries in the Netherlands (Alzheimer Center Amsterdam) and Germany (Center for memory disorders, Cologne). PARTICIPANTS Individuals with SCD (N=137, 65±9y, 57% female). MEASUREMENTS We assessed user-experiences quantitatively with rating daily advices and usefulness, satisfaction and ease of use questionnaires as well as qualitatively using telephone interviews. RESULTS Quantitative data showed that daily advices were rated moderately useful (3.5 ±1.5, range 1-5 points). Participants (n=101, 78%) gave moderate ratings on the programs' usability (3.7±1.3, max 7), ease of learning (3.6±1.9) and satisfaction (4.0±1.5), and marginal ratings on the overall usability (63.7±19.0, max 100). Qualitative data collected during telephone interviews showed that participants highly appreciated the content of the program. They elaborated that lower ratings of the program were mainly due to technical issues that hindered a smooth walk through. Participants reported that the program increased awareness of lifestyle factors related to brain health. CONCLUSIONS Overall user-experience of the online lifestyle program was moderate to positive. Qualitative data showed that content was appreciated and that flawless, easy access technique is essential. The heterogeneity in ratings of program content and in program use highlights the need for personalization. These findings support the use of online self-applied lifestyle programs when aiming to reach large groups of motivated at-risk individuals for brain health promotion.
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Affiliation(s)
- L M P Wesselman
- Linda M.P. Wesselman, Alzheimer Center Amsterdam and Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands, Telephone: +31-204440816; Fax: +31-204448529; E-mail:
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18
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Capper T, Brennan S, Woodside J, McKinley M. The EIT Food School Network: Integrating solutions to improve eating habits and reduce food wastage in secondary schoolchildren. NUTR BULL 2019. [DOI: 10.1111/nbu.12406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Capper
- Centre for Public Health Belfast Queen's University Belfast Ringgold Belfast UK
| | - S. Brennan
- Centre for Public Health Belfast Queen's University Belfast Ringgold Belfast UK
| | - J. Woodside
- Centre for Public Health Belfast Queen's University Belfast Ringgold Belfast UK
| | - M. McKinley
- Centre for Public Health Belfast Queen's University Belfast Ringgold Belfast UK
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19
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Mehanna H, Kong A, Hartley A, Mistry P, Dalby M, Fulton-Lieuw T, Robinson M, Gray A, Foran B, Sen M, O'Toole L, Dyker K, Al Booz H, Moleron R, Brennan S, Aynsley E, Chan A, Srinivasan D, Buter J, Dunn J. Cetuximab versus cisplatin in patients with HPV-positive, low risk oropharyngeal cancer, receiving radical radiotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.046] [Citation(s) in RCA: 3] [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] [Indexed: 11/15/2022] Open
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20
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Brennan S, Osada H, Doan T, Yee-Melichar D. ENVIRONMENTAL DESIGN AND QOL IN LONG-TERM CARE FACILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - H. Osada
- J.F. Oberlin University, Tokyo, Japan,
| | - T. Doan
- San Francisco State University, San Francisco, California
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21
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Lovell R, Knox M, Weston M, Siegler JC, Brennan S, Marshall PWM. Hamstring injury prevention in soccer: Before or after training? Scand J Med Sci Sports 2017; 28:658-666. [DOI: 10.1111/sms.12925] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- R. Lovell
