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Montanaro C, Boyle S, Wander G, Johnson MR, Roos-Hesselink JW, Patel R, Rafiq I, Silversides CK, Gatzoulis MA. Pregnancy in Patients with the Fontan Operation. Eur J Prev Cardiol 2024:zwae157. [PMID: 38669446 DOI: 10.1093/eurjpc/zwae157] [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] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024]
Abstract
Improved survival rates for patients with a Fontan circulation has allowed more women with this complex cardiac physiology to contemplate pregnancy. However, pregnancy in women with a Fontan circulation is associated with a high risk of adverse maternal and fetal outcomes, high rates of miscarriage and preterm delivery. Factors associated with a successful pregnancy outcome are: younger age, normal body weight, absence of significant functional limitation, no Fontan-related complications, and well-functioning single ventricle physiology. Appropriate care with timely preconception counselling and regular, frequent clinical reviews by a multidisciplinary team based at a tertiary centre, improves the chance of a successful pregnancy. Empowerment of patients with education on their specific congenital cardiac condition and its projected trajectory, helps them make informed choices regarding their health, reproductive choices and assists them to achieve their life goals.
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Affiliation(s)
- C Montanaro
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - S Boyle
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, Logan Hospital, Queensland, Australia
| | - G Wander
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | - M R Johnson
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | | | - R Patel
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Imperial College London, , Chelsea and Westminster Hospital, 369 Fulham Road, London, United Kingdom
| | - I Rafiq
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - C K Silversides
- Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - M A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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Boyle S, Roddie C, O'Reilly M, Menne T, Norman J, Gibb A, Lugthart S, Chaganti S, Gonzalez Arias C, Jones C, Latif A, Uttenthal BJ, Seymour F, Osborne W, Springell D, Hardefeldt P, Yallop D, Thoulouli E, Bloor A, Besley C, Mathew A, Burns D, Cwynarski K, Sanderson R, Kuhnl A. Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time. Br J Haematol 2024; 204:507-513. [PMID: 37848384 DOI: 10.1111/bjh.19157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
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Affiliation(s)
- S Boyle
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
| | - M O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - S Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | - B J Uttenthal
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - F Seymour
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - D Springell
- Department of Haematology, University College London Hospitals, London, UK
| | - P Hardefeldt
- Department of Haematology, King's College Hospital, London, UK
| | - D Yallop
- Department of Haematology, King's College Hospital, London, UK
| | - E Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - A Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - D Burns
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - K Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
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Furlan A, Corona A, Boyle S, Sharma R, Rubino R, Habel J, Gablenz EC, Giovanniello J, Beyaz S, Janowitz T, Shea SD, Li B. Neurotensin neurons in the extended amygdala control dietary choice and energy homeostasis. Nat Neurosci 2022; 25:1470-1480. [PMID: 36266470 PMCID: PMC9682790 DOI: 10.1038/s41593-022-01178-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/06/2022] [Indexed: 01/13/2023]
Abstract
Obesity is a global pandemic that is causally linked to many life-threatening diseases. Apart from some rare genetic conditions, the biological drivers of overeating and reduced activity are unclear. Here, we show that neurotensin-expressing neurons in the mouse interstitial nucleus of the posterior limb of the anterior commissure (IPAC), a nucleus of the central extended amygdala, encode dietary preference for unhealthy energy-dense foods. Optogenetic activation of IPACNts neurons promotes obesogenic behaviors, such as hedonic eating, and modulates food preference. Conversely, acute inhibition of IPACNts neurons reduces feeding and decreases hedonic eating. Chronic inactivation of IPACNts neurons recapitulates these effects, reduces preference for sweet, non-caloric tastants and, furthermore, enhances locomotion and energy expenditure; as a result, mice display long-term weight loss and improved metabolic health and are protected from obesity. Thus, the activity of a single neuronal population bidirectionally regulates energy homeostasis. Our findings could lead to new therapeutic strategies to prevent and treat obesity.
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Affiliation(s)
- Alessandro Furlan
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,Correspondence: (A.F.); (B.L.)
| | - Alberto Corona
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,School of Biological Sciences, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,These authors contributed equally
| | - Sara Boyle
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,School of Biological Sciences, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,These authors contributed equally
| | | | - Rachel Rubino
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Jill Habel
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Eva Carlotta Gablenz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Jacqueline Giovanniello
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,School of Biological Sciences, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Semir Beyaz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - Tobias Janowitz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | | | - Bo Li
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA,Correspondence: (A.F.); (B.L.)
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Howell TJ, Nieforth L, Thomas-Pino C, Samet L, Agbonika S, Cuevas-Pavincich F, Fry NE, Hill K, Jegatheesan B, Kakinuma M, MacNamara M, Mattila-Rautiainen S, Perry A, Tardif-Williams CY, Walsh EA, Winkle M, Yamamoto M, Yerbury R, Rawat V, Alm K, Avci A, Bailey T, Baker H, Benton P, Binney C, Boyle S, Brandes H, Carr AM, Coombe W, Coulter K, Darby A, Davies L, Delisle E, Enders-Slegers MJ, Fournier A, Fox M, Gee N, Graham TM, Hamilton-Bruce A, Hansen TGB, Hart L, Heirs M, Hooper J, Howe R, Johnson E, Jones M, Karagiannis C, Kieson E, Kim SA, Kivlen C, Lanning B, Lewis H, Linder D, Mai DL, Mariti C, Mead R, Ferreira GM, Ngai D, O’Keeffe S, O’Connor G, Olsen C, Ormerod E, Power ER, Pritchard PA, Rodriguez K, Rook D, Ruby MB, Schofield L, Signal T, Steel J, Stone W, Symonds M, van Rooy D, Warda T, Wilson M, Young J, Bennett P. Defining Terms Used for Animals Working in Support Roles for People with Support Needs. Animals (Basel) 2022; 12:ani12151975. [PMID: 35953965 PMCID: PMC9367407 DOI: 10.3390/ani12151975] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 01/20/2023] Open
Abstract
Simple Summary Although animals are being employed for a growing number of roles to support people, the terms used to describe those animals (e.g., “therapy animal” and “emotional support animal”) can be confusing. The same term may be used to describe different types of work, or the same role can be described with different terms. This paper presents the results of a collaboration between over 100 researchers, practitioners, and end users of animal-based supports from all over the world. We created working definitions for the following nine terms: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. In this paper, we describe the defining characteristics of each animal type and how it is different from the other types. We recommend phasing out the terms “skilled companion animal” and “service animal”, because they are similar to other terms. We discuss how our definitions may be received in different parts of the world. Abstract The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: “assistance animal”, “companion animal”, “educational/school support animal”, “emotional support animal”, “facility animal”, “service animal”, “skilled companion animal”, “therapy animal”, and “visiting/visitation animal”. At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., “skilled companion animal” and “service animal”) due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.
