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Crew KD, Anderson GL, Arnold KB, Stieb AP, Amenta JN, Collins N, Law CW, Pruthi S, Sandoval-Leon A, Bertoni D, Grosse Perdekamp MT, Colonna S, Krisher S, King T, Yee LD, Ballinger TJ, Braun-Inglis C, Mangino D, Wisinski KB, DeYoung CA, Ross M, Floyd J, Kaster A, Vander Walde L, Saphner T, Zarwan C, Lo S, Graham C, Conlin A, Yost K, Agnese D, Jernigan C, Hershman DL, Neuhouser ML, Arun B, Kukafka R. Making informed choices on incorporating chemoprevention into carE (MiCHOICE, SWOG 1904): Design and methods of a cluster randomized controlled trial. Contemp Clin Trials 2024:107564. [PMID: 38704119 DOI: 10.1016/j.cct.2024.107564] [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: 12/12/2023] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy. METHODS/DESIGN We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation. RESULTS/DISCUSSION With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S. CLINICAL SETTINGS TRIAL REGISTRATION NCT04496739.
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Affiliation(s)
- K D Crew
- Columbia University Irving Medical Center, New York, NY, USA.
| | - G L Anderson
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - K B Arnold
- SWOG Statistics and Data Management Center, Seattle, WA, USA
| | - A P Stieb
- Columbia University Irving Medical Center, New York, NY, USA
| | - J N Amenta
- Columbia University Irving Medical Center, New York, NY, USA
| | - N Collins
- Columbia University Irving Medical Center, New York, NY, USA
| | - C W Law
- Columbia University Irving Medical Center, New York, NY, USA
| | - S Pruthi
- Mayo Clinic, Rochester, MN, United States of America
| | - A Sandoval-Leon
- Miami Cancer Institute at Baptist Health South Florida, Miami, FL, USA
| | - D Bertoni
- Good Samaritan Hospital Corvallis, Corvallis, OR , USA
| | | | - S Colonna
- Huntsman Cancer Institute / University of Utah Medical Center, Salt Lake City, UT, USA
| | - S Krisher
- Holy Redeemer Hospital and Medical Center, Meadowbrook, PA, USA
| | - T King
- Dana-Farber Brigham Cancer Center, Brigham and Women's Hospital, Boston, MA, USA
| | - L D Yee
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - T J Ballinger
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - D Mangino
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K B Wisinski
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | | | - M Ross
- Virginia Commonwealth University, Richmond, VA, USA
| | - J Floyd
- Cancer Care Specialists of Illinois, Heartland NCORP, Decatur, IL, USA
| | - A Kaster
- Sanford Roger Maris Cancer Center, Fargo, ND, United States of America
| | - L Vander Walde
- Baptist Memorial Health Care, Memphis, TN, United States of America
| | | | - C Zarwan
- Lahey Hospital & Medical Center, Burlington, MA, USA
| | - S Lo
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - C Graham
- Emory University Hospital/Winship Cancer Institute, Atlanta, GA, USA
| | - A Conlin
- Providence Cancer Institute, Portland, OR, USA
| | - K Yost
- Cancer Research Consortium of West Michigan NCORP, Kalamazoo, MI, USA
| | - D Agnese
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - C Jernigan
- Columbia University Irving Medical Center, New York, NY, USA
| | - D L Hershman
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - B Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Kukafka
- Columbia University Irving Medical Center, New York, NY, USA
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Wang YY, Cheng KH, Hung AC, Lo S, Chen PY, Wu YC, Hou MF, Yuan SSF. Differential impact of cytoplasmic vs. nuclear RAD51 expression on breast cancer progression and patient prognosis. Int J Oncol 2024; 64:12. [PMID: 38063232 PMCID: PMC10734667 DOI: 10.3892/ijo.2023.5600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
RAD51 recombinase is one of the DNA damage repair proteins associated with breast cancer risk. Apart from its function to maintain genomic integrity within the cell nucleus, RAD51 localized to the cytoplasm has also been implicated in breast malignancy. However, limited information exists on the roles of cytoplasmic vs. nuclear RAD51 in breast cancer progression and patient prognosis. In the present study, the association of cytoplasmic and nuclear RAD51 with clinical outcomes of patients with breast cancer was analyzed, revealing that elevated cytoplasmic RAD51 expression was associated with breast cancer progression, including increased cancer stage, grade, tumor size, lymph node metastasis and chemoresistance, along with reduced patient survival. By contrast, elevated nuclear RAD51 expression largely had the inverse effect. Results from in vitro investigations supported the cancer‑promoting effect of RAD51, showing that overexpression of RAD51 promoted breast cancer cell growth, chemoresistance and metastatic ability, while knockdown of RAD51 repressed these malignant behaviors. The current data suggest that differential expression of subcellular RAD51 had a distinct impact on breast cancer progression and patient survival. Specifically, cytoplasmic RAD51 in contrast to nuclear RAD51 was potentially an adverse marker in breast cancer.
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Affiliation(s)
- Yen-Yun Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807
- Drug Development and Value Creation Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
| | - Kuang-Hung Cheng
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan, R.O.C
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Amos C. Hung
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Steven Lo
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Pang-Yu Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Yi-Chia Wu
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Shyng-Shiou F. Yuan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
- Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan, R.O.C
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
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Lo S, Rose A, Fowers S, Darko K, Britto A, Spina T, Ankrah L, Godonu A, Ntreh D, Lalwani R, Graham C, Tittsworth D, McIntyre A, O'Dowd C, Watson S, Maguire R, Hoak A, Ampomah O, Cutler B. Ghana 3D Telemedicine International MDT: A proof-of-concept study. J Plast Reconstr Aesthet Surg 2024; 88:425-435. [PMID: 38091684 DOI: 10.1016/j.bjps.2023.10.130] [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: 05/12/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 01/02/2024]
Abstract
A real-time 3D Telemedicine system - leveraging Microsoft's Holoportation™ communication technology - enabled an international multidisciplinary team meeting (MDT) to consult with complex reconstructive patients before, during, and after an overseas surgical collaboration. METHODS A proof-of-concept international 3D MDT clinic took place in November 2022, between the Canniesburn Plastic Surgery Unit, UK, and the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana. The 3D system was utilised 1) previsit to assess patients and enable logistical planning, 2) on-site in Ghana to further allow patients to see themselves and proposed operations in 3D, and 3) post visit to debrief the team and patients. RESULTS Four Ghana patients were followed through their patient journey (mandibular ameloblastoma, sarcoma thigh, maxillary tumour, sarcoma back). Thirteen participants (four patients, four Ghana clinicians, and five UK clinicians) completed feedback on the 3D MDT. Outcome measures were rated highly with satisfaction 84.31/100, perceived benefit 4.54/5, overall quality 127.3/147 (Telehealth Usability Questionnaire), and usability 83.2/100 (System Usability Scale). These data show close alignment with that previously published on high-income countries. CONCLUSIONS This novel technology has the potential to enhance the delivery of overseas surgical visits to low-to-middle-income countries, by improving planning, informed discussion with patients, expert consensus on complex cases, and fostering engagement with professionals who may be thousands of miles away. This is the first demonstration that real-time 3D Telemedicine can both work, and enhance care within an international MDT clinic, and may thus enable change in the approach to overseas surgical collaborations.
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Affiliation(s)
- Steven Lo
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Anna Rose
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Kwame Darko
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Levi Ankrah
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Arnold Godonu
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Daniel Ntreh
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ruchi Lalwani
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | - Catriona Graham
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK
| | | | - Aileen McIntyre
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | | | - Stuart Watson
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK
| | - Roma Maguire
- Computer and Information Sciences, Livingstone Tower, University of Strathclyde, Glasgow G1 1XH, UK
| | | | - Opoku Ampomah
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
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Lo S, Fowers S, Darko K, Spina T, Graham C, Britto A, Rose A, Tittsworth D, McIntyre A, O'Dowd C, Maguire R, Chang W, Young D, Hoak A, Young R, Dunlop M, Ankrah L, Messow M, Ampomah O, Cutler B, Armstrong R, Lalwani R, Davison R, Bagnall S, Hudson W, Shepperd M, Johnson J. Participatory development of a 3D telemedicine system during COVID: The future of remote consultations. J Plast Reconstr Aesthet Surg 2023; 87:479-490. [PMID: 36890078 DOI: 10.1016/j.bjps.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The COVID pandemic brought the need for more realistic remote consultations into focus. 2D Telemedicine solutions fail to replicate the fluency or authenticity of in-person consultations. This research reports on an international collaboration on the participatory development and first validated clinical use of a novel, real-time 360-degree 3D Telemedicine system worldwide. The development of the system - leveraging Microsoft's Holoportation™ communication technology - commenced at the Canniesburn Plastic Surgery Unit, Glasgow, in March 2020. METHODS The research followed the VR CORE guidelines on the development of digital health trials, placing patients at the heart of the development process. This consisted of three separate studies - a clinician feedback study (23 clinicians, Nov-Dec 2020), a patient feedback study (26 patients, Jul-Oct 2021), and a cohort study focusing on safety and reliability (40 patients, Oct 2021-Mar 2022). "Lose, Keep, and Change" feedback prompts were used to engage patients in the development process and guide incremental improvements. RESULTS Participatory testing demonstrated improved patient metrics with 3D in comparison to 2D Telemedicine, including validated measures of satisfaction (p<0.0001), realism or 'presence' (Single Item Presence scale, p<0.0001), and quality (Telehealth Usability Questionnaire, p = 0.0002). The safety and clinical concordance (95%) of 3D Telemedicine with a face-to-face consultation were equivalent or exceeded estimates for 2D Telemedicine. CONCLUSIONS One of the ultimate goals of telemedicine is for the quality of remote consultations to get closer to the experience of face-to-face consultations. These data provide the first evidence that Holoportation™ communication technology brings 3D Telemedicine closer to this goal than a 2D equivalent.
