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Penman D, Keogh A, Ahmed S, Ahmed S, Farrell C, Andrews T, Javed A, Sarkar S. Substratifying the risk of covert malignancy in significant rectal polyps: Outcomes from a specialist multidisciplinary team (MDT). Colorectal Dis 2024. [PMID: 38702861 DOI: 10.1111/codi.17007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/06/2023] [Accepted: 05/30/2023] [Indexed: 05/06/2024]
Abstract
AIM A treatment strategy for patients with a significant polyp or early colon cancer (SPECC) of the rectum presents a challenge due to the significant rate of covert malignancy and lack of standardized assessment. For this reason, NICE recommends multidisciplinary meetings to improve outcomes. The primary aim of the present study was to report the performance of our specialist early rectal cancer (SERC) multidisciplinary team (MDT) in correctly substratifying the risk of cancer and to discuss the limitations of staging investigations in those patients with "poor outcomes". METHOD This was a retrospective review of patients referred to our SERC MDT from 2014 to 2019. Lesions were assigned by the MDT to three pre-resection categories (low, intermediate, high) according to the risk of covert malignancy. Resection method and final histology were compared to the pre-resection categories. RESULTS Of 350 SPECC lesions, 174 were assessed as low-risk, 108 intermediate-risk and 68 high-risk. The cancer incidence was 4.8%, 8.3% and 53%, respectively (15.5% overall). Eight lesions were categorized as low-risk but following piecemeal resection were found to be malignant. Five lesions, three of which were categorized as high-risk, were ultimately benign following conventional surgery. One pT1sm1 cancer, removed by anterior resection, may have been treated by local excision. CONCLUSION A total of 83% of malignant polyps were triaged to an en bloc resection technique and surgical resection avoided for nearly all benign lesions. However, 12 patients from this cohort were deemed to have a poor outcome because of miscategorization. Further comparative research is needed to establish the optimum strategy for rectal SPECC lesion assessment. ORIGINALITY STATEMENT There is currently no consensus for staging significant polyps of the rectum. This paper reports the effectiveness of a specialist early rectal cancer MDT to correctly risk-stratify significant rectal polyps. It underscores the importance of accurate categorization for treatment decision-making, while acknowledging the limitations of current staging modalities.
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Affiliation(s)
- Douglas Penman
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ashley Keogh
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Shakil Ahmed
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Suhail Ahmed
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Catriona Farrell
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ahsan Javed
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Sanchoy Sarkar
- The Department of Colorectal Surgery, Liverpool University Hospitals Foundation Trust, Liverpool, UK
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Cooper VT, Armour KC, Hakim GJ, Tierney JE, Osman MB, Proistosescu C, Dong Y, Burls NJ, Andrews T, Amrhein DE, Zhu J, Dong W, Ming Y, Chmielowiec P. Last Glacial Maximum pattern effects reduce climate sensitivity estimates. Sci Adv 2024; 10:eadk9461. [PMID: 38630811 PMCID: PMC11023557 DOI: 10.1126/sciadv.adk9461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Here, we show that the Last Glacial Maximum (LGM) provides a stronger constraint on equilibrium climate sensitivity (ECS), the global warming from increasing greenhouse gases, after accounting for temperature patterns. Feedbacks governing ECS depend on spatial patterns of surface temperature ("pattern effects"); hence, using the LGM to constrain future warming requires quantifying how temperature patterns produce different feedbacks during LGM cooling versus modern-day warming. Combining data assimilation reconstructions with atmospheric models, we show that the climate is more sensitive to LGM forcing because ice sheets amplify extratropical cooling where feedbacks are destabilizing. Accounting for LGM pattern effects yields a median modern-day ECS of 2.4°C, 66% range 1.7° to 3.5°C (1.4° to 5.0°C, 5 to 95%), from LGM evidence alone. Combining the LGM with other lines of evidence, the best estimate becomes 2.9°C, 66% range 2.4° to 3.5°C (2.1° to 4.1°C, 5 to 95%), substantially narrowing uncertainty compared to recent assessments.