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Affiliation(s)
- Tiffani J. Howell
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
- Correspondence:
| | - Leanne Nieforth
- OHAIRE, Comparative Pathobiology, Center for the Human Animal Bond, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Clare Thomas-Pino
- Human-Animal Interaction, Department of Animal and Agriculture, Hartpury University, Gloucester GL19 3BE, UK
- School of Food and Agriculture, University of Maine, Orono, ME 04469, USA
| | | | | | - Francisca Cuevas-Pavincich
- Centro de Estudios en Bienestar y Convivencia Social, Facultad de Psicología, Universidad del Desarrollo, Santiago 7610658, Chile
| | - Nina Ekholm Fry
- Institute for Human-Animal Connection, University of Denver, Denver, CO 80208, USA
| | - Kristine Hill
- EASE Working Group, College of Social Sciences and International Studies, University of Exeter, Exeter EX4 4PY, UK
| | | | - Miki Kakinuma
- Department of Veterinary Medicine, Nippon Veterinary and Life Science University, Musashino, Tokyo 180-8602, Japan
| | - Maureen MacNamara
- Department of Social Work, Beaver College of Health Sciences, Appalachian State University, Boone, NC 28607, USA
| | - Sanna Mattila-Rautiainen
- Sports and Exercise Medicine, Biomedicine, University of Eastern Finland, Yliopistonranta 1, 70600 Kuopio, Finland
| | - Andy Perry
- Department of Anthrozoology, University of Exeter (alumnus), Exeter EX4 4PY, UK
| | | | | | - Melissa Winkle
- Dogwood Therapy Services, Albuquerque, NM 87120, USA
- Animal Assisted Interventions International, 6537 HN Nijmegen, The Netherlands
| | - Mariko Yamamoto
- Department of Animal Sciences, Teikyo University of Science, Uenohara, Yamanashi 409-0193, Japan
| | - Rachel Yerbury
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Vijay Rawat
- School of Health, Medical & Applied Sciences, Central Queensland University, Melbourne, VIC 3000, Australia
| | - Kathy Alm
- Professional Association of Therapeutic Horsemanship International, Denver, CO 80233, USA
| | - Ashley Avci
- Risk Frontiers, St Leonards, NSW 2065, Australia
- Faculty of Law, Macquarie University, Sydney, NSW 2019, Australia
| | - Tanya Bailey
- Boynton Health, Office of Student Affairs, University of Minnesota, Minneapolis, MN 55455, USA
| | - Hannah Baker
- University Centre Sparsholt, University of Winchester, Sparsholt, Winchester SO21 2NF, UK
| | - Pree Benton
- Dogs for Life, Caulfield South, VIC 3162, Australia
| | | | - Sara Boyle
- Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
| | - Hagit Brandes
- The Program for Animal-Assisted-Psychotherapy, Tel-Hai College, Upper Galilee 1220800, Israel
| | - Alexa M. Carr
- Department of Human Development, Washington State University, Pullman, WA 99164, USA
| | - Wendy Coombe
- Animal Therapies Ltd., Gold Coast, QLD 4209, Australia
| | - Kendra Coulter
- Management and Organizational Studies, Huron University College at Western University, London, ON N6G 1H3, Canada
| | - Audrey Darby
- Equine Therapy Unit, ChildVision National Education Centre for Blind Children, D09 WKOH Dublin, Ireland
| | | | - Esther Delisle
- The Canadian Institute of Animal-Assisted Interventions, Montréal, QC H3V 1C7, Canada
| | - Marie-Jose Enders-Slegers
- Faculty of Psychology and Educational Sciences, Open University the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Angela Fournier
- Department of Psychology, Bemidji State University, Bemidji, MN 56601, USA
| | - Marie Fox
- School of Law & Social Justice, University of Liverpool, Liverpool L69 3BX, UK
| | - Nancy Gee
- Center for Human-Animal Interaction, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | - Anne Hamilton-Bruce
- Stroke Research Programme, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Woodville South, SA 5011, Australia
| | - Tia G. B. Hansen
- Center for Human Animal Psychology, Department of Communication and Psychology, Aalborg University, 9000 Aalborg, Denmark
| | - Lynette Hart
- School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Morag Heirs
- Clinical Animal Behaviour, Well Connected Canine, York YO24 3HG, UK
| | - Jade Hooper
- Faculty of Social Science, University of Stirling, Stirling FK9 4LA, UK
| | - Rachel Howe
- School of Nursing, Midwifery & Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Elizabeth Johnson
- Department of Anthropology, University of Nevada, Las Vegas, Las Vegas 89183, NV, USA
| | - Melanie Jones
- Orygen Centre for Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC 3000, Australia
- Lead The Way Institute Ferntree Gully, Boronia, VIC 3156, Australia
| | | | | | - Sun-A Kim
- Clinical Animal Behavior Service, Veterinary Medical Teaching Hospital, Chungbuk National University, Cheongju 28644, Korea
| | - Christine Kivlen
- Occupational Therapy, Health Care Sciences, Wayne State University, Detroit, MI 48202, USA
| | - Beth Lanning
- Department of Public Health, Baylor University, Waco, TX 76798, USA
| | - Helen Lewis
- Department of Education and Childhood Studies, Swansea University, Swansea SA2 8PP, UK
| | - Deborah Linder
- Department of Clinical Sciences, Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536, USA
| | - Dac Loc Mai
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
| | - Chiara Mariti
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy
| | | | - Gilly Mendes Ferreira
- Scottish SPCA (Scottish Society for the Prevention of Cruelty to Animals), Dunfermline KY11 8RY, UK
| | - Debbie Ngai
- Hong Kong Animal Assisted Therapy Association (HKAATA), Hong Kong, China
| | | | | | | | - Elizabeth Ormerod
- Society for Companion Animal Studies, Godmachester, Cambridgeshire PE29 2BQ, UK
| | - Emma R. Power
- Institute for Culture and Society, School of Social Sciences, Western Sydney University, Penrith, NSW 2751, Australia
| | - Peggy A. Pritchard
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Kerri Rodriguez
- Human-Animal Bond in Colorado, School of Social Work, Colorado State University, Fort Collins, CO 80526, USA
| | - Deborah Rook
- Northumbria Law School, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Matthew B. Ruby
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
| | - Leah Schofield
- Solihull College and University Centre, Solihull B91 1SB, UK
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian EH25 9RG, UK
| | - Tania Signal
- School of Health, Medical & Applied Sciences, College of Psychology, Central Queensland University, Rockhampton, QLD 4702, Australia
| | - Jill Steel
- Moray House School of Education and Sports Science, University of Edinburgh, Edinburgh EH8 8AQ, UK
| | - Wendy Stone
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC 3000, Australia
| | - Melissa Symonds
- Faculty of Health, Education and Society, The University of Northampton, Northampton NN1 5PH, UK