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - M. Knox
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - M. Weston
- School of Social Sciences; Business & Law; Teesside University; Middlesbrough UK
| | - J. C. Siegler
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - S. Brennan
- School of Science and Health; Western Sydney University; Penrith NSW Australia
| | - P. W. M. Marshall
- School of Science and Health; Western Sydney University; Penrith NSW Australia
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22
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Glynn A, O Shea J, McDermott R, Brennan S. EP-1099: Evaluation of laryngeal preservation & outcomes following RT for locally advanced laryngeal SCC. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31535-9] [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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23
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Brennan S, Cresswell A, Farris D, Lichtwark G. Mechanical and energetic determinants of optimal cycling cadence. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.014] [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: 10/20/2022]
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24
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, D'Costa C, Blane C, Giles M, Peter MB, Hirst NA, Hossain T, Pannu A, El-Dhuwaib Y, Morrison TEM, Taylor GW, Thompson RLE, McCune K, Loughlin P, Lawther R, Byrnes CK, Simpson DJ, Mawhinney A, Warren C, McKay D, McIlmunn C, Martin S, MacArtney M, Diamond T, Davey P, Jones C, Clements JM, Digney R, Chan WM, McCain S, Gull S, Janeczko A, Dorrian E, Harris A, Dawson S, Johnston D, McAree B, Ghareeb E, Thomas G, Connelly M, McKenzie S, Cieplucha K, Spence G, Campbell W, Hooks G, Bradley N, Hill ADK, Cassidy JT, Boland M, Burke P, Nally DM, Hill ADK, Khogali E, Shabo W, Iskandar E, McEntee GP, O'Neill MA, Peirce C, Lyons EM, O'Sullivan AW, Thakkar R, Carroll P, Ivanovski I, Balfe P, Lee M, Winter DC, Kelly ME, Hoti E, Maguire D, Karunakaran P, Geoghegan JG, Martin ST, McDermott F, Cross KS, Cooke F, Zeeshan S, Murphy JO, Mealy K, Mohan HM, Nedujchelyn Y, Fahad Ullah M, Ahmed I, Giovinazzo F, Milburn J, Prince S, Brooke E, Buchan J, Khalil AM, Vaughan EM, Ramage MI, Aldridge RC, Gibson S, Nicholson GA, Vass DG, Grant AJ, Holroyd DJ, Jones MA, Sutton CMLR, O'Dwyer P, Nilsson F, Weber B, Williamson TK, Lalla K, Bryant A, Carter CR, Forrest CR, Hunter DI, Nassar AH, Orizu MN, Knight K, Qandeel H, Suttie S, Belding R, McClarey A, Boyd AT, Guthrie GJK, Lim PJ, Luhmann A, Watson AJM, Richards CH, Nicol L, Madurska M, Harrison E, Boyce KM, Roebuck A, Ferguson G, Pati P, Wilson MSJ, Dalgaty F, Fothergill L, Driscoll PJ, Mozolowski KL, Banwell V, Bennett SP, Rogers PN, Skelly BL, Rutherford CL, Mirza AK, Lazim T, Lim HCC, Duke D, Ahmed T, Beasley WD, Wilkinson MD, Maharaj G, Malcolm C, Brown TH, Shingler GM, Mowbray N, Radwan R, Morcous P, Wood S, Kadhim A, Stewart DJ, Baker AL, Tanner N, Shenoy H, Hafiz S, Marchi JA, Singh-Ranger D, Hisham E, Ainley P, O'Neill S, Terrace J, Napetti S, Hopwood B, Rhys T, Downing J, Kanavati O, Coats M, Aleksandrov D, Kallaway C, Yahya S, Weber B, Templeton A, Trotter M, Lo C, Dhillon A, Heywood N, Aawsaj Y, Hamdan A, Reece-Bolton O, McGuigan A, Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - E Nofal
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - K Madbak
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | | | | | | | - P Ziprin
- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
| | | | | | - A Hussain
- Mid Staffordshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - S Ali
- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
| | - H Ali
- Tunbridge Wells and Maidstone NHS Trust
| | - R Lane
- Tunbridge Wells and Maidstone NHS Trust
| | | | | | - D Mirza