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Affiliation(s)
- Steven Lo
- School of Medicine, Dentistry and Nursing, University of Glasgow, UK; Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK.
| | | | - Kwame Darko
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Catriona Graham
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK
| | | | - Anna Rose
- Canniesburn Regional Plastic Surgery Unit, Glasgow G4 0SF, UK
| | | | - Aileen McIntyre
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | | | - Roma Maguire
- Computer and Information Sciences, Livingstone Tower, University of Strathclyde, Glasgow G1 1XH, UK
| | | | - David Young
- Mathematics and Statistics, Livingstone Tower, University of Strathclyde, Glasgow G1 1XH, UK
| | | | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, G12 8QQ, UK
| | - Mark Dunlop
- Computer and Information Sciences, Livingstone Tower, University of Strathclyde, Glasgow G1 1XH, UK
| | - Levi Ankrah
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Martina Messow
- Robertson Centre for Biostatistics, University of Glasgow, Boyd Orr Building, G12 8QQ, UK
| | - Opoku Ampomah
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Roma Armstrong
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | - Ruchi Lalwani
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | - Ruairidh Davison
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
| | - Sophie Bagnall
- West of Scotland NHS Innovation Hub, Queen Elizabeth University Hospital Campus, Govan Road, Glasgow G51 4TF, UK
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Galbraith NJ, McCollum C, Di Mascio L, Lowrie J, Hinckley M, Lo S, Watson S, Telfer JR, Roxburgh CS, Horgan PG, Chong PS, Quinn M, Steele CW. Effect of differing flap reconstruction strategies in perineal closure following advanced pelvic oncological resection: a retrospective cohort study. Int J Surg 2023; 109:3375-3382. [PMID: 37678294 PMCID: PMC10651229 DOI: 10.1097/js9.0000000000000617] [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: 02/19/2023] [Accepted: 07/09/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Advancing approaches to locally invasive pelvic malignancy creates a large tissue defect resulting in perineal wound complications, dehiscence, and perineal hernia. Use of reconstructive flaps such as vertical rectus abdominus myocutaneous (VRAM) flap, gracilis, anterolateral thigh and gluteal flaps have been utilised in our institution to address perineal closure. The authors compared outcomes using different flap techniques along with primary perineal closure in advanced pelvic oncological resection. METHODS A prospectively maintained database of patients undergoing advanced pelvic oncological resection in a single tertiary hospital was retrospectively analysed. This study included consecutive patients between 2014 and 2021 according to the Strengthening The Reporting of Cohort Studies in Surgery (STROCSS) criteria. Primary outcome measures were the frequency of postoperative perineal complications between primary closure, VRAM, gluteal and thigh (anterolateral thigh and gracilis) reconstruction. RESULTS One hundred twenty-two patients underwent advanced pelvic resection with perineal closure. Of these, 40 patients underwent extra-levator abdominoperineal resection, and 70 patients underwent pelvic exenteration. Sixty-four patients received reconstructive flap closure, which included VRAM (22), gluteal (21) and thigh flaps (19). Perineal infection and dehiscence rates were low. Infection rates were lower in the flap group despite a higher rate of radiotherapy ( P <0.050). Reoperation rates were infrequent (<10%) but specific for each flap, such as donor-site hernia following VRAM and flap dehiscence after thigh flap reconstruction. CONCLUSIONS In patients who are at high risk of postoperative perineal infections, reconstructive flap closure offers acceptable outcomes. VRAM, gluteal and thigh flaps offer comparable outcomes and can be tailored to the individual patient.
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Affiliation(s)
- Norman J. Galbraith
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Catherine McCollum
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Lucia Di Mascio
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Joanna Lowrie
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Matthew Hinckley
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Steven Lo
- Canniesburn Department of Plastic and Reconstructive Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Stuart Watson
- Canniesburn Department of Plastic and Reconstructive Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - John R.C. Telfer
- Canniesburn Department of Plastic and Reconstructive Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Paul G. Horgan
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Peter S. Chong
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Martha Quinn
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
| | - Colin. W. Steele
- Academic Department of Surgery, Glasgow Royal Infirmary, University of Glasgow
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Ansel S, Yan X, Chong P, Lo S, McCleery M, Mahendra A, MacDuff E, Cowie F, Nixon I, White J. Tenosynovial giant cell tumor: a case report. J Med Case Rep 2023; 17:419. [PMID: 37798760 PMCID: PMC10557153 DOI: 10.1186/s13256-023-04156-w] [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: 01/27/2022] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND This case reports the synchronous diagnosis of two rare unrelated diseases; leiomyosarcoma and tenosynovial giant cell tumor of the knee. It focuses on the challenges of diagnosing tenosynovial giant cell tumor, including cognitive biases in clinical medicine that delay diagnosis. It also demonstrates the pathogenic etiology of tenosynovial giant cell tumor, evidenced by the transient deterioration of the patients' knee symptoms following the administration of prophylactic granulocyte colony-stimulating factor given as part of the chemotherapeutic regime for leiomyosarcoma. CASE PRESENTATION A 37-year-old Caucasian man presented with a left groin lump and left knee pain with swelling and locking. Investigations including positron emission tomography-computed tomography and biopsy revealed leiomyosarcoma in a lymph node likely related to the spermatic cord, with high-grade uptake in the left knee that was presumed to be the primary site. His knee symptoms temporarily worsened each time granulocyte colony-stimulating factor was administered with each cycle of chemotherapy for leiomyosarcoma to help combat myelosuppressive toxicity. Subsequent magnetic resonance imaging and biopsy of the knee confirmed a tenosynovial giant cell tumor. His knee symptoms relating to the tenosynovial giant cell tumor improved following the completion of his leiomyosarcoma treatment. CONCLUSIONS Tenosynovial giant cell tumor remains a diagnostic challenge. We discuss the key clinical features and investigations that aid prompt diagnosis. The National Comprehensive Cancer Network clinical practice guidelines for soft tissue sarcoma have recently been updated to include the pharmacological management of tenosynovial giant cell tumor. Our case discussion provides an up-to-date review of the evidence for optimal management of patients with tenosynovial giant cell tumor, with a particular focus on novel pharmacological options that exploit underlying pathogenesis.
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Affiliation(s)
- Sonam Ansel
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland.
| | - Xiangfei Yan
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Peter Chong
- Departments of General Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Steven Lo
- Departments of Plastic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Mark McCleery
- Departments of Radiology, Glasgow Royal Infirmary Glasgow Royal Infirmary, Glasgow, Scotland
| | - Ashish Mahendra
- Departments of Orthopaedic Oncology, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Elaine MacDuff
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Fiona Cowie
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Ioanna Nixon
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow Royal Infirmary, Glasgow, Scotland
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Yuan SSF, Wang YM, Chan LP, Hung AC, Nguyen HDH, Chen YK, Hu SCS, Lo S, Wang YY. IL-1RA promotes oral squamous cell carcinoma malignancy through mitochondrial metabolism-mediated EGFR/JNK/SOX2 pathway. J Transl Med 2023; 21:473. [PMID: 37461111 PMCID: PMC10351194 DOI: 10.1186/s12967-023-04343-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Interleukin-1 receptor antagonist (IL-1RA), a member of the IL-1 family, has diverse roles in cancer development. However, the role of IL-1RA in oral squamous cell carcinoma (OSCC), in particular the underlying mechanisms, remains to be elucidated. METHODS Tumor tissues from OSCC patients were assessed for protein expression by immunohistochemistry. Patient survival was evaluated by Kaplan-Meier curve analysis. Impact of differential IL-1RA expression on cultured OSCC cell lines was assessed in vitro by clonogenic survival, tumorsphere formation, soft agar colony formation, and transwell cell migration and invasion assays. Oxygen consumption rate was measured by Seahorse analyzer or multi-mode plate reader. PCR array was applied to screen human cancer stem cell-related genes, proteome array for phosphorylation status of kinases, and Western blot for protein expression in cultured cells. In vivo tumor growth was investigated by orthotopic xenograft in mice, and protein expression in xenograft tumors assessed by immunohistochemistry. RESULTS Clinical analysis revealed that elevated IL-1RA expression in OSCC tumor tissues was associated with increased tumor size and cancer stage, and reduced survival in the patient group receiving adjuvant radiotherapy compared to the patient group without adjuvant radiotherapy. In vitro data supported these observations, showing that overexpression of IL-1RA increased OSCC cell growth, migration/invasion abilities, and resistance to ionizing radiation, whereas knockdown of IL-1RA had largely the opposite effects. Additionally, we identified that EGFR/JNK activation and SOX2 expression were modulated by differential IL-1RA expression downstream of mitochondrial metabolism, with application of mitochondrial complex inhibitors suppressing these pathways. Furthermore, in vivo data revealed that treatment with cisplatin or metformin-a mitochondrial complex inhibitor and conventional therapy for type 2 diabetes-reduced IL-1RA-associated xenograft tumor growth as well as EGFR/JNK activation and SOX2 expression. This inhibitory effect was further augmented by combination treatment with cisplatin and metformin. CONCLUSIONS The current study suggests that IL-1RA promoted OSCC malignancy through mitochondrial metabolism-mediated EGFR/JNK activation and SOX2 expression. Inhibition of this mitochondrial metabolic pathway may present a potential therapeutic strategy in OSCC.