| | | | - Tiamat Warda
- Institute for Human-Animal Connection, University of Denver, Denver, CO 80208, USA
| | - Monica Wilson
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Janette Young
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Pauleen Bennett
- School of Psychology and Public Health, La Trobe University, Bendigo, VIC 3552, Australia
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O'Donnell K, Boyle S, Abdulrahman S, O'Leary E. Unexpected intraoperative hypotension in a chronic cocaine user. Anaesth Rep 2022; 10:e12177. [DOI: 10.1002/anr3.12177] [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] [Accepted: 06/14/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- K. O'Donnell
- Department of Anaesthesiology Tallaght University Hospital Dublin Ireland
| | - S. Boyle
- Department of Ear, Nose and Throat Surgery Tallaght University Hospital Dublin Ireland
| | - S. Abdulrahman
- Department of Ear, Nose and Throat Surgery Tallaght University Hospital Dublin Ireland
| | - E. O'Leary
- Department of Anaesthesiology Tallaght University Hospital Dublin Ireland
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Johnsson H, Hunter R, Boyle S. POS1468 PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY IN A PATIENT WITH A BACKGROUND OF LUPUS NEPHRITIS AND CEREBRAL LUPUS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundProgressive multifocal leukocencephalopathy (PML) is a potentially fatal degenerative condition caused by reactivation of the human polyomavirus 2 (JC virus) in immunodeficient individuals. It is well recognised in individuals who have received Rituximab, but patients treated with other immunosuppressants are at risk also (1). Moreover, patients with SLE may be at increased risk, even when they are not taking immunosuppressants (1, 2).ObjectivesDescribe the case of a patient with a history of lupus nephritis and cerebral lupus, on long-term Mycophenolate mofetil (MMF) and Prednisolone, diagnosed with PML complicated by immune reconstitution inflammatory syndrome (IRIS).MethodsCase report.ResultsThis patient first presented in 2010 at the age of 18 with ankle swelling and proteinuria. She had high ANA and anti-dsDNA titres, and renal biopsy showed class IV lupus nephritis. She went into remission on high dose Prednisolone and MMF and elected to stop her MMF. Four months later, she developed behaviour changes and worsening proteinuria. MRI showed a mild high signal lesion in the right cerebral hemisphere, and she was diagnosed with cerebral lupus. She recovered after treatment with IV methylprednisolone and MMF. Over the subsequent eight years, she had three flares of her lupus nephritis, with repeat biopsies in 2013 and 2018 showing active proliferative (class IVA) glomerulonephritis. Consequently she was treated with varying doses of oral Prednisolone and MMF for most of this period. She never received any B-cell depleting therapies.In October 2020, she presented to A&E with numbness in her left face and down her left arm and leg. MRI demonstrated signal abnormalities in her right hemisphere, involving the cortex, white matter and leptomeninges. She was lymphopenic (0.58x10^9/L) with a low CD4 count of 136 cells/uL (normal range 620-1990 cells/uL). A recent dsDNA had risen to 70 IU/ml. Her cerebrospinal fluid revealed mildly raised white cells and a weakly positive JC virus PCR. The differential diagnoses included cerebral lupus, opportunistic infection and malignancy. During this period of diagnostic uncertainty, she was treated with an increased dose of oral Prednisolone and plasma exchange. She went on to have a brain biopsy that showed peri-vascular lymphocytic infiltration and JC virus was present in high copy numbers in the brain tissue (49221.8 IU/mL), confirming a diagnosis of PML. Her MMF was stopped but she continued a low dose Prednisolone with the addition of Hydroxychloroquine.She was re-admitted two weeks after discharge in December 2020 with a right-sided headache, left facial weakness and loss of dexterity in her left hand. MRI showed evidence of IRIS in the right hemisphere with cerebral oedema causing midline shift. She was treated with IV Dexamethasone then Prednisolone 30 mg daily, with a gradual taper over a year.She has made a good recovery with minimal neurological deficit; she had recurrent seizures which responded well to anticonvulsant therapy. Her SLE has not flared.ConclusionThis describes a case of PML in the context of longstanding lupus nephritis, treated with prednisolone and MMF. Her longstanding lymphopenia with low CD4 counts were attributed to the combined consequences of active lupus and her cumulative immunosuppressive burden. CD4 lymphopenia is associated with PML in the HIV population, and may provide information about which patients on immunosuppressive treatments are at risk of developing PML (3). However, not enough is known to routinely screen patients and the counts of other lymphocyte subsets are likely to be important too.The case highlights that PML can be associated with different immunosuppressants, other than B-cell depletion. The prompt diagnosis, facilitated by brain biopsy, and appropriate management led to a good medium-term outcome for this patient, showing that PML is eminently survivable.References[1]Calabrese LH, Molloy ES. ARD 2008;67:iii64-iii65[2]Henegar CE et al. Lupus 2016;25(6):617-26[3]Mills EA, Mao-Draayer Y. Front Immunol 2018;9:138Disclosure of InterestsNone declared
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Huynh L, Keit E, Huang E, Carillo R, Ahlering T, Boyle S, Enke C, Baine M. PD-0573 Protective Effect of Metformin for Biochemical Failure post Radical Prostatectomy or Radiation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huynh L, Keit E, Carrillo R, Huang E, Ahlering T, Boyle S, Enke C, Baine M. PO-1395 Impact of Statin Use on Biochemical Failure following Radical Prostatectomy or Radiation Therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Huynh E, Boyle S, Campbell J, Penney J, Mak RH, Schoenfeld JD, Leeman JE, Williams CL. Technical Note: Toward implementation of MR-guided radiation therapy for Laryngeal cancer with healthy volunteer imaging and a custom MR-CT larynx phantom. Med Phys 2022; 49:1814-1821. [PMID: 35090060 DOI: 10.1002/mp.15472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Internal motion of the larynx can cause normal tissue toxicity and/or tumor underdosage during radiotherapy. MR-guided radiation therapy (MRgRT) provides improved soft-tissue contrast for patient setup, and real-time gating of radiation based on cine imaging of tumor motion, potentially making it an advantageous modality for laryngeal treatments. However, there are potential concerns regarding the small target size, proximity