- University Hospital Birmingham NHS Foundation Trust
| | - S Puig
- University Hospital Birmingham NHS Foundation Trust
| | - K Al Amari
- University Hospital Birmingham NHS Foundation Trust
| | - D Vijayan
- University Hospital Birmingham NHS Foundation Trust
| | - R Sutcliffe
- University Hospital Birmingham NHS Foundation Trust
| | | | - Z Hamady
- University Hospital Coventry and Warwickshire NHS Trust
| | - A R Prasad
- University Hospital Coventry and Warwickshire NHS Trust
| | - A Patel
- University Hospital Coventry and Warwickshire NHS Trust
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust
| | - P Kaur
- University Hospital of North Staffordshire NHS Trust
| | - L Bowen
- University Hospital of North Staffordshire NHS Trust
| | - J P Byrne
- University Hospital Southampton NHS Foundation Trust
| | - K L Pearson
- University Hospital Southampton NHS Foundation Trust
| | - T G Delisle
- University Hospital Southampton NHS Foundation Trust
| | - J Davies
- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - P Burke
- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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Marchi R, Brennan S, Mijares ME. A novel mutation in the fibrinogen γ-chain 216 Gly>Glu causes hypofibrinogenemia. Thromb Res 2016; 147:61-62. [PMID: 27676255 DOI: 10.1016/j.thromres.2016.09.025] [Citation(s) in RCA: 2] [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: 06/23/2016] [Revised: 08/09/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Affiliation(s)
- R Marchi
- Lab. Biología del Desarrollo de la Hemostasia, Instituto Venezolano de Investigaciones Científicas (IVIC), Caracas, Venezuela.
| | - S Brennan
- Molecular Pathology Laboratory, University of Otago, Christchurch, New Zealand
| | - M E Mijares
- Banco Municipal de Sangre del Distrito Capital, Caracas, Venezuela
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Donnelly Y, Brennan S, Gilbert F, Gorham A, Parks C, Glynn A. MON-P088: Establishing a Reactive Homeng Service Using Cortrak Enteral Access System (EAS) for Head and Neck Cancer Patients Undergoing Radiotherapy and/or Chemotherapy. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30722-1] [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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Keenan L, O'Sullivan S, Glynn A, Totaro M, Brennan S. EP-1397: Patterns of failure in patients treated with adjuvant radiotherapy post lymphadenectomy for melanoma. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32647-0] [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: 11/15/2022]
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Hatoum D, Yagoub D, Brennan S, Nassif N, McGowan E. P14ARF-p53-p21 alters the metabolic pathway in breast cancer – a novel proteomic global approach. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv116.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dolan C, Lawlor B, Brennan S, Bruce I. An Exploration of Diabetes Brain Health Literacy Among the General Public, Healthcare Professionals and Diabetic Patients. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31133-0] [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: 10/23/2022] Open
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Rafee S, Elamin YY, Cronin K, Brennan S, Osman N. A rare case of nasopharyngeal carcinoma with widespread CNS metastases. Ir Med J 2014; 107:180-181. [PMID: 24988837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Nasopharyngeal cancer is unique among head and neck cancers. Despite definitive treatment, there is a high rate of recurrence, most commonly in the bone, lung or liver. Brain metastases and particularly, leptomeningeal carcinomatosis are extremely rare. We present a case of recurrent nasopharyngeal carcinoma with brain metastases and leptomeningeal carcinomatosis in the absence of local recurrence and systemic metastases.