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Affiliation(s)
- Shyng-Shiou F Yuan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
| | - Yun-Ming Wang
- Department of Biological Science and Technology, Institute of Molecular Medicine and Bioengineering, Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, 75 Bo-Ai Street, Hsinchu, 300, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
| | - Leong-Perng Chan
- Cohort Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
| | - Amos C Hung
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hieu D H Nguyen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan
| | - Steven Lo
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow, G4 0SF, UK
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Yen-Yun Wang
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, No.100, Shih-Chuan 1St Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
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8
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Lo S, Yonjan I, Rose A, Roditi G, Drury C, MacLean A. In search of the ideal periosteal flap for bone non-union: The chimeric fibula-periosteal flap. J Plast Reconstr Aesthet Surg 2023; 83:221-232. [PMID: 37285775 DOI: 10.1016/j.bjps.2023.04.012] [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: 02/04/2023] [Revised: 03/13/2023] [Accepted: 04/07/2023] [Indexed: 06/09/2023]
Abstract
Vascularised periosteal flaps may increase the union rates in recalcitrant long bone non-union. The fibula-periosteal chimeric flap utilises the periosteum raised on an independent periosteal vessel. This allows the periosteum to be inset freely around the osteotomy site, thereby facilitating bone consolidation. PATIENTS AND METHODS Ten patients underwent fibula-periosteal chimeric flaps (2016-2022) at the Canniesburn Plastic Surgery Unit, UK. Preceding non-union 18.6 months, with mean bone gap of 7.5 cm. Patients underwent preoperative CT angiography to identify the periosteal branches. A case-control approach was used. Patients acted as their own controls, with one osteotomy covered by the chimeric periosteal flap and one without, although in two patients both the osteotomies were covered using a long periosteal flap. RESULTS A chimeric periosteal flap was used in 12 of the 20 osteotomy sites. Periosteal flap osteotomies had a primary union rate of 100% (11/11) versus those without flaps at 28.6% (2/7) (p = 0.0025). Union occurred in the chimeric periosteal flaps at 8.5 months versus 16.75 months in the control group (p = 0.023). One case was excluded from primary analysis due to recurrent mycetoma. The number needed to treat = 2, indicating that 2 patients would require a chimeric periosteal flap to avoid one non-union. Survival curves with a hazard ratio of 4.1 were observed, equating to a 4 times higher chance of union with periosteal flaps (log-rank p = 0.0016). CONCLUSIONS The chimeric fibula-periosteal flap may increase the consolidation rates in difficult cases of recalcitrant non-union. This elegant modification of the fibula flap uses periosteum that is normally discarded, and this adds to the accumulating data supporting the use of vascularised periosteal flaps in non-union.
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Affiliation(s)
- Steven Lo
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom; School of Medicine, Dentistry and Nursing, University of Glasgow, G12 8QQ, United Kingdom.
| | - Indira Yonjan
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Anna Rose
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Colin Drury
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
| | - Angus MacLean
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
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9
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Holtkamp LHJ, Lo S, Drummond M, Thompson JF, Nieweg OE, Hong AM. Hypofractionated or Conventionally Fractionated Adjuvant Radiotherapy After Regional Lymph Node Dissection for High-Risk Stage III Melanoma. Clin Oncol (R Coll Radiol) 2023; 35:e85-e93. [PMID: 35851490 DOI: 10.1016/j.clon.2022.06.012] [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: 11/22/2021] [Revised: 06/04/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS Adjuvant radiotherapy can be beneficial after regional lymph node dissection for high-risk stage III melanoma, as it has been shown to reduce the risk of recurrence in the node field. However, the optimal fractionation schedule is unknown and both hypofractionated and conventionally fractionated adjuvant radiotherapy are used. The present study examined the oncological outcomes of these two approaches in patients treated in an era before effective systemic immunotherapy became available. MATERIALS AND METHODS This retrospective cohort study involved 335 patients with stage III melanoma who received adjuvant radiotherapy after therapeutic regional lymph node dissection for metastatic melanoma between 1990 and 2011. Information on tumour characteristics, radiotherapy doses and fractionation schedules and patient outcomes was retrieved from the institution's database and patients' medical records. RESULTS Hypofractionated radiotherapy (median dose 33 Gy in six fractions over 3 weeks) was given to 95 patients (28%) and conventionally fractionated radiotherapy (median dose 48 Gy in 20 fractions over 4 weeks) to 240 patients (72%). Five-year lymph node field control rates were 86.0% (95% confidence interval 78.4-94.4%) for the hypofractionated group and 85.5% (95% confidence interval 80.5-90.7%) for the conventional fractionation group (P = 0.87). There were no significant differences in recurrence-free survival (RFS) (41.7%, 95% confidence interval 32.5-53.5 versus 31.9%, 95% confidence interval 26.1-38.9; P = 0.18) or overall survival (41.2%, 95% confidence interval 32.1-52.8 versus 45.0%, 95% confidence interval 38.7-52.4; P = 0.77). On multivariate analysis, extranodal spread was associated with decreased RFS (P = 0.04) and the number of resected lymph nodes containing metastatic melanoma was associated with decreased RFS (P = 0.0006) and overall survival (P = 0.01). CONCLUSION Lymph node field control rates, RFS and overall survival were similar after hypofractionated and conventionally fractionated adjuvant radiotherapy. The presence of extranodal spread and an increasing number of positive lymph nodes were predictive of an unfavourable outcome.
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Affiliation(s)
- L H J Holtkamp
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - M Drummond
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - O E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A M Hong
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia; GenesisCare, Radiation Oncology, Mater Sydney Hospital, Sydney, NSW, Australia
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10
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Al-Falahi Z, Tran H, Middleton P, Basilakis J, Lo S, Dang V, Joseph V, Femia G, Nia A, Moore N, Houltham J, Silva R. Corrigendum to ‘Automation of Optical Coherence Tomography (OCT) Tissued Morphology and Vessel Sizing With Artificial Intelligence’ [Heart, Lung and Circulation volume 31 (2022) S321-S322]. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Jamal J, Idris H, Faour A, Yang W, McLean A, Burgess S, Shugman I, Oloughlin A, Leung D, Mussap CJ, Juergens CP, Lo S, French JK. Reperfusion strategy and late clinical outcomes of patients with ST-elevation myocardial infarction (STEMI) in the absence of standard modifiable risk factors (SMuRFs). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2034] [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
Introduction
There is growing evidence that patients presenting with STEMI in the absence of standard modifiable cardiovascular risk factors (SMuRFs; smoking, hypertension, hypercholesterolemia, diabetes) have poorer outcomes compared to those with atleast one SMuRF. It has been hypothesised that this may be in part due to decreased administration of pharmacotherapies in the post-infarct period due to perceived low risk. Long term outcomes of patients without SMuRFs based on reperfusion strategy received during the index admission have not been investigated.
Purpose
We sought to analyse late clinical outcomes of STEMI patients with and without SMuRFs based on reperfusion strategy received during the index admission.
Methods
All patients who underwent PCI between 2003 and 2014 were identified from a PCI centre STEMI database. Late clinical outcomes of patients with and without SMuRFs were analysed overall and based on reperfusion strategy [primary PCI (pPCI) vs pharmaco-invasive PCI (PI-PCI)]. Propensity matching was used to account for differences in baseline characteristics between the groups.
Results
Amongst 2,091 STEMI patients, 531 (25%) had no SMuRFs (51% pPCI, 49% PI-PCI) and 1560 (75%) had ≥1 SMuRF (52% pPCI, 48% PI-PCI). Unadjusted late mortality in SMuRF-less patients was 13.4% (18.8% pPCI, 7.7% PI-PCI) and for those with ≥1 SMuRF was 9.7% (11.0% pPCI, 8.4% PI-PCI). After propensity-matching clinical and angiographic characteristics, 5 year mortality rates were significantly higher for patients without SMuRFs compared to those with SMuRFs [HR 1.36, CI: 1.03–1.81, p=0.031]. This difference was attenuated for patients who underwent pPCI [HR 1.72, CI: 1.22–2.43, p=0.002]. Interestingly, this discrepancy was not observed amongst individuals who underwent pharmaco-invasive PCI [HR 1.13, CI: 0.53–1.48, p=0.638], as SMuRF-less patients had similar mortality rates to their counterparts. Long term rates of reinfarction, stent thrombosis and target vessel revascularisation were similar between the groups. Additionally, there was no significant difference in rates of stroke and major bleeding amongst all 4 subgroups.