to heterogeneous tissue interfaces in the airway that may cause dosimetric errors in the presence of the magnetic field, and uncertainty about the ability of MR-linear accelerator (MR-Linac) systems to visualize and track laryngeal motion. To date, there have been no reports of the use of MRgRT for laryngeal treatments. METHODS A healthy volunteer was imaged on a ViewRay MRIdian MR-Linac. Organs-at-risk and a laryngeal pseudo target were contoured and used to generate a stereotactic body radiotherapy plan. A custom phantom was created using 3D-printing based on structures delineated on the volunteer images to construct an enclosure containing the target and airway anatomy, with a gap for radiochromic film, and filled with gelatin . The treatment plan was mapped onto the phantom and delivered dose assessed on radiochromic film with global normalization and a 10% dose threshold. A cine MR of the volunteer was acquired to assess the magnitude of larynx motion with speaking and swallowing, and system's ability to gate radiation. RESULTS A clinically acceptable laryngeal treatment plan and larynx phantom that was MR and CT-visible were successfully created. The delivered dose had good agreement with the treatment plan with a gamma passing rate of 96.5% (3%/2mm). The MR-Linac was able to visualize, track, and gate larynx motion. CONCLUSIONS The MRgRT workflow for laryngeal treatments was assessed and performed in preparation for clinical implementation on the MR-Linac, demonstrating that it is feasible to treat laryngeal cancer patients on the MR-Linac. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elizabeth Huynh
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Present address: London Regional Cancer Program, London Health Sciences Centre, London, ON, N6K 1C2, Canada
| | - Sara Boyle
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jennifer Campbell
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jessica Penney
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher L Williams
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Koenig J, Cagney D, Huynh E, Boyle S, Lee H, Williams C, Han Z, Leeman J, Mak R, Mancias J, Singer L. Target Coverage, Organ at Risk Metrics, and Tumor Control for Metastases to the Pancreas Treated With Adaptive MR-Guided Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1327] [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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Merriman A, Boyle S. OP0079 LIMB GIRDLE MUSCULAR DYSTROPHY TYPE 2B - A RARE MYOSITIS MIMIC. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Proximal muscle weakness with associated raised creatine kinase (CK) commonly leads to referral to Rheumatology for the investigation of Idiopathic Inflammatory Myopathy (IIM). Some genetic myopathies can have a similar presentation with investigations that suggest inflammatory disease, leading to difficulty with accurate diagnosis (Amato & Brown, 2011; Harlan & Mammen, 2019).Objectives:To describe the case of a patient with Limb Girdle Muscular Dystrophy Type 2B (LGMD2B), whose initial presentation mimicked an inflammatory myopathy.Methods:Case report.Results:A 43-year-old patient was reviewed by Rheumatology due to proximal muscle weakness with a raised CK. Muscle biopsy was suggestive of inflammatory myopathy. Therefore, he was started on treatment with corticosteroids. Corticosteroid treatment resulted in no improvement in his weakness or CK. His diagnosis was reviewed, and he was referred to the Neurology and Genetics services. Following molecular genetic analysis, a diagnosis of Limb Girdle Muscular Dystrophy Type 2B was made.Conclusion:Muscle biopsies can suggest an inflammatory aetiology in some genetic myopathies (Amato & Brown, 2011; Harlan & Mammen, 2019). If a patient with suspected IIM presents with atypical features, or they do not respond as expected to treatment, then consider a genetic myopathy such as LGMD2B as a cause and involve the Neurology and Genetics services in the case.References:[1]Amato, A. A., & Brown, R. H., Jr. (2011). Dysferlinopathies. Handb Clin Neurol, 101, 111-118. https://doi.org/10.1016/b978-0-08-045031-5.00007-4[2]Harlan, M & Mammen A. L (2019). Myositis Mimics: The Differential Diagnosis of Myositis. In: R. Aggarwal and C. V. Oddis (Eds.) Managing Myositis (pp. 209-223). Springer, Cham.Disclosure of Interests:None declared
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Boyle PJ, Huynh E, Boyle S, Campbell J, Penney J, Usta I, Neubauer Sugar E, Hacker F, Williams C, Cagney D, Mak R, Singer L. Use of a healthy volunteer imaging program to optimize clinical implementation of stereotactic MR-guided adaptive radiotherapy. Tech Innov Patient Support Radiat Oncol 2020; 16:70-76. [PMID: 33305025 PMCID: PMC7710639 DOI: 10.1016/j.tipsro.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE MR-linacs (MRLs) have enabled the use of stereotactic magnetic resonance (MR) guided online adaptive radiotherapy (SMART) across many cancers. As data emerges to support SMART, uncertainty remains regarding optimal technical parameters, such as optimal patient positioning, immobilization, image quality, and contouring protocols. Prior to clinical implementation of SMART, we conducted a prospective study in healthy volunteers (HVs) to determine optimal technical parameters and to develop and practice a multidisciplinary SMART workflow. METHODS HVs 18 years or older were eligible to participate in this IRB-approved study. Using a 0.35 T MRL, simulated adaptive treatments were performed by a multi-disciplinary treatment team in HVs. For each scan, image quality parameters were assessed on a 5-point scale (5 = extremely high, 1 = extremely poor). Adaptive recontouring times were compared between HVs and subsequent clinical cases with a t-test. RESULTS 18 simulated treatments were performed in HVs on MRL. Mean parameters for visibility of target, visibility of nearby organs, and overall image quality were 4.58, 4.62, and 4.62, respectively (range of 4-5 for all measures). In HVs, mean ART was 15.7 min (range 4-35), comparable to mean of 16.1 (range 7-33) in the clinical cases (p = 0.8963). Using HV cases, optimal simulation and contouring guidelines were developed across a range of disease sites and have since been implemented clinically. CONCLUSIONS Prior to clinical implementation of SMART, scans of HVs on an MRL resulted in acceptable image quality and target visibility across a range of organs with similar ARTs to clinical SMART. We continue to utilize HV scans prior to clinical implementation of SMART in new disease sites and to further optimize target tracking and immobilization. Further study is needed to determine the optimal duration of HV scanning prior to clinical implementation.