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Tamborini A, Papakonstantinou S, Brown A, Brennan S, Shiel RE, Mills JN, Mooney CT. Comparison of manual and laboratory PCV and total protein using EDTA and lithium heparin canine samples. J Small Anim Pract 2014; 55:258-64. [DOI: 10.1111/jsap.12198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Tamborini
- University College Dublin Veterinary Hospital, School of Veterinary Medicine; University College Dublin; Dublin Ireland
| | - S. Papakonstantinou
- University College Dublin Veterinary Hospital, School of Veterinary Medicine; University College Dublin; Dublin Ireland
| | - A. Brown
- Murdoch University Veterinary Hospital; Murdoch University; Murdoch WA Australia
| | - S. Brennan
- University College Dublin Veterinary Hospital, School of Veterinary Medicine; University College Dublin; Dublin Ireland
| | - R. E. Shiel
- Murdoch University Veterinary Hospital; Murdoch University; Murdoch WA Australia
| | - J. N. Mills
- Murdoch University Veterinary Hospital; Murdoch University; Murdoch WA Australia
| | - C. T. Mooney
- University College Dublin Veterinary Hospital, School of Veterinary Medicine; University College Dublin; Dublin Ireland
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Buchanan BG, Rossell SL, Maller JJ, Toh WL, Brennan S, Castle DJ. Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychol Med 2013; 43:2513-2521. [PMID: 23473554 DOI: 10.1017/s0033291713000421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several neuroimaging studies have investigated brain grey matter in people with body dysmorphic disorder (BDD), showing possible abnormalities in the limbic system, orbitofrontal cortex, caudate nuclei and temporal lobes. This study takes these findings forward by investigating white matter properties in BDD compared with controls using diffusion tensor imaging. It was hypothesized that the BDD sample would have widespread significantly reduced white matter connectivity as characterized by fractional anisotropy (FA). METHOD A total of 20 participants with BDD and 20 healthy controls matched on age, gender and handedness underwent diffusion tensor imaging. FA, a measure of water diffusion within a voxel, was compared between groups on a voxel-by-voxel basis across the brain using tract-based spatial statistics within the FSL package. RESULTS Results showed that, compared with healthy controls, BDD patients demonstrated significantly lower FA (p < 0.05) in most major white matter tracts throughout the brain, including in the superior longitudinal fasciculus, inferior fronto-occipital fasciculus and corpus callosum. Lower FA levels could be accounted for by increased radial diffusivity as characterized by eigenvalues 2 and 3. No area of higher FA was found in BDD. CONCLUSIONS This study provided the first evidence of compromised white matter integrity within BDD patients. This suggests that there are inefficient connections between different brain areas, which may explain the cognitive and emotion regulation deficits within BDD patients.
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Affiliation(s)
- B G Buchanan
- Monash Alfred Psychiatry Research Centre, School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
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Gunardi A, Brennan S, Wang Y, Cicuttini F, Pasco J, Kotowicz M, Nicholson G, Wluka A. THU0505 Associations Between Measures of Obesity over 10 Years and Patella Cartilage in a Population-Based Cohort of Young to Middle Aged, Asymptomatic Women. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1033] [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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Cagney D, Walsh L, Dunne M, Gillham C, Fraser I, Hollywood D, Armstrong J, Thirion P, Brennan S. PO-079: Review of Cetuximab Versus Cisplatin Concurrent with Radiotherapy in Lahnscc: A Single Institution Experience. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34698-3] [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: 11/25/2022]
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Felton TW, Roberts SA, Isalska B, Brennan S, Philips A, Whiteside S, Doran HM, Leonard C, Al-Aloul M, Yonan N, Hope WW. Isolation of Aspergillus species from the airway of lung transplant recipients is associated with excess mortality. J Infect 2012; 65:350-6. [PMID: 22863902 DOI: 10.1016/j.jinf.2012.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/19/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Aspergillus spp. are the leading cause of invasive fungal infection in lung transplant recipients. We investigated the relationship between the isolation of Aspergillus spp. from the respiratory tract of lung transplant recipients and their risk of mortality. METHODS A retrospective, observational cohort study of all patients who received lung allografts between January 1999 and May 2011 at a single UK centre was performed. The time from transplantation to death was analysed using Cox regression models. Isolation of Aspergillus spp. from the respiratory tract was included as a covariate in the Cox regression model. RESULTS Two hundred-thirteen patients were included. The median follow-up time was 5 years during which 102 patients (47.9%) died. Aspergillus was isolated from 74 (34.7%) patients. Twenty patients (27%) had Aspergillus isolated in the first 60 days post-transplant. Forty-one patients (55.4%) in the Aspergillus group and 61 patients (43.9%) in the non-Aspergillus group died during follow-up. A hazard ratio of 2.2 (95% CI 1.5-3.3; P < 0.001) for death following a positive Aspergillus sample was observed. CONCLUSION Isolation of Aspergillus spp. from patients following lung transplantation is associated with a significant increase in mortality. Novel preventative strategies are required to minimise the impact of Aspergillus in lung transplant recipients.