Conclusion
Patients presenting with STEMI in the absence of SMuRFs have increased overall late mortality compared to those with at least one SMuRF. However, this difference was not observed in patients who underwent a pharmaco-invasive strategy, whereby patients without SMuRFs had similar outcomes to those with SMuRFs after adjusting for confounders. Our findings suggest the use of a pharmaco-invasive strategy in appropriate SMuRF-less patients presenting with STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Jamal
- Liverpool Hospital , Sydney , Australia
| | - H Idris
- Liverpool Hospital , Sydney , Australia
| | - A Faour
- Liverpool Hospital , Sydney , Australia
| | - W Yang
- Liverpool Hospital , Sydney , Australia
| | - A McLean
- Liverpool Hospital , Sydney , Australia
| | - S Burgess
- Liverpool Hospital , Sydney , Australia
| | - I Shugman
- Liverpool Hospital , Sydney , Australia
| | | | - D Leung
- Liverpool Hospital , Sydney , Australia
| | | | | | - S Lo
- Liverpool Hospital , Sydney , Australia
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12
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Presley C, Grogan M, Hoyd R, Compston A, Hock K, Knauss B, Redder E, Arrato N, Lo S, Benedict J, Janse S, Hayes S, Williams N, Wheeler C, Carbone D, Paskett E, Andersen B, Spakowicz D. Resiliency among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT, NCT04229381): The feasibility of a novel supportive care intervention with collection of longitudinal gut microbiome specimens and activity tracking during the COVID-19 Pandemic. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00320-4] [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: 11/07/2022]
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13
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Lo S, Childs C, Mahendra A, Young P, Carse B. Functional Quadriceps Reconstruction: 3D Gait Analysis, EMG and Environmental Simulator outcomes. J Plast Reconstr Aesthet Surg 2022; 75:3924-3937. [DOI: 10.1016/j.bjps.2022.08.009] [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] [Received: 03/29/2022] [Revised: 06/28/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022]
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14
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Ramachandran J, Pender P, Assad J, Wang A, Faour A, Leung D, Rajaratnam R, Mussap C, Juergens C, Lo S. Pericardiocentesis over 3 years at a tertiary referral Australian hospital. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.112] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Pericardiocentesis is a lifesaving intervention performed both percutaneously or surgically. We analysed 3 years of experience in a major tertiary hospital in Sydney Australia.
Purpose
To examine the indications, safety and delivery of a pericardiocentesis service at a major teaching hospital.
Methods
We retrospectively audited consecutive patients who underwent pericardiocentesis for pericardial effusion[PE] at a major teaching hospital from February 2018 to December 2020. Eligible patients were identified from the electronic medical records with this coding diagnosis.
Results
89 patients identified with mean age 60.8 ± 18.9years and 58.4%(51/89) male. Follow-up to August 2021 showed 41.5% had died, with an index hospitalisation mortality of 19%(17/89). Malignancy was the most common aetiology 30.3%(27/89) and attributable cause of hospitalisation death in 29.4%. Alternate causes included pericarditis 14.6%, idiopathic 13.4%, percutaneous-coronary-intervention(PCI) 5.6%(6/89) and electrophysiology 4.5%(4/89) complications. Three patients had aortic dissection (3.3%) and two were fatal. Clinical tamponade was present in 66.2%(55/89), PE identification occurred via echocardiography(TTE) in 55% cases (49/89) and incidental CT-diagnosis in 20.2%. TTE findings: right atrial collapse 54%(47/87), right ventricular collapse 60.9%(53/87), fixed and dilated inferior vena cava 64.7%. Pericardiocentesis was performed by cardiology trainees in 90.5% cases, 64.5% with consultant supervision and during working hours in 57.3% of cases. Percutaneous drainage was successful in 96%(72/75) of cases and was performed in the coronary care unit (30.3%), catheterisation laboratory (23.5%), emergency department (19.1%) and ICU (11.2%). Subxiphoid approach in 70%(62/89) was the most common then trans-apical 15%(13/89), parasternal 3%(3/89) and surgical 16%(14/89). TTE confirmed drain position in 76%(54/71), fluoroscopy in 28.5%(6/21) and agitated saline in 38.9%(30/77). Haemo-serous fluid noted in 77%(67/87) with average initial fluid drainage 480 ± 326mls and mean drain removal time 54 ± 33hrs. 17%(15/89) required re-drainage with adenocarcinoma found in 33.3%(5/15). Background antiplatelet treatment in 30.6%(27/88) and of these 67%(18/27) were on dual antiplatelets. 33%(29/89) patients were anticoagulated and 31.3%(9/29) required reversal prior to drainage. Complications were rare, 4%(3/75) had right heart chamber perforation needing emergency surgery. Two were post complex PCI (one died during admission from multiorgan failure) and one with pericarditis .
Conclusions
Pericardiocentesis is a safe and effective procedure for tamponade treatment and largely guided by echocardiography in our experience. Complications are rare and prognosis depends on aetiology with malignancy the most common. Drainage is often successfully performed emergently where the patient is located. Tamponade resulting from procedural complications are rare in our cohort.
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Affiliation(s)
| | - P Pender
- Liverpool Hospital, Sydney, Australia
| | - J Assad
- Liverpool Hospital, Sydney, Australia
| | - A Wang
- Liverpool Hospital, Sydney, Australia
| | - A Faour
- Liverpool Hospital, Sydney, Australia
| | - D Leung
- Liverpool Hospital, Sydney, Australia
| | | | - C Mussap
- Liverpool Hospital, Sydney, Australia
| | | | - S Lo
- Liverpool Hospital, Sydney, Australia
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15
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kadappu K, Gibbs O, Kachwalla K, Nguyen P, Hopkins A, Lo S. Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.130] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions.
Purpose
Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes.
Methods
All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded.
Results
67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI. IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion.
Conclusion
Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI
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Affiliation(s)
- J Leung
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - J French
- Liverpool Hospital, Liverpool, Australia
| | - D Leung
- Liverpool Hospital, Liverpool, Australia
| | - C Mussap
- Liverpool Hospital, Liverpool, Australia
| | - K Asrress
- Liverpool Hospital, Liverpool, Australia
| | - D Taylor
- Liverpool Hospital, Liverpool, Australia
| | | | - K Kadappu
- Liverpool Hospital, Liverpool, Australia
| | - O Gibbs
- Liverpool Hospital, Liverpool, Australia
| | | | - P Nguyen
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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16
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Kaul R, Khoo J, Pender P, Hopkins A, Lo S. P2Y12 pre-treatment for NSTE-ACS in a tertiary hospital centre: real world compliance experience with ESC 2020 guidelines. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.091] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The 2020 ESC guidelines for managing NSTE-ACS recommend against routine pre-treatment with a P2Y12 receptor inhibitor if coronary anatomy is not known and an early (<24h) invasive management is planned. With delayed (>24h) invasive management, pre-treatment may be considered in selected cases.
Purpose
Evaluate antiplatelet pre-treatment practices for NSTE-ACS in a tertiary cardiology centre in Australia.
Methods
Retrospective analysis of NSTE-ACS cases from January to August 2021 were obtained from the cardiac laboratory database. Patients on a P2Y12 inhibitor prior to presentation were excluded. Clinical, demographic, angiographic and medication data were obtained from the electronic database.
Results
85 cases were included. Mean age was 62 ± 11.5 and 81% were male. The prevalence of hypertension, hypercholesterolaemia, type 2 diabetes and active smoking was 54.8%, 51.2%, 38.1% and 34.5% respectively. Mean time to angiography was 1.7 ± 1.4 days and the median peak pre-procedural troponin T was 191.5 (80 to 852). Access was predominantly radial (84.5%) with the remainder femoral (15.5%).
Angiographic findings included, obstructive disease amenable to percutaneous coronary intervention (50.0%), obstructive disease for surgical revascularisation (22.6%), and non-obstructive disease (27.4%). The mean time from angiography to surgical revascularisation was 6.4 ± 4.4 days. Three patients (3.6%) had bleeding [managed conservatively], specifically upper limb haematoma, groin haematoma, and haemoptysis.
The majority of patients (79.8%) received P2Y12 inhibitors (40.5% clopidogrel and 39.3% ticagrelor) prior to angiography. Of these, 49.3% had percutaneous angioplasty, 17.9% had surgical revascularisation and 32.8% had non-obstructive disease (managed with single antithrombotic agent). Of those who did not receive P2Y12 inhibitors [n = 17, 20.2%]. Of these, 53% had percutaneous angioplasty, 40% had surgical revascularisation, and 5% had non-obstructive disease.