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Affiliation(s)
- Patrick J. Boyle
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Huynh
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sara Boyle
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jennifer Campbell
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jessica Penney
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Emily Neubauer Sugar
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Fred Hacker
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Christopher Williams
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Daniel Cagney
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raymond Mak
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Lisa Singer
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Boyle P, Huynh E, Neubauer Sugar E, Hacker F, Boyle S, Usta I, Campbell J, Penney J, Bernal A, Williams C, Cagney D, Mak R, Singer L. Impact of Healthy Volunteer MR-Linac Imaging on Clinical Implementation of Stereotactic MR-Guided Online Adaptive Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Williams C, Huynh E, Campbell J, Penney J, Boyle S, Usta I, Sugar EN, Hacker F, Han Z, Price A, Singer L, Cagney D, Mak R. Initial Experience With Online Adaptive Radiotherapy Workflows on an MRI-guided Linear Accelerator. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2327] [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]
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Boyle S, McCallum C, Cox S, Vollbon W, Chong A, Wahi S. 354 Incidence and Implication of Persistently Positive Agitated Saline Contrast Studies (ASCS) at 6 Months Post-transcatheter Patent Foramen Ovale (PFO) Closure - Is the Juice Worth the Squeeze? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Harris L, Hankey C, Jones N, Murray H, Pert C, Tobin J, Boyle S, Shearer R, Melville CA. Process evaluation of a cluster-randomised controlled trial of multi-component weight management programme in adults with intellectual disabilities and obesity. J Intellect Disabil Res 2019; 63:49-63. [PMID: 30417575 DOI: 10.1111/jir.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/10/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full-scale clinical trial of the TAKE 5 multi-component weight management programme. METHODS The study was a 12-month pilot cluster-randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed-methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context. RESULTS The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers. CONCLUSIONS The extensive process evaluation illustrated that a full-scale trial of a multi-component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity.
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Affiliation(s)
- L Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Hankey
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jones
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Pert
- Learning Disability Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Tobin
- Glasgow City CHP North East Sector, Eastbank Conference Training Centre, Glasgow, UK
| | - S Boyle
- Consultant Clinical Psychologist NHS Greater, Glasgow, UK
| | - R Shearer
- Glasgow and Clyde Specialist Weight Management Service, Glasgow, UK
| | - C A Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
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Somaiah N, Anbalagan S, Strom C, Downs J, Jeggo P, Wilkins A, Boyle S, Rothkamm K, Yarnold J. OC-0380: Cell cycle checkpoint modulates radiotherapy fraction size sensitivity in normal and malignant cells. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30690-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Boyle S, Harle R, Lai T, Jenkins C, Dahiya A. Palm Tree Heart: The Utility of Multimodality Imaging and The Importance of Clinical Monitoring in Isolated Left Ventricular Non–Compaction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.486] [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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20
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Boyle S, Olive G, Townell N, Henderson A, Bowler S, Blum S. Legionella longbeachae pneumonia as a complication of alemtuzumab therapy. J Clin Neurosci 2017; 46:67-69. [DOI: 10.1016/j.jocn.2017.08.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/15/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022]
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Wen SYB, Peng AZY, Boyle S, Cai S, Pope L, Tran MT, Short TG, Aneman A, Jaeger M, Chuan A. A Pilot Study Using Preoperative Cerebral Tissue Oxygen Saturation to Stratify Cardiovascular Risk in Major Non-Cardiac Surgery. Anaesth Intensive Care 2017; 45:202-209. [PMID: 28267942 DOI: 10.1177/0310057x1704500210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability. Eleven patients (13.6%) suffered a major adverse event, and 28 patients (34.6%) experienced new disability. Room air cerebral tissue oxygen saturation was significantly different between patients who had a major adverse event, 67% (95% confidence interval [CI] 65–70) versus unaffected, 71% (95% CI 70–72; P=0.04). No statistical difference was found between patients for new disability (range 70%– 74%; P=0.73). Room air cerebral tissue oxygen saturation was significantly associated with major adverse events (odds ratio 1.36 (95% CI 1.03–1.79), P=0.03). Saturation levels ≤68% carried a positive likelihood ratio of 2.2 for death or severe morbidity, P=0.04. A definitive trial is required to confirm if cerebral oximetry can be used to stratify the cardiovascular risk of patients presenting for non-cardiac surgery.
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Affiliation(s)
- S. Y. B. Wen
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Z. Y. Peng
- South West Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - S. Boyle
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - S. Cai
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - L. Pope
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - M. T. Tran
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
| | - T. G. Short
- Department of Anaesthesia, Auckland City Hospital, New Zealand
| | - A. Aneman
- Department of Intensive Care, Liverpool Hospital, Sydney, New South Wales
| | - M. Jaeger
- South Western Sydney Clinical School, University of NSW, Sydney, New South Wales
| | - A. Chuan
- Department of Anaesthesia, Liverpool Hospital, Sydney, New South Wales
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Boyle S, An J, Krishnasamy V, Metwalli A, Wood B. Accelerated growth rate of ipsilateral renal tumors after radiofrequency ablation in multifocal hereditary RCC. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.678] [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] Open
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Beck J, Newburn E, Clark M, Lefterova M, Helman E, Alla R, Church D, Boyle S, Luo S, Morra M, Harris J, Leng N, Haudenschild C, Chen R, West J. Analytical validation of comprehensive assays for genomic profiling of cancer from DNA and RNA. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herskind C, Nuta O, Somaiah N, Boyle S, Chua M, Gothard L, Rothkamm K, Yarnold J. Subgroup Analysis of Functional Associations Between In Vitro Radiation Response of Fibroblasts and Late Toxicity After Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.164] [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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McLean RC, Morrison DS, Shearer R, Boyle S, Logue J. Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clin Obes 2016; 6:133-42. [PMID: 26842226 DOI: 10.1111/cob.12136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2) = 0.094, P < 0.001 and r(2) = 0.175, P < 0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5 kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P = 0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P < 0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.