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Affiliation(s)
- T W Felton
- The University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
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van Esch E, Brennan S. Sebaceous gland metaplasia in the oesophagus of a cynomolgus monkey (Macaca fascicularis). J Comp Pathol 2012; 147:248-52. [PMID: 22305858 DOI: 10.1016/j.jcpa.2011.11.201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 11/11/2011] [Accepted: 11/22/2011] [Indexed: 12/21/2022]
Abstract
Microscopical evaluation of tissues from a mature female cynomolgus monkey assigned to a 13-week oral toxicity study revealed nests of sebaceous cells within the mucosa of the distal oesophagus. The sebaceous cell nests showed normal differentiation from basally-oriented seboblasts to centrally-orientated mature sebocytes. No excretory ducts were found, but solitary or small groups of vacuolated sebocytes were present in the overlying normal, non-keratinized squamous epithelium. The finding of sebaceous cells, of presumed ectodermal origin, in the oesophageal mucosa, which is of endodermal origin, is of scientific interest. Different theories may explain the existence of this peculiarity, but sebaceous gland metaplasia is the most plausible. The mucosal change was thought to be unrelated to treatment and is the first case of sebaceous gland metaplasia reported in the oesophagus of a non-human primate.
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Affiliation(s)
- E van Esch
- InSight Pathology B.V., Oss, The Netherlands.
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Abstract
The prevalence of A, B and AB blood types and of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) infection was determined in cats in Ireland, in order to determine risk factors for blood taken for transfusion purposes. EDTA blood samples were available from 137 non-pedigree cats and 39 pedigree cats (91 females and 85 males, aged four months to 15.0 years) in the Dublin area of Ireland. Of the 176 EDTA blood samples obtained, 112 (from 92 healthy cats and 20 sick cats) were tested for the presence of both FIV antibodies and FeLV antigens. Blood typing was performed using an immunochromatographic cartridge (CHROM; Alvedia). Testing for FIV and FeLV was performed by ELISA (SNAP FIV/FeLV Combo Test; Idexx Laboratories). Of the 39 pedigree cats, the majority (38 [97.4 per cent]) was type A, and only one (2.6 per cent) was type B. Of the 137 non-pedigree cats, the majority (116 [84.7 per cent]) was type A, 20 (14.6 per cent) were type B, and one (0.7 per cent) was type AB. Of the 92 healthy cats tested, the prevalence of FIV and FeLV positivity was 4.35 and 1.09 per cent, respectively. None of the 20 sick cats tested was FIV-positive; two (10 per cent) of the 20 sick cats were FeLV-positive.
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Affiliation(s)
- F Juvet
- University Veterinary Hospital, University College Dublin, Belfield, Dublin 4, Ireland.