Conclusions
Overall, pre-treatment with a P2Y12 inhibitor was still very common, risking delays to bypass surgery and increasing bleeding. Practice did not generally align with contemporary ESC 2020 guidelines. Understanding the reasons for guideline non-compliance would be important for optimising treatments. Education for emergency and cardiology staff as well as creation of local practice policies may help increase compliance with evidence-based guidelines.
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Affiliation(s)
- R Kaul
- Liverpool Hospital, Liverpool, Australia
| | - J Khoo
- Liverpool Hospital, Liverpool, Australia
| | - P Pender
- Liverpool Hospital, Liverpool, Australia
| | - A Hopkins
- Liverpool Hospital, Liverpool, Australia
| | - S Lo
- Liverpool Hospital, Liverpool, Australia
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17
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Ho JCY, Yu YH, Choi LCW, Tang IWH, Ng SLK, Tsang WLC, Fung SKS, Kwan TH, Li PKT, Leung CB, Chak WL, Wong S, Mak SK, Yong DSP, Yeung S, Lo S, Chan DTM, Kwok JSY. Modified urine typing to enhance clinical management in kidney transplant patients with unknown donor human leukocyte antigen typing: abridged secondary publication. Hong Kong Med J 2022; 28 Suppl 1:31-34. [PMID: 35260514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- J C Y Ho
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - Y H Yu
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - L C W Choi
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - I W H Tang
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - S L K Ng
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - W L C Tsang
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
| | - S K S Fung
- Jockey Club Nephrology & Urology Centre, Princess Margaret Hospital, Hong Kong
| | - T H Kwan
- Department of Medicine & Geriatrics, Tuen Mun Hospital
| | - P K T Li
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital
| | - C B Leung
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital
| | - W L Chak
- Department of Medicine, Queen Elizabeth Hospital
| | - S Wong
- Department of Medicine & Geriatrics, United Christian Hospital
| | - S K Mak
- Department of Medicine & Geriatrics, Kwong Wah Hospital
| | - D S P Yong
- Department of Medicine, Caritas Medical Centre
| | - S Yeung
- Department of Medicine, Tseung Kwan O Hospital
| | - S Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital
| | - D T M Chan
- Department of Medicine, Queen Mary Hospital
| | - J S Y Kwok
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong
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18
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Thakur A, Kaul R, Lin M, Lo S. Trastuzumab Induced Left Atrial Inflammation Confirmed on PET Presenting With Perimyocarditis With Pericardial Effusion and Atrial Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.300] [Citation(s) in RCA: 1] [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]
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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib Badie T, Kaddapu K, Xu J, Kachwalla H, Hopkins A, Gibbs O, Lo S. Intravascular Lithotripsy versus Rotational Atherectomy Cutting Balloon on Stent Expansion for Heavily Calcified Coronary Lesions. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.599] [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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20
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Pender P, Leung J, Lo S. Initial Single Centre Experience of SYNERGY MEGATRON BP Stent. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.597] [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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Al-Mukhtar O, Peter K, Gooley R, Farouque O, Van Gaal W, Hiew C, Layland J, Oqueli E, Lefkovits J, Brennan A, Reid C, Walton A, Stub D, Kaye D, Lo S, Cox N, Chan W. Contemporary Practice of Heparin Prescription and Its Monitoring via Activated Clotting Time in Percutaneous Coronary Intervention in Victoria, Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.571] [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: 10/16/2022]
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22
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Al-Falahi Z, Tran H, Middleton P, Basilakis J, Lo S, Dang V, Joseph V, Fema G, Nia A, Moore N, Houltham J, Silva R. Automation of Optical Coherence Tomography (OCT) Tissued Morphology and Vessel Sizing With Artificial Intelligence. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.561] [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: 10/16/2022]
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23
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Jayanti S, Juergens C, Makris A, Hennessy A, Lo S, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Rajaratnam R, French J, Leung D, Nguyen P. Ultrasound Guidance Facilitates Ideal Femoral Puncture for Coronary Angiography. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.640] [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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Dang V, Pender P, Hopkins A, Rajaratnam R, Leung D, Lo S. Percutaneous Coronary Intervention (PCI) for Spontaneous Coronary Artery Dissection (SCAD) Induced Acute Coronary Syndrome (ACS): 21 Year Experience in a Single Australian Centre. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.610] [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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Pires da Silva I, Zakria D, Ahmed T, Trojaniello C, Dimitriou F, Allayous C, Gerard C, Zimmer L, Lo S, Michielin O, Lebbe C, Mangana J, Ascierto P, Johnson D, Carlino M, Menzies A, Long G. 1042P Anti-PD1 (PD1) monotherapy or in combination with ipilimumab (IPI) after BRAF/MEK inhibitors (BRAF/MEKi) in BRAF mutant metastatic melanoma (MM) patients (pts). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1427] [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] Open
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Dimitriou F, Namikawa K, Teterycz P, Reijers I, Buchbinder E, Soon J, Zimmer L, Mooradian M, Vitale M, Armstrong E, Johnson D, Guo J, Lebbe C, Robert C, Mandala M, Bhave P, Farid M, Kähler K, Lo S, Long G. 1049P Clinical models to predict response in mucosal melanoma (MM) patients (pts) treated with anti-PD-1 (PD1) or combined with ipilimumab (PD1+IPI). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Dimitriou F, Lo S, Tan A, Emmett L, Kapoor R, Carlino M, Long G, Menzies A. 1054P FDG-PET to predict long-term outcome from anti-PD1 (PD1) therapy in metastatic melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1439] [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] Open
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28
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Waldstein C, Wang W, Wang W, Lo S, Shivalingam B, Fogarty G, Carlino M, Menzies A, Long G, Hong A. PO-1413 Melanoma brain metastasis: The outcome of WBRT in the era of effective systemic therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07864-6] [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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McCabe HM, Smrke A, Cowie F, White J, Chong P, Lo S, Mahendra A, Gupta S, Ferguson M, Boddie D, Mmekka W, Stirling L, Campbell L, Jones RL, Nixon I. What Matters to Us: Impact of Telemedicine During the Pandemic in the Care of Patients With Sarcoma Across Scotland. JCO Glob Oncol 2021; 7:1067-1073. [PMID: 34191537 PMCID: PMC8457876 DOI: 10.1200/go.20.00599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/29/2022] Open
Abstract
In Scotland, approximately 350 sarcoma cases are diagnosed per year and treated in one of the five specialist centers. Many patients are required to travel long distances to access specialist care. The COVID-19 pandemic brought a number of rapid changes into the care for patients with cancer, with increasing utilization of telemedicine. We aimed to evaluate how the utilization of telemedicine affects professionals and patients across Scotland and care delivery, at the Beatson West of Scotland Cancer Centre Sarcoma Unit.
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Affiliation(s)
- Holly M McCabe
- Department of Management Science, University of Strathclyde, Glasgow, United Kingdom
| | - Alannah Smrke
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Fiona Cowie
- Scottish Sarcoma Network, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jeff White
- Scottish Sarcoma Network, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Peter Chong
- Scottish Sarcoma Network, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Steven Lo
- Scottish Sarcoma Network, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Ashish Mahendra
- Scottish Sarcoma Network, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Sanjay Gupta
- Scottish Sarcoma Network, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Michelle Ferguson
- Scottish Sarcoma Network, Ninewells Hospital, Dundee, United Kingdom
| | - David Boddie
- Scottish Sarcoma Network, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Walter Mmekka
- Scottish Sarcoma Network, Raigmore Hospital, Inverness, United Kingdom
| | - Lorraine Stirling
- Scottish Sarcoma Network, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lindsay Campbell
- Scottish Sarcoma Network, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Robin L Jones
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
| | - Ioanna Nixon
- Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.,Scottish Sarcoma Network, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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Dessinioti C, Geller AC, Stergiopoulou A, Dimou N, Lo S, Keim U, Gershenwald JE, Haydu LE, Dummer R, Mangana J, Hauschild A, Egberts F, Vieira R, Brinca A, Zalaudek I, Deinlein T, Evangelou E, Thompson JF, Scolyer RA, Peris K, Garbe C, Stratigos AJ. A multicentre study of naevus-associated melanoma vs. de novo melanoma, tumour thickness and body site differences. Br J Dermatol 2021; 185:101-109. [PMID: 33454993 DOI: 10.1111/bjd.19819] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 01/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Whether melanoma in histological contiguity with a naevus [naevus-associated melanoma (NAM)] is distinctly different from melanoma arising de novo remains unclear. OBJECTIVES To determine whether the characteristics of de novo melanoma differ from NAM and are not due to naevus obliteration in thicker tumours. METHODS We conducted a multicentre retrospective study of de novo melanoma and NAM in seven referral centres in Europe, Australia and the USA between 2006 and 2015. RESULTS In a total of 9474 localized melanomas, de novo melanoma was associated with thicker tumours and body site differences compared with NAM. In the subset of T1 melanomas (n = 5307), similar body site differences were found in multivariate analysis by body site. When compared with NAM, de novo melanoma was more likely to affect older individuals (≥ 70 years) when located on the head/neck [odds ratio (OR) 4·65, 95% confidence interval (CI) 2·55-8·46], the trunk (OR 1·82, 95% CI 1·40-2·36) or the upper extremity (OR 1·69, 95% CI 1·14-2·50), was more likely to affect female patients when located on the lower extremities (OR 1·36, 95% CI 1·03-1·80), and was more likely to be of the nodular melanoma subtype (OR 2·23, 95% CI 1·14-4·35) when located on the trunk. De novo melanoma was less likely to have regression present compared with NAM. CONCLUSIONS Clinicopathological and body site differences between de novo melanoma and NAM support the divergent pathway model of development. These differences were also found in thin melanomas, suggesting that de novo melanomas are different from NAM and their differences are not due to the obliteration of naevus remnants in thicker tumours.