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Affiliation(s)
- R C McLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D S Morrison
- West of Scotland Cancer Surveillance Unit, 1 Lilybank Gardens, Glasgow, UK
| | - R Shearer
- Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S Boyle
- Glasgow and Clyde Weight Management Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Herskind C, Nuta O, Somaiah N, Boyle S, Chua M, Gothard L, Rothkamm K, Yarnold J. PO-0991: p53 and in vitro radiation response of fibroblasts from RT-sensitive and -resistant patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32241-1] [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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Landeg S, Kirby A, Lee S, Bartlett F, Donovan E, Locke I, Gothard L, Boyle S, Titmarsh K, Griffin C, McNair H. PO-0782: Breast radiotherapy: invisible tattoos for external references (The BRITER study). Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40774-1] [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: 11/24/2022]
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Somaiah N, Rodrigues D, Cheang M, Heindl A, Daley F, Boyle S, Rakha E, A'Hern R, Bliss J, Yuan Y, Yarnold J. OC-0392: Tumour characteristics associated with local relapse after hypofractionated radiotherapy in early breast cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40388-3] [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: 11/30/2022]
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Vallot C, Hérault A, Boyle S, Bickmore WA, Radvanyi F. PRC2-independent chromatin compaction and transcriptional repression in cancer. Oncogene 2015; 34:741-51. [PMID: 24469045 DOI: 10.1038/onc.2013.604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 07/09/2013] [Revised: 12/10/2013] [Accepted: 12/20/2013] [Indexed: 12/13/2022]
Abstract
The silencing of large chromosomal regions by epigenetic mechanisms has been reported to occur frequently in cancer. Epigenetic marks, such as histone methylation and acetylation, are altered at these loci. However, the mechanisms of formation of such aberrant gene clusters remain largely unknown. Here, we show that, in cancer cells, the epigenetic remodeling of chromatin into hypoacetylated domains covered with histone H3K27 trimethylation is paralleled by changes in higher-order chromatin structures. Using fluorescence in situ hybridization, we demonstrate that regional epigenetic silencing corresponds to the establishment of compact chromatin domains. We show that gene repression is tightly correlated to the state of chromatin compaction and not to the levels of H3K27me3-its removal through the knockdown of EZH2 does not induce significant gene expression nor chromatin decompaction. Moreover, transcription can occur with intact high-H3K27me3 levels; treatment with histone deacetylase inhibitors can relieve chromatin compaction and gene repression, without altering H3K27me3 levels. Our findings imply that compaction and subsequent repression of large chromatin domains are not direct consequences of PRC2 deregulation in cancer cells. By challenging the role of EZH2 in aberrant gene silencing in cancer, these findings have therapeutical implications, notably for the choice of epigenetic drugs for tumors with multiple regional epigenetic alterations.
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Affiliation(s)
- C Vallot
- 1] CNRS, UMR 144 - Cell Biology Department, Institut Curie, Paris, France [2] Institut Curie, Centre de Recherche, Paris, France
| | - A Hérault
- 1] CNRS, UMR 144 - Cell Biology Department, Institut Curie, Paris, France [2] Institut Curie, Centre de Recherche, Paris, France
| | - S Boyle
- Chromosome and Gene Expression Section, MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine at the University of Edinburgh, Scotland, UK
| | - W A Bickmore
- 1] Chromosome and Gene Expression Section, MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine at the University of Edinburgh, Scotland, UK [2] Breakthrough Breast Cancer Research Unit, University of Edinburgh, Scotland, UK
| | - F Radvanyi
- 1] CNRS, UMR 144 - Cell Biology Department, Institut Curie, Paris, France [2] Institut Curie, Centre de Recherche, Paris, France
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Spanos D, Hankey C, Boyle S, Melville C. Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities. J Hum Nutr Diet 2013; 27:22-9. [DOI: 10.1111/jhn.12051] [Citation(s) in RCA: 10] [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] [Indexed: 11/27/2022]
Affiliation(s)
- D. Spanos
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - C. Hankey
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - S. Boyle
- Glasgow and Clyde Weight Management Service NHS Greater Glasgow and Clyde Glasgow UK
| | - C. Melville
- College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
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Spanos D, Hankey CR, Boyle S, Koshy P, Macmillan S, Matthews L, Miller S, Penpraze V, Pert C, Robinson N, Melville CA. Carers' perspectives of a weight loss intervention for adults with intellectual disabilities and obesity: a qualitative study. J Intellect Disabil Res 2013; 57:90-102. [PMID: 22369631 DOI: 10.1111/j.1365-2788.2011.01530.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To date, no studies have explored the role of carers in supporting adults with intellectual disabilities (ID) and obesity during a weight loss intervention. The present study explored perceptions of carers supporting adults with ID, as they participated in a 6-month multi-component weight loss intervention (TAKE 5). METHODS Semi-structured interviews were used to explore the experiences of 24 carers. The transcripts were analysed qualitatively using thematic analysis. RESULTS Three themes emerged from the analysis: carers' perceptions of participants' health; barriers and facilitators to weight loss; and carers' perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted. CONCLUSION This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.