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Marti JL, Goldberg JI, Patil S, Barbashina VV, Giri DD, Brennan S, Lee C, Vallejo C, Morris EA, Van Zee KJ. Breast conservation (BCT) for DCIS: A prospective study of how MRI impacts management (MGMT). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.546] [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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Brennan S, Liberman L, Dershaw D, Morris E. Breast MRI Screening of Women with a Prior High-Risk Lesion: Preliminary Results. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To determine the frequency of breast cancer detection in women at increased risk due to a prior high-risk lesion.Materials and methods: An IRB approved retrospective review was performed of the records of 2184 breast MRIs starting from 1999, to identify patients who commenced screening breast MRI who had a history of a prior high risk lesion. Eighty-three women were identified who had a prior biopsy demonstrating a high-risk lesion such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS). History, imaging, and pathologic findings were reviewed.Results: Histologies of prior high-risk lesions in these 83 women were ADH in 24, LCIS in 54 and ALH in 5. The median length of MRI follow-up was four (range, 1-9) years. Biopsies were recommended based on MRI findings in 39 (47%) of 83 women, yielding cancer in seven (8%) women (four of whom also had benign biopsies), and benign findings only in 32 (39%) women. Six of the seven women who developed a breast cancer also had a family history of breast cancer. Histologic findings in these seven cancers were ductal carcinoma in situ (DCIS) in 4 (57%) and invasive cancer in three (43%). Invasive cancer histologies (n=3) were ductal in one and lobular in two; maximal histologic size was 2.0 cm. This large invasive cancer had a mammographic, sonographic, and palpable correlate, and was node-positive; the other cancers were identified by MRI only. Among these seven cancers, two (29%) were detected in screening year 1, two (29%) in screening year 2, two (29%) in screening year 3 and one in screening year 4 (14%). Three (43%) of the seven cancers were in the contralateral breast. In these 83 women, the likelihood of detecting cancer by MRI was higher in those with, rather than without, a family history of breast cancer (6/54=11% vs. 1/29=3%) and in women with prior LCIS rather than prior ADH (6/54=11% vs. 1/24=4%).Conclusion: Breast MRI detected cancer in 7 (8%) of 83 women with a prior high-risk lesion, six (86%) of whom also had a family history of breast cancer. Among these cancers, all were detected during the first four years of screening and less than half were invasive (43%). Further work with more patients is needed to determine the utility of breast MRI screening in women with specific prior high-risk lesions, with and without additional risk factors.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4002.
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Affiliation(s)
- S. Brennan
- 1Memorial Sloan-Kettering Cancer Center, NY,
| | - L. Liberman
- 1Memorial Sloan-Kettering Cancer Center, NY,
| | - D. Dershaw
- 1Memorial Sloan-Kettering Cancer Center, NY,
| | - E. Morris
- 1Memorial Sloan-Kettering Cancer Center, NY,
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Kidd S, Brennan S, Stephen R, Minns R, Beattie T. Comparison of morphine concentration-time profiles following intravenous and intranasal diamorphine in children. Arch Dis Child 2009; 94:974-8. [PMID: 19793724 DOI: 10.1136/adc.2008.140194] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 11/04/2022]
Abstract
BACKGROUND Current best practice for treating acute severe pain in children is to administer intravenous or intranasal opioid. Intranasal diamorphine offers less traumatic analgesia than the potentially difficult and distressing intravenous route. However, there has been no direct comparison of intranasal and intravenous diamorphine nor are there pharmacokinetic data for intranasal diamorphine in children. OBJECTIVE To compare plasma morphine concentration-time profiles following intranasal and intravenous diamorphine administration. DESIGN Observational. SETTING A&E department in a city-centre paediatric teaching hospital. PATIENTS Children, aged 3-13 years, with isolated limb fracture. INTERVENTIONS An intravenous catheter was sited and baseline blood taken. The first 12 children received intravenous diamorphine (0.1 mg/kg), and the subsequent 12 intranasal diamorphine (0.1 mg/kg) in 0.2 ml sterile water drops. Subsequent samples were taken at 2, 5, 10, 20, 30 and 60 min. MEASUREMENTS Plasma morphine radioimmunoassay. RESULTS Peak plasma morphine concentrations were higher (median 109 vs 36 nmol/l), and occurred earlier (median 2 vs 10 min), with greater area under the curve (3761 vs 1794 nmol/l/h) following intravenous compared to intranasal diamorphine (all p<0.001, Mann-Whitney U test). Higher plasma concentrations at 60 min (47 vs 32 nmol/l) were also observed following intravenous diamorphine (p = 0.01, Mann-Whitney U test). CONCLUSIONS Our evidence supports the wider use of diamorphine administration by nasal drops in children, as it shows that adequate plasma levels of morphine are usually achieved. However, we demonstrated significantly attenuated and delayed peak plasma morphine levels with lower levels at 1 h with intranasal compared with intravenous diamorphine.
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Affiliation(s)
- S Kidd
- Accident and Emergency Department, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK.