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Affiliation(s)
- C Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard TH School of Public Health, Boston, MA, USA
| | - A Stergiopoulou
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - N Dimou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioaninna, Greece
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - U Keim
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - J E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center (MD Anderson), Houston, TX, USA
| | - L E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center (MD Anderson), Houston, TX, USA
| | - R Dummer
- Department of Dermatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - J Mangana
- Department of Dermatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - F Egberts
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - R Vieira
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - A Brinca
- Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
- Division of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - T Deinlein
- Division of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | - E Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioaninna, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
- New South Wales Health Pathology, Sydney, NSW, Australia
| | - K Peris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - C Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
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Star P, Rawson RV, Drummond M, Lo S, Scolyer RA, Guitera P. Lentigo maligna: defining margins and predictors of recurrence utilizing clinical, dermoscopic, confocal microscopy and histopathology features. J Eur Acad Dermatol Venereol 2021; 35:1811-1820. [PMID: 33998703 DOI: 10.1111/jdv.17349] [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] [Received: 01/09/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lentigo maligna (LM) is a subtype of melanoma in situ with poorly defined margins and a high recurrence rate. The biological behaviour of LM appears to differ widely between cases, from biologically indolent to biologically active variants, with some patients experiencing multiple recurrences. It is not known whether this is secondary to inadequate margins, field cancerization or the innate biology of the lesion itself. OBJECTIVES (a) Describe the margins of LM in detail by analysing LM in three zones, that is centre, edge and surround using reflectance confocal microscopy (RCM) and histopathology; (b) ascertain association of histological distance of LM and atypical melanocytic hyperplasia from the surgical margin with multi-recurrent (MR) disease and (c) identify features (clinical, dermoscopy, RCM and histopathology) associated with MR LM. METHODS (1) Descriptive observational study comparing the centre, edge and surround of LM on histopathology and RCM; (2) retrospective cohort study comparing parameters associated with MR and non-recurrent (NR) LM. RESULTS 30 patients (median follow-up time 6.2 years) were included. On histopathology, confluent or near confluent lentiginous proliferation, melanocyte density >15 per 0.5 mm and adnexal spread were best for distinguishing surround from edge of LM. On RCM, predominant melanocytes, lentiginous proliferation and pleomorphism distinguished surround from centre/edge. MR patients had a median histological distance of LM from the surgical margin of 2mm (versus NR patients with an average distance of 4mm). MR patients had a greater proportion of more florid features, compared with NR on histopathology at both the centre and the edge but were similar in the surround. CONCLUSION These data may help pathologists and confocalists better define margins of LM. More florid features in MR patients, despite a similar background of sun-damaged skin, suggest the innate biology of the lesion rather than the field of cancerization may explain MR LM.
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Affiliation(s)
- P Star
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - M Drummond
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - S Lo
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - P Guitera
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre (SMDC), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Royer G, Roisin L, Demontant V, Lo S, Coutte L, Lim P, Pawlotsky JM, Jacquier H, Lepeule R, Rodriguez C, Woerther PL. Microdiversity of Enterococcus faecalis isolates in cases of infective endocarditis: selection of non-synonymous mutations and large deletions is associated with phenotypic modifications. Emerg Microbes Infect 2021; 10:929-938. [PMID: 33913790 PMCID: PMC8158287 DOI: 10.1080/22221751.2021.1924865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Context: Today, infective endocarditis (IE) caused by Enterococcus faecalis represents 10% of all IE and is marked by its difficult management and the frequency of relapses. Although the precise reasons for that remain to be elucidated, the evolution of the culprit strain under selective pressure through microdiversification could be, at least in part, involved. Material and methods: To further study the in situ genetic microdiversity and its possible phenotypic manifestations in E. faecalis IE, we sequenced and compared multiple isolates from the valves, blood culture and joint fluid of five patients who underwent valvular surgery. Growth rate and early biofilm production of selected isolates were also compared. Results: By sequencing a total of 58 E. faecalis genomes, we detected a considerable genomic microdiversity, not only among strains from different anatomical origins, but also between isolates from the same studied cardiac valves. Interestingly, deletions of thousands of bases including the well-known virulence factors ebpA/B/C, and srtC, as well as other large prophage sequences containing genes coding for proteins implicated in platelet binding (PlbA and PlbB) were evidenced. The study of mutations helped unveil common patterns in genes related to the cell cycle as well as central metabolism, suggesting an evolutionary convergence in these isolates. As expected, such modifications were associated with a significant impact on the in-vitro phenotypic heterogeneity, growth, and early biofilm production. Conclusion: Genome modifications associated with phenotypic variations may allow bacterial adaptation to both antibiotic and immune selective pressures, and thus promote relapses.
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Affiliation(s)
- G Royer
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,LABGeM, Génomique Métabolique, Genoscope, Institut François Jacob, CEA, CNRS, Univ Evry, Université Paris-Saclay, Evry, France
| | - L Roisin
- EA 7380, Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC Anses, Créteil, France
| | - V Demontant
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - S Lo
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - L Coutte
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - P Lim
- Department of Cardiovascular Medicine and SOS Endocardites Unit, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - J M Pawlotsky
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - H Jacquier
- Bacteriology Unit, Lariboisière Hospital, APHP, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - R Lepeule
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France
| | - C Rodriguez
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - P L Woerther
- Department of Microbiology, Henri Mondor Hospital, AP-HP, Université Paris-Est, Créteil, France.,EA 7380, Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC Anses, Créteil, France
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Wang YY, Chen YK, Lo S, Chi TC, Chen YH, Hu SCS, Chen YW, Jiang SS, Tsai FY, Liu W, Li RN, Hsieh YC, Huang CJ, Yuan SSF. MRE11 promotes oral cancer progression through RUNX2/CXCR4/AKT/FOXA2 signaling in a nuclease-independent manner. Oncogene 2021; 40:3510-3532. [PMID: 33927349 PMCID: PMC8134045 DOI: 10.1038/s41388-021-01698-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 01/23/2023]
Abstract
MRE11, the nuclease component of RAD50/MRE11/NBS1 DNA repair complex which is essential for repair of DNA double-strand-breaks in normal cells, has recently garnered attention as a critical factor in solid tumor development. Herein we report the crucial role of MRE11 in oral cancer progression in a nuclease-independent manner and delineate its key downstream effectors including CXCR4. MRE11 expression in oral cancer samples was positively associated with tumor size, cancer stage and lymph node metastasis, and was predictive of poorer patient survival and radiotherapy resistance. MRE11 promoted cell proliferation/migration/invasion in a nuclease-independent manner but enhanced radioresistance via a nuclease-dependent pathway. The nuclease independent promotion of EMT and metastasis was mediated by RUNX2, CXCR4, AKT, and FOXA2, while CXCR4 neutralizing antibody mitigated these effects in vitro and in vivo. Collectively, MRE11 may serve as a crucial prognostic factor and therapeutic target in oral cancer, displaying dual nuclease dependent and independent roles that permit separate targeting of tumor vulnerabilities in oral cancer treatment.
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Affiliation(s)
- Yen-Yun Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Steven Lo
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tsung-Chen Chi
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Hua Chen
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ya-Wen Chen
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shih Sheng Jiang
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Fang-Yu Tsai
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Wangta Liu
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ruei-Nian Li
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ching Hsieh
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyng-Shiou F Yuan
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Biological Science and Technology, College of Biological Science and Technology, National ChiaoTung University, Hsinchu, Taiwan. .,Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan.