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Affiliation(s)
- D Spanos
- Institute of Health and Wellbeing, College of Medical and Veterinary Life Sciences, University of Glasgow, UK
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Boyle S, Latini R, Jhund P, MacDonald M, Petrie M, Pitt B, Maggioni A, Chang W, Lewsey J, Solomon S, McMurray J. Dual Renin–angiotensin System Blockade with Aliskiren in Patients with Heart Failure, with or without Diabetes Mellitus: Insights from ALOFT. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.179] [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: 11/27/2022]
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Sawyer S, Boyle S, Young MA, Kovalenko S, Doherty R, McKinley J, Alsop K, Rehfisch M, Macaskill S, Ha A, Beshay V, Lindeman G, Harris M, Fox S, Mitchell G, James P. The contribution of LARGE genomic rearrangements of BRCA1 and BRCA2 gene mutations in breast and ovarian cancer families in a clinical cohort. Hered Cancer Clin Pract 2012. [PMCID: PMC3327262 DOI: 10.1186/1897-4287-10-s2-a89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Boyle S, Walters MR. Clinically significant interaction between warfarin and popular cough lozenges 'Fisherman's Friend'. Case Reports 2011; 2011:bcr.09.2011.4791. [DOI: 10.1136/bcr.09.2011.4791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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35
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O'Connell C, Razavi P, Ghalichi M, Boyle S, Vasan S, Mark L, Caton A, Duddalwar V, Boswell W, Grabow K, Liebman HA. Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost 2011; 9:305-11. [PMID: 20955348 DOI: 10.1111/j.1538-7836.2010.04114.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND While symptomatic venous thromboembolism adversely impacts survival among cancer patients, the outcome of cancer patients with unsuspected pulmonary embolism (UPE) found on routine cancer staging multi-row detector computed tomography (MDCT) scans is unknown. OBJECTIVE To determine whether UPE detected on routine staging MDCT scans impacts overall survival among cancer patients. PATIENTS AND METHODS We performed a matched cohort study of cancer patients diagnosed with UPE on routine staging scans between May 2003 and August 2006. Two controls (n = 137) were individually matched by age (± 5 years), cancer type and stage for each UPE patient (n = 70). We used Cox's proportional hazard models to compare the mortality between UPE patients and their matched controls. RESULTS The hazard ratio (HR) for death among UPE patients was 1.51 (95% CI 1.01-2.27, P = 0.048). Compared with their matched controls, patients with UPE more proximal than the subsegmental arterial branches had a HR for death at 6 months of 2.28 (95% CI 1.20-4.33, P = 0.011) and an overall HR of 1.70 (95% CI 1.06-2.74, P = 0.027). Survival among UPE patients with isolated subsegmental PE (ISSPE) was not significantly different than that of matched controls (HR 1.04 95% CI 0.44-2.39, P = 0.92). CONCLUSIONS UPE identified more proximal than the subsegmental arterial branches has a significant negative impact on survival among cancer patients.
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Affiliation(s)
- C O'Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Affiliation(s)
- D Bolton
- Institute of Psychiatry, Kings College London, UK.
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Kuykendal A, Bennett CL, McKoy JM, Boyle S, West DP, Edwards BJ, Courtney DM, Sartor AO, Lai SY, Henke M. Tumor progression and mortality associated with administration of erythropoiesis stimulating agents (ESAs) to cancer patients: Is toxicity due to ESAs or elevated hemoglobin (Hgb) levels. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11115] [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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Abstract
Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence-based clinical weight management services.
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Affiliation(s)
- S Hamilton
- Section of Psychological Medicine, University of Glasgow, Glasgow, UK
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Abstract
People with intellectual disabilities experience significant health inequalities compared with the general population, including a shorter life expectancy and high levels of unmet health needs. Another accepted measure of health inequalities, the prevalence of obesity, has been shown to be higher in adults with intellectual disabilities than in the general population. While the factors contributing to the increased prevalence among adults with intellectual disabilities are not well understood, the high rates of obesity among younger adults highlight the need for further research involving children and adolescents with intellectual disabilities. To take forward the priorities for research and the development of effective, accessible services, there is a need for collaboration between professionals working in the fields of intellectual disabilities and obesity.
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Affiliation(s)
- C A Melville
- Section of Psychological Medicine, University of Glasgow, Glasgow, UK.
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Lovvorn H, Westrup J, Shi G, Boyle S, De Caestecker M. P248. J Surg Res 2007. [DOI: 10.1016/j.jss.2006.12.432] [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]
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41
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O'Connell C, Mark L, Boswell W, Boyle S, Vasan S, Ghalichi M, Liebman H. PO-99 Outcomes in cancer patients with unsuspected pulmonary emboli found on staging CT scans. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70252-9] [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: 11/27/2022]
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42
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Boyce Cam NJ, Muthukumar N, Boyle S, Lawton JO, Stretch R. Rib impingement in first class cricketers: case reports of two patients who underwent rib resection. Br J Sports Med 2006; 40:732-3; discussion 733. [PMID: 16790483 PMCID: PMC2579480 DOI: 10.1136/bjsm.2006.027995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two first class cricket bowlers presented with costoiliac pain secondary to rib impingement. In both patients, conservative management of the injury had failed to improve symptoms. Surgical resection of the affected rib was undertaken. At follow up, both patients had made a good recovery and had returned to competitive cricket.
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Affiliation(s)
- N J Boyce Cam
- Department of Orthopaedic & Trauma Surgery, Leeds General Infirmary, Leeds NHS Teaching Hospital Trust, Great George Street, Leeds, UK.
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Abstract
We describe the development of the Safe Tractor Assessment and Rating System (STARS), a design-based tractor safety rating system that can be applied to new or used tractors to provide an objective assessment of their inherent safety features. A predictive rating system model, based on technical inspection, was used. Key principles underlying the system included the potential for design features to reduce the risk of an injury event occurring, and to reduce the risk of injury if such an event did occur. The rating system was based on current standards, research literature, injury and fatality data, and farmer input via focus groups. Development was an iterative process involving field, pilot, and inter-rater reliability tests. The final system was divided into six domains: rollover protection, runover protection, user protection, information and controls, pedestrian protection, and options. Within each domain, optimum design features were described for the common or serious potential injury risks, and a score was assigned for each feature. Scores were translated into a star rating, from zero stars for virtually no inherent safety features to five stars for the highest inherent safety, for each of the six domains. STARS distinguished well between older tractor models known to have few inherent safety features and newer tractor models known to have higher levels of inherent safety. STARS can provide tractor manufacturers, dealers, and users with information critical for managing tractor-associated injury risk. In Australia, it is initially being implemented within the curriculum of the technical education and training sector.
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Affiliation(s)
- L Day
- Monash University Accident Research Centre, Monash University, Victoria, Australia.