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Germain F, Brennan S, Corry J, Herschtal A. 196 HYPOPHARYNX CARCINOMA – REVIEW OF THE PETER MACCALLUM CANCER CENTRE (PMCC) EXPERIENCE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72583-5] [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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Alva G, Farlow M, Sadowsky C, Brennan S. SWAP: the safety and tolerability of switching from donepezil tablets to rivastigmine transdermal patch in Alzheimer's disease. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238715] [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: 10/20/2022]
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Thirion P, Brennan S, Fitzpatrick D, Armstrong J, Dunne M, O'Shea C, McElroy A. ESCALATED DOSE FOR NON-SMALL-CELL LUNG CANCER WITH ACCELERATED HYPOFRACTIONATED THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72714-7] [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: 11/16/2022]
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Brennan S, Sly PD, Gangell CL, Sturges N, Winfield K, Wikstrom M, Gard S, Upham JW. Alveolar macrophages and CC chemokines are increased in children with cystic fibrosis. Eur Respir J 2009; 34:655-61. [DOI: 10.1183/09031936.00178508] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Andrews JC, Brennan S, Liu Y, Pianetta P, Almeida EAC, van der Meulen MCH, Wu Z, Mester Z, Ouerdane L, Gelb J, Feser M, Rudati J, Tkachuk A, Yun W. Full-field transmission x-ray microscopy for bio-imaging. J Phys Condens Matter 2009; 186:12081. [PMID: 20111669 PMCID: PMC2811963 DOI: 10.1088/1742-6596/186/1/012081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A full-field hard-x-ray microscope at SSRL has successfully imaged samples of biological and environmental origin at 40 nm resolution. Phase contrast imaging of trabeculae from a female mouse tibia, loaded in vivo to study the effects of weight-bearing on bone structure, revealed a complex network of osteocytes and canaliculi. Imaging of cordgrass roots exposed to mercury revealed nanoparticles with strong absorption contrast. 3D tomography of yeast cells grown in selenium rich media showed internal structure.
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Affiliation(s)
- J C Andrews
- Stanford Synchrotron Radiation Laboratory, Menlo Park CA 94025, USA
| | - S Brennan
- Stanford Synchrotron Radiation Laboratory, Menlo Park CA 94025, USA
| | - Y Liu
- Institute of High Energy Physics, Beijing, China
| | - P Pianetta
- Stanford Synchrotron Radiation Laboratory, Menlo Park CA 94025, USA
| | - E A C Almeida
- NASA Ames Research Center, Moffett Field, CA 94035, USA
| | | | - Z Wu
- Institute of High Energy Physics, Beijing, China
| | - Z Mester
- Institute for National Measurement Standards, Ottawa ON K1A0R6, Canada
| | - L Ouerdane
- Institute for National Measurement Standards, Ottawa ON K1A0R6, Canada
| | - J Gelb
- Xradia Inc., Concord CA 94520, USA
| | - M Feser
- Xradia Inc., Concord CA 94520, USA
| | - J Rudati
- Xradia Inc., Concord CA 94520, USA
| | | | - W Yun
- Xradia Inc., Concord CA 94520, USA
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Douglas TA, Brennan S, Gard S, Berry L, Gangell C, Stick SM, Clements BS, Sly PD. Acquisition and eradication of P. aeruginosa in young children with cystic fibrosis. Eur Respir J 2008; 33:305-11. [PMID: 19010992 DOI: 10.1183/09031936.00043108] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When do infants and young children with cystic fibrosis acquire infection with Pseudomonas aeruginosa? Can this be eradicated when first detected? Children <6 yrs of age participated in an annual bronchoalveolar lavage (BAL)-based microbiological surveillance programme in Perth, Australia. When P. aeruginosa was detected, an eradication programme using combination treatment with i.v., oral and nebulised antibiotics was undertaken. Repeat BAL was performed 3 months following treatment, to assess eradication success. P. aeruginosa was detected in 33 (28.4%) children; median (range) age at detection was 30.5 (3.3-71.4) months. P. aeruginosa was mucoid at detection in six (18.2%) out of 33 patients and associated with respiratory symptoms in 16 (48.5%) out of 33 children. In total, 26 children underwent eradication therapy, with P. aeruginosa eradicated in 20 (77%) out of 26 following one eradication cycle and in three (total 88%) additional children following a second cycle. Eradication was associated with a significant decrease in neutrophil elastase and interleukin-1beta in BAL fluid 12 months post eradication. Eradication of Pseudomonas aeruginosa infection is achievable in young children with cystic fibrosis for up to 5 yrs using combination i.v., oral and nebulised antibiotic therapy and is associated with reduced pulmonary inflammation 12 months post eradication.