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Xu J, Juergens C, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Leung D, Lo S. Ticagrelor is Superior to Clopidogrel in Preserving Vasodilatory Capacity of the Coronary Microcirculation After Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.510] [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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Tran T, Le N, Lo S, Rajaratnam R, Juergens C, Premawardhana U, Shalaby G, Dang V, Vijayarajan V, Al-Falahi Z, Burns A, Johnson R, Hu Q, Sechi R, Narayanan SS. Cardi Bot: A Natural Language Application That Answers Your Cardiology Questions. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.427] [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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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib BT, Kaddapu K, Gibbs O, Kachwalla H, Nguyen P, Hopkins A, Lo S. Initial Experience with Intravascular Lithotripsy with Shockwave Balloon for Calcified Coronary Lesions During Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Brachial Artery Flow-Mediated Vasodilation is Related to the Coronary Index of Microcirculatory Resistance in Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Femia G, Ramachandran J, Poon J, Hopkins A, Mussap C, Rajaratnam R, French J, Leung D, Lo S, Juergens C. The Impact of COVID-19 on ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [PMCID: PMC8324111 DOI: 10.1016/j.hlc.2021.06.507] [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: 11/25/2022]
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Pender P, Leung J, Gibbs O, Hopkins A, Kadapu K, Asrress K, Juergens C, Lo S. Contemporary Management of Coronary Stent Embolisation: Southwestern Sydney Local Health District Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.461] [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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Wang YY, Chen HD, Lo S, Chen YK, Huang YC, Hu SCS, Hsieh YC, Hung AC, Hou MF, Yuan SSF. Visfatin Enhances Breast Cancer Progression through CXCL1 Induction in Tumor-Associated Macrophages. Cancers (Basel) 2020; 12:cancers12123526. [PMID: 33256011 PMCID: PMC7760195 DOI: 10.3390/cancers12123526] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/08/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/23/2022] Open
Abstract
Visfatin, an adipocytokine highly expressed in breast tumor tissues, is associated with breast cancer progression. Recent studies showed that adipocytokines mediate tumor development through adipocytokine tumor-stromal interactions in the tumor microenvironment. This study focused on the interaction between one key stromal constituent-tumor-associated macrophages-and visfatin. Pretreatment of THP-1 and peripheral blood mononuclear cells (PBMCs) with recombinant visfatin resulted in M2-polarization determined by CD163 and CD206 expression. Indirect co-culture with visfatin-treated THP-1 (V-THP-1) promoted the viability, migration, tumorsphere formation, EMT, and stemness of breast cancer cells. Cytokine array identified an increased CXCL1 secretion in V-THP-1 conditioned medium and recombinant CXCL1 enhanced cell migration and invasion, which were abrogated by the CXCL1-neutralizing antibody. Additionally, visfatin induced pERK in THP-1 cells and clinical samples confirmed a positive CXCL1/pERK correlation. In an orthotopic mouse model, the tumor bioluminescent signal of luciferase-expressing MDA-MB-231 (Luc-MDA-MB-231) cells co-cultured with V-THP-1 and the expression of proliferation marker Ki67 were significantly higher than that co-cultured with THP-1. Furthermore, tail vein-injected Luc-MDA-MB-231 pretreated with V-PBMCs conditioned medium metastasized to lungs more frequently compared to control, and this was reversed by CXCL1 blocking antibody. In summary, this study demonstrated that visfatin enhanced breast cancer progression via pERK/CXCL1 induction in macrophages.
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Affiliation(s)
- Yen-Yun Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-Y.W.); (Y.-K.C.)
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (H.-D.C.); (A.C.H.)
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Huan-Da Chen
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (H.-D.C.); (A.C.H.)
| | - Steven Lo
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK;
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Y.-Y.W.); (Y.-K.C.)
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Ci Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Dermatology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Ya-Ching Hsieh
- Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1BD, UK;
| | - Amos C. Hung
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (H.-D.C.); (A.C.H.)
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Ming-Feng Hou
- Division of General and Gastroenterological Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Shyng-Shiou F. Yuan
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (H.-D.C.); (A.C.H.)
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Chiao Tung University, Hsinchu 300, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101 (ext. 2557)
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Lo S, Foster N, Campbell L, White J, Nixon I, Mansell J, McCleery M, Whyte L, Cowie F. A need for clarity on surgical management of breast sarcoma: Scottish sarcoma network guidelines and regional audit. J Plast Reconstr Aesthet Surg 2020; 74:1180-1192. [PMID: 33308991 DOI: 10.1016/j.bjps.2020.10.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/05/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
Currently, there are no comprehensive breast sarcoma guidelines in the UK. There is therefore a need for guidelines to clarify surgical management, which we have based on data from our regional audit, current evidence, and consensus between West of Scotland Breast Cancer and Scottish Sarcoma Managed Clinical Networks. Methods and results: From 2007 to 2019, 46 patients were treated with breast sarcoma in the West of Scotland. Sarcoma Centre versus Peripheral Hospitals: Incomplete excision rate was 0% at sarcoma centre and 50% at peripheral hospitals (p = 0.0002, Odds Ratio 43). For angiosarcoma, 0% positive margin at the sarcoma centre versus 62.5% at the peripheral unit (p = 0.0036, odds ratio 39.3). Tumours treated at the sarcoma centre were larger than those treated at peripheral hospitals (92.5 versus 39.7 mm, p = 0.0009). WLE (wide local excision) versus mastectomy: Out of eight WLE patients, seven (87.5%) had positive margins, with 6 of these patients proceeding to mastectomy (i.e. 75% WLE patients ultimately had a mastectomy). The positive margin rate was significantly higher in WLE (87.5%) than in mastectomy (10.3%) (p = 0.0001, odds ratio 60.7). Survival: No difference was noted between the sarcoma centre and peripheral hospitals for overall survival (p = 0.43), stratified for tumours <5 cm (p = 0.16), and disease-free survival (p = 0.45). Conclusions: Our data strongly suggest that specific guidelines are needed for breast sarcoma, and that managing these patients according to breast carcinoma protocols in peripheral hospitals is sub-optimal. We recommend centralisation of breast sarcoma patient care to a specialist sarcoma centre, with WLE not recommended as a firstline surgical option given both the high rates of incomplete excision and subsequent need for completion mastectomy.
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Affiliation(s)
- Steven Lo
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Castle Street, Glasgow, UK. G4 0SF.
| | - Naomi Foster
- Canniesburn Regional Plastic Surgery and Burns Unit, Glasgow Royal Infirmary, Castle Street, Glasgow, UK. G4 0SF
| | | | - Jeff White
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Ioanna Nixon
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - James Mansell
- Department of General Surgery, University Hospital Wishaw, 50 Netherton St, Lanarkshire, ML2 0DP, UK
| | - Mark McCleery
- Department of Radiology, Glasgow Royal Infirmary, Castle St, G4 0SF, UK
| | - Lynsey Whyte
- Pathology Department, Queen Elizabeth University Hospital, Glasgow, UK G51 4TF
| | - Fiona Cowie
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
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Tetzlaff MT, Adhikari C, Lo S, Rawson RV, Amaria RN, Menzies AM, Wilmott JS, Ferguson PM, Ross MI, Spillane AJ, Vu KA, Ma J, Ning J, Haydu LE, Saw RPM, Wargo JA, Tawbi HA, Gershenwald JE, Long GV, Davies MA, Scolyer RA. Histopathological features of complete pathological response predict recurrence-free survival following neoadjuvant targeted therapy for metastatic melanoma. Ann Oncol 2020; 31:1569-1579. [PMID: 32739408 DOI: 10.1016/j.annonc.2020.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recent clinical trials demonstrated the safety and efficacy of neoadjuvant dabrafenib and trametinib (DT) among patients with surgically resectable clinical stage III BRAFV600E/K mutant melanoma. Although patients achieving a complete pathological response (pCR) exhibited superior recurrence-free survival (RFS) versus those who did not, 30% of pCR patients relapsed. We sought to identify whether histopathological features of the pathological response further delineated risk of relapse. METHODS Surgical resection specimens from DT-treated patients in two phase 2 clinical trials were reviewed. Histopathological features, including relative amounts of viable tumour, necrosis, melanosis, and fibrosis (hyalinized or immature/proliferative) were assessed for associations with patient outcomes. RESULTS Fifty-nine patients underwent surgical resection following neoadjuvant DT. Patients achieving pCR (49%) had longer RFS compared with patients who did not (P = 0.005). Patients whose treated tumour showed any hyalinized fibrosis had longer RFS versus those without (P = 0.014), whereas necrosis (P = 0.012) and/or immature/proliferative fibrosis (P = 0.026) correlated with shorter RFS. Multivariable analyses showed absence of pCR or presence of immature fibrosis independently predicted shorter RFS. Among pCR patients, mature/hyalinized-type fibrosis correlated with improved RFS (P = 0.035). CONCLUSIONS The extent and composition of the pathological response following neoadjuvant DT in BRAFV600E/K mutant melanoma correlates with RFS, including pCR patients. These findings support the need for detailed histological analysis of specimens collected after neoadjuvant therapy.
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Affiliation(s)
- M T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - C Adhikari
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia
| | - S Lo
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia
| | - R V Rawson
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia
| | - R N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - J S Wilmott
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia
| | - P M Ferguson
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia
| | - M I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A J Spillane
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - K A Vu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R P M Saw
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - J A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - M A Davies
- Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia.