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Dix FP, Boyle S, McCollum CN. Mild and moderate varicose vein reflux does not deteriorate over time. Phlebology 2005. [DOI: 10.1258/0268355053300820] [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: 11/18/2022]
Abstract
Objective: To prioritize varicose vein (VV) waiting lists, superficial venous reflux was timed in patients with primary VVs using hand-held Doppler (HHD) and classified as 'severe' (≤4s), 'moderate' (>4; ≤6s) or 'mild' (>6s). Only patients with severe reflux were offered surgery. The progression of reflux in those not offered surgery was investigated over two years. Methods: Patients seen in the VV clinic between November 1999 and October 2000 with reflux ≥4s were re-assessed two years later. Reflux was timed at the saphenofemoral (SFJ) and saphenopopliteal (SPJ) junctions using HHD. Patients completed a basic symptom questionnaire. The severity of VVs and skin changes of venous insufficiency were graded. Results: In all, 38/54 patients attended for review at two years. There were 44 limbs with 48 sites of reflux, 38 at the SFJ and 10 at the SPJ. Reflux improved at 27 sites, remained the same at five and deteriorated at 16. Reflux became 'severe' in eight limbs, but only four patients requested surgery. Median (interquartile range) reflux time was 6.0 (5–6)s in 1999–2000 and 7.0 (4–10)s in 2002 ( P = 0.13). Median symptom scores for aching and the severity of VV remained unchanged. The cosmetic appearance of VV and skin signs of venous insufficiency significantly improved ( P < 0.01). Conclusions: Mild and moderate reflux did not deteriorate in most VV patients. HHD may be a useful adjunct to grade venous reflux and prioritize patients for VV surgery.
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Affiliation(s)
- F P Dix
- Department of Vascular Surgery, South Manchester University Hospitals NHS Trust, Manchester, UK
| | - S Boyle
- Department of Vascular Surgery, South Manchester University Hospitals NHS Trust, Manchester, UK
| | - C N McCollum
- Department of Vascular Surgery, South Manchester University Hospitals NHS Trust, Manchester, UK
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Lovvorn H, Boyle S, Shi G, de Caestecker M. Cited 1 and its role in Wilms’ tumorigenesis. J Surg Res 2003. [DOI: 10.1016/j.jss.2003.08.199] [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: 10/27/2022]
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46
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Owa AO, Boyle S, Gallimore AP. Eosinophilic angiocentric fibrosis as a cause of nasal obstruction. Rhinology 2002; 40:41-3. [PMID: 12012953] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We present the tenth case of Eosinophilic Angiocentric Fibrosis (EAF) in the english literature, which presented as nasal obstruction in a patient of Indian descent. The histopathological and clinical features of this underreported condition is discussed as well as other lesions that may show similar features to EAF.
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Affiliation(s)
- A O Owa
- ENT Department, Northwick Park Hospital, London, United Kingdom.
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Burke M, Burke KI, Boyle S, Shah K, Price AB, Zammit C. Late results of selective axillary surgery based on contact cytology in women with operable breast cancer. Br J Surg 2002; 89:341-3. [PMID: 11872060 DOI: 10.1046/j.0007-1323.2001.02028.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Interest in the possibility of intraoperative analysis of sentinel lymph nodes to select patients with operable breast cancer for immediate axillary clearance encouraged this review of a long-term experience of selective axillary surgery based on intraoperative contact cytology of conventionally sampled nodes. Survival was assessed as a potential marker for understaging. METHODS Records of 437 patients who had surgery between 1991 and 1994 were reviewed to compare rates of axillary recurrence in patients who had contact cytology only with those who had contact cytology and axillary clearance. RESULTS Axillary recurrence occurred in seven (3 per cent) of 219 patients who had negative contact cytology, three (4 per cent) of 75 patients who had positive contact cytology with axillary clearance and one (1 per cent) of 93 who had axillary clearance alone. In patients with positive contact cytology, 131 (78 per cent) of 168 positive nodes were in the sample specimen, which included all positive nodes on 19 occasions. Survival probability at 36, 72 and 96 months was 92, 87 and 84 per cent respectively for patients with negative contact cytology, and 85, 73 and 71 per cent for patients with positive cytology and axillary clearance. CONCLUSION A selective approach to axillary surgery based on intraoperative contact cytology of sampled lymph nodes gave good long-term control of axillary disease.
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Affiliation(s)
- M Burke
- Departments of Surgery and Cellular Pathology, Northwick Park Hospital, Harrow, UK.
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Boyle S, Appleby J. NHS activity. Short measure. Health Serv J 2001; 111:24-7. [PMID: 11810754] [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: 04/17/2023]
Abstract
Despite a large increase in NHS funding, the rate of activity has slowed and may be decreasing. Elective activity has fallen at times when more money is going in. Growth in elective activity has tended to be in planned admissions, which have no direct impact on waiting lists. Unless money is redirected into activity-generating areas that impact on waiting times, the NHS will struggle to deliver on waiting-time targets.
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Appleby J, Boyle S. Health spending. Extra time. Health Serv J 2001; 111:22-5. [PMID: 11706805] [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: 02/22/2023]
Abstract
The government is committed to raise spending on healthcare in the UK up to the European average by 2006. There is debate about the exact target figure, but agreement that the key consideration is how the extra money will be spent. If the UK is to achieve the EU average, it will probably have to increase private as well as public spending. To match German levels of staffing, the UK would need an extra 100,000 doctors and 300,000 nurses. There has been little analysis of how the extra expenditure will improve outcomes.
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50
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Dundas SR, Boyle S, Bellamy CO, Hawkins W, Garden OJ, Ross JA, Bickmore W. Dual Y-chromosome painting and immunofluorescence staining of archival human liver transplant biopsies. J Histochem Cytochem 2001; 49:1321-2. [PMID: 11561017 DOI: 10.1177/002215540104901015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Combining fluorescence in situ hybridization (FISH) and indirect immunofluorescence staining of protein markers provides a highly specific method for identifying chromosomes in phenotypically defined cells and tissues. We developed a technique enabling dual chromosome painting and immunofluorescence staining of archival formalin-fixed, paraffin-embedded material, and used this to phenotype chimeric cells in female-to-male human liver transplants.
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Affiliation(s)
- S R Dundas
- Department of Clinical and Surgical Sciences, University of Edinburgh, Scotland, UK.
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