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Affiliation(s)
- T A Douglas
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia Perth, Western Australia
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Brennan S, Salib O, O'Shea C, Moriarty M. A randomized prospective study of extended tocopherol and pentoxifylline therapy, in addition to carbogen, in the treatment of radiation late effects. Ecancermedicalscience 2008; 2:81. [PMID: 22275970 PMCID: PMC3234064 DOI: 10.3332/ecms.2008.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 04/21/2008] [Indexed: 11/17/2022] Open
Abstract
Purpose: pentoxifylline (PTX) and tocopherol (vitamin E) are antioxidants previously shown to be useful in combination in the treatment of late radiation induced toxicity. The purpose of this study was to investigate the benefit of combination therapy with carbogen pentoxifylline and tocopherol in the mitigation of late radiation effects. As the optimal duration of PTX and tocopherol treatment has not been fully established, we studied short versus extended treatment duration. Methods: we conducted a phase II prospective randomized study of short versus prolonged treatment with pentoxifylline (800 mg) and tocopherol (1000 IU) orally once daily in patients with grade three toxicity post-radical radiotherapy. In addition, all 18 patients received inhaled carbogen (95% O + 5% CO2) over 90 minutes, five days/week, for three weeks. The primary end point was improved in maximum Lent-Soma toxicity scores. Results: maximum Lent-Soma scores improved in six of the 18 patients (response rate 33%). The proportion of patients responding to treatment in the prolonged treatment arm B was more than double than in the shorter arm A, but this did not reach statistical significance (p=0.321). Two patients who had prolonged treatment (arm B) had complete resolution of their symptoms, which was maintained at two and three year follow-ups. Conclusions: we recommend prolonged treatment for 12 months, with PTX and tocopherol in combination with carbogen therapy, in the management of late radiation effects.
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Affiliation(s)
- S Brennan
- St Luke's Hospital, Dublin, Ireland.
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Brennan S, Salib O, O'Shea C, Moriarty M. A randomised prospective study of extended tocopherol and pentoxifylline therapy, in addition to carbogen, in the treatment of radiation late effects. Ecancermedicalscience 2008. [DOI: 10.3332/ecancer.2008.81] [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: 11/06/2022] Open
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Andrews JC, Brennan S, Patty C, Luening K, Pianetta P, Almeida E, van der Meulen MCH, Feser M, Gelb J, Rudati J, Tkachuk A, Yun WB. A high resolution, hard x-ray bio-imaging facility at SSRL. ACTA ACUST UNITED AC 2008. [PMID: 19830271 DOI: 10.1080/08940880802123043] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J C Andrews
- Stanford Synchrotron Radiation Laboratory, Menlo Park, CA 94025
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Andrews JC, Brennan S, Patty C, Luening K, Pianetta P, Almeida E, van der Meulen MCH, Feser M, Gelb J, Rudati J, Tkachuk A, Yun WB. A high resolution, hard x-ray bio-imaging facility at SSRL. Synchrotron Radiat News 2008; 21:17-26. [PMID: 19830271 PMCID: PMC2760939 DOI: 10.1080/08940880802406067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J C Andrews
- Stanford Synchrotron Radiation Laboratory, Menlo Park, CA 94025
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