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Owen C, Bai X, Quah T, Lo S, Callaghan S, Martínez-Vila C, Bhave P, Reijers I, Gerard C, Aspelagh S, Xu W, Welsh S, Sandhu S, Mangana J, McQuade J, Ascierto P, Zimmer L, Johnson D, Lebbé C, Menzies A. 1138P Delayed immune-related adverse events (irAEs) on anti-PD1-based therapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1261] [Citation(s) in RCA: 2] [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: 11/29/2022] Open
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Dièye A, Diop Dia A, Niang S, Diallo S, Dia D, Diédhiou M, Seck B, Lo S, Dia-Badiane N. Connaissances, attitudes et pratiques des détenus sur la tuberculose. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.325] [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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Owen CN, Shoushtari AN, Chauhan D, Palmieri DJ, Lee B, Rohaan MW, Mangana J, Atkinson V, Zaman F, Young A, Hoeller C, Hersey P, Dummer R, Khattak MA, Millward M, Patel SP, Haydon A, Johnson DB, Lo S, Blank CU, Sandhu S, Carlino MS, Larkin JMG, Menzies AM, Long GV. Management of early melanoma recurrence despite adjuvant anti-PD-1 antibody therapy ☆. Ann Oncol 2020; 31:1075-1082. [PMID: 32387454 PMCID: PMC9211001 DOI: 10.1016/j.annonc.2020.04.471] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anti-programmed cell death protein 1 (PD-1) antibodies (PD1) prolong recurrence-free survival in high-risk resected melanoma; however, approximately 25%-30% of patients recur within 1 year. This study describes the pattern of recurrence, management and outcomes of patients who recur with adjuvant PD1 therapy. PATIENTS AND METHODS Consecutive patients from 16 centres who recurred having received adjuvant PD1 therapy for resected stage III/IV melanoma were studied. Recurrence characteristics, management and outcomes were examined; patients with mucosal melanoma were analysed separately. RESULTS Melanoma recurrence occurred in 147 (17%) of ∼850 patients treated with adjuvant PD1. In those with cutaneous melanoma (n = 136), median time to recurrence was 4.6 months (range 0.3-35.7); 104 (76%) recurred during (ON) adjuvant PD1 after a median 3.2 months and 32 (24%) following (OFF) treatment cessation after a median 12.5 months, including in 21 (15%) who ceased early for toxicity. Fifty-nine (43%) recurred with locoregional disease only and 77 (57%) with distant disease. Of those who recurred locally, 22/59 (37%) subsequently recurred distantly. Eighty-nine (65%) patients received systemic therapy after recurrence. Of those who recurred ON adjuvant PD1, none (0/6) responded to PD1 alone; 8/33 assessable patients (24%) responded to ipilimumab (alone or in combination with PD1) and 18/23 (78%) responded to BRAF/MEK inhibitors. Of those who recurred OFF adjuvant PD1, two out of five (40%) responded to PD1 monotherapy, two out of five (40%) responded to ipilimumab-based therapy and 9/10 (90%) responded to BRAF/MEK inhibitors. CONCLUSIONS Most patients who recur early despite adjuvant PD1 develop distant metastases. In those who recur ON adjuvant PD1, there is minimal activity of further PD1 monotherapy, but ipilimumab (alone or in combination with PD1) and BRAF/MEK inhibitors have clinical utility. Retreatment with PD1 may have activity in select patients who recur OFF PD1.
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Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | | | - D Chauhan
- The Royal Marsden NHS Foundation Trust, London, UK
| | - D J Palmieri
- Westmead Hospital and Blacktown Hospitals, Sydney, Australia
| | - B Lee
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M W Rohaan
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Mangana
- University Hospital Zurich, Zürich, Switzerland
| | - V Atkinson
- Greenslopes Private Hospital, Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - F Zaman
- The Alfred Hospital, Melbourne, Australia
| | - A Young
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hoeller
- Medical University of Vienna, Vienna, Austria
| | - P Hersey
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - R Dummer
- University Hospital Zurich, Zürich, Switzerland
| | - M A Khattak
- Fiona Stanley Hospital, The University of Western Australia, Perth, Australia
| | - M Millward
- School of Medicine and Pharmacology, Nedlands, Australia
| | - S P Patel
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - S Sandhu
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead Hospital and Blacktown Hospitals, Sydney, Australia
| | - J M G Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia.
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Cust AE, Badcock C, Smith J, Thomas NE, Haydu LE, Armstrong BK, Law MH, Thompson JF, Kanetsky PA, Begg CB, Shi Y, Kricker A, Orlow I, Sharma A, Yoo S, Leong SF, Berwick M, Ollila DW, Lo S. A risk prediction model for the development of subsequent primary melanoma in a population-based cohort. Br J Dermatol 2020; 182:1148-1157. [PMID: 31520533 PMCID: PMC7069770 DOI: 10.1111/bjd.18524] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Accepted: 09/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines for follow-up of patients with melanoma are based on limited evidence. OBJECTIVES To guide skin surveillance, we developed a risk prediction model for subsequent primary melanomas, using demographic, phenotypical, histopathological, sun exposure and genomic risk factors. METHODS Using Cox regression frailty models, we analysed data for 2613 primary melanomas from 1266 patients recruited to the population-based Genes, Environment and Melanoma study in New South Wales, Australia, with a median of 14 years' follow-up via the cancer registry. Discrimination and calibration were assessed. RESULTS The median time to diagnosis of a subsequent primary melanoma decreased with each new primary melanoma. The final model included 12 risk factors. Harrell's C-statistic was 0·73 [95% confidence interval (CI) 0·68-0·77], 0·65 (95% CI 0·62-0·68) and 0·65 (95% CI 0·61-0·69) for predicting second, third and fourth primary melanomas, respectively. The risk of a subsequent primary melanoma was 4·75 times higher (95% CI 3·87-5·82) for the highest vs. the lowest quintile of the risk score. The mean absolute risk of a subsequent primary melanoma within 5 years was 8·0 ± SD 4.1% after the first primary melanoma, and 46·8 ± 15·0% after the second, but varied substantially by risk score. CONCLUSIONS The risk of developing a subsequent primary melanoma varies considerably between individuals and is particularly high for those with two or more primary melanomas. The risk prediction model and its associated nomograms enable estimation of the absolute risk of subsequent primary melanoma, on the basis of on an individual's risk factors, and can be used to tailor surveillance intensity, communicate risk and provide patient education. What's already known about this topic? Current guidelines for the frequency and length of follow-up to detect new primary melanomas in patients with one or more previous primary melanomas are based on limited evidence. People with one or more primary melanomas have, on average, a higher risk of developing another primary invasive melanoma, compared with the general population, but an accurate way of estimating individual risk is needed. What does this study add? We provide a comprehensive risk prediction model for subsequent primary melanomas, using data from 1266 participants with melanoma (2613 primary melanomas), over a median 14 years' follow-up. The model includes 12 risk factors comprising demographic, phenotypical, histopathological and genomic factors, and sun exposure. It enables estimation of the absolute risk of subsequent primary melanomas, and can be used to tailor surveillance intensity, communicate individual risk and provide patient education.
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Affiliation(s)
- A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Badcock
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - J Smith
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - N E Thomas
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, U.S.A
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, U.S.A
| | - L E Haydu
- University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - P A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - C B Begg
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, U.S.A
| | - Y Shi
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, U.S.A
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - A Kricker
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - I Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - A Sharma
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Yoo
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S F Leong
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - M Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, U.S.A
| | - D W Ollila
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, U.S.A
- Department of Surgery, University of North Carolina, Chapel Hill, NC, U.S.A
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Lo S, Chapman P. The first worldwide use and evaluation of augmented reality (AR) in "Patient information leaflets" in plastic surgery. J Plast Reconstr Aesthet Surg 2020; 73:1357-1404. [PMID: 32317231 DOI: 10.1016/j.bjps.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Steven Lo
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom; College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom; Translational Research Centre, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Paul Chapman
- School of Simulation and Visualisation, The Glasgow School of Art, United Kingdom
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Ipenburg NA, Nieweg OE, Lo S. Author response to: Comment on: External validation of a prognostic model to predict survival of patients with sentinel node-negative melanoma. Br J Surg 2020; 107:616. [DOI: 10.1002/bjs.11529] [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: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/08/2022]
Affiliation(s)
- N A Ipenburg
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - O E Nieweg
- Melanoma Institute Australia, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - S Lo
- Melanoma Institute Australia, Sydney, New South Wales, Australia
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Mazur N, Osinga R, Lo S. Split median superficial sural artery perforator (MSSAP) flap and medial sural artery perforator (MSAP) flap for posterior thigh sarcoma reconstruction. BMJ Case Rep 2020; 13:13/2/e233352. [PMID: 32029521 DOI: 10.1136/bcr-2019-233352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Reconstruction of composite defects of the posterior thigh and knee is challenging. Pedicled medial gastrocnemius flaps are the traditional reconstructive approach, but late contractures related to skin grafted muscle may affect knee function. More recently, the medial sural artery perforator (MSAP) flap has been described for such defects, although may necessitate skin grafting of the donor site. To minimise the drawbacks with these options, we describe a combination of a median superficial sural artery perforator (MSSAP) flap and MSAP flap. This allows both tension free closure of the donor site without skin grafting, and facilitates coverage of a round defect by splitting the flap into two adjacent triangular flaps. This is the first report of posterior thigh defect reconstruction with a combination of MSSAP and MSAP flaps.
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Affiliation(s)
- Natalia Mazur
- Medical School, Medical University of Gdansk, Gdansk, Poland.,Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Rik Osinga
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK .,Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Steven Lo
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. 805 Clopidogrel Versus Ticagrelor on Coronary Microvascular and Peripheral Endothelial Function After Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS): Results of a Randomised Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.812] [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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