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Affiliation(s)
- Vincent T. Cooper
- Department of Atmospheric Sciences, University of Washington, Seattle, WA, USA
| | - Kyle C. Armour
- Department of Atmospheric Sciences, University of Washington, Seattle, WA, USA
- School of Oceanography, University of Washington, Seattle, WA, USA
| | - Gregory J. Hakim
- Department of Atmospheric Sciences, University of Washington, Seattle, WA, USA
| | | | | | - Cristian Proistosescu
- Department of Climate, Meteorology, and Atmospheric Sciences and Department of Earth Sciences and Environmental Change, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Yue Dong
- Cooperative Institute for Research in Environmental Science, University of Colorado, Boulder, CO, USA
| | - Natalie J. Burls
- Department of Atmospheric, Oceanic & Earth Sciences, Center for Ocean-Land-Atmosphere Studies, George Mason University, Fairfax, VA, USA
| | | | - Daniel E. Amrhein
- Climate and Global Dynamics Laboratory, NSF National Center for Atmospheric Research, Boulder, CO, USA
| | - Jiang Zhu
- Climate and Global Dynamics Laboratory, NSF National Center for Atmospheric Research, Boulder, CO, USA
| | - Wenhao Dong
- Cooperative Programs for the Advancement of Earth System Science, University Corporation for Atmospheric Research, Boulder, CO, USA
- NOAA/Geophysical Fluid Dynamics Laboratory, Princeton, NJ, USA
| | - Yi Ming
- Earth and Environmental Sciences and Schiller Institute for Integrated Science and Society, Boston College, Boston, MA, USA
| | - Philip Chmielowiec
- Department of Climate, Meteorology, and Atmospheric Sciences and Department of Earth Sciences and Environmental Change, University of Illinois at Urbana Champaign, Urbana, IL, USA
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Armour KC, Proistosescu C, Dong Y, Hahn LC, Blanchard-Wrigglesworth E, Pauling AG, Jnglin Wills RC, Andrews T, Stuecker MF, Po-Chedley S, Mitevski I, Forster PM, Gregory JM. Sea-surface temperature pattern effects have slowed global warming and biased warming-based constraints on climate sensitivity. Proc Natl Acad Sci U S A 2024; 121:e2312093121. [PMID: 38466843 PMCID: PMC10962993 DOI: 10.1073/pnas.2312093121] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/15/2023] [Indexed: 03/13/2024] Open
Abstract
The observed rate of global warming since the 1970s has been proposed as a strong constraint on equilibrium climate sensitivity (ECS) and transient climate response (TCR)-key metrics of the global climate response to greenhouse-gas forcing. Using CMIP5/6 models, we show that the inter-model relationship between warming and these climate sensitivity metrics (the basis for the constraint) arises from a similarity in transient and equilibrium warming patterns within the models, producing an effective climate sensitivity (EffCS) governing recent warming that is comparable to the value of ECS governing long-term warming under CO[Formula: see text] forcing. However, CMIP5/6 historical simulations do not reproduce observed warming patterns. When driven by observed patterns, even high ECS models produce low EffCS values consistent with the observed global warming rate. The inability of CMIP5/6 models to reproduce observed warming patterns thus results in a bias in the modeled relationship between recent global warming and climate sensitivity. Correcting for this bias means that observed warming is consistent with wide ranges of ECS and TCR extending to higher values than previously recognized. These findings are corroborated by energy balance model simulations and coupled model (CESM1-CAM5) simulations that better replicate observed patterns via tropospheric wind nudging or Antarctic meltwater fluxes. Because CMIP5/6 models fail to simulate observed warming patterns, proposed warming-based constraints on ECS, TCR, and projected global warming are biased low. The results reinforce recent findings that the unique pattern of observed warming has slowed global-mean warming over recent decades and that how the pattern will evolve in the future represents a major source of uncertainty in climate projections.
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Affiliation(s)
- Kyle C. Armour
- Department of Atmospheric Sciences, University of Washington, Seattle, WA98195
- School of Oceanography, University of Washington, Seattle, WA98195
| | - Cristian Proistosescu
- Department of Climate, Meteorology, and Atmospheric Sciences, University of Illinois, Urbana-Champaign, Champaign, IL61801
- Department of Earth Sciences and Environmental Change, University of Illinois, Urbana-Champaign, Champaign, IL61801
| | - Yue Dong
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO80309
| | - Lily C. Hahn
- Scripps Institution of Oceanography, La Jolla, CA92093
| | | | | | - Robert C. Jnglin Wills
- Department of Atmospheric Sciences, University of Washington, Seattle, WA98195
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, CH8092
| | | | - Malte F. Stuecker
- Department of Oceanography and International Pacific Research Center, School of Ocean and Earth Science and Technology, University of Hawai’i at Mānoa, Honolulu, HI96822
| | - Stephen Po-Chedley
- Program for Climate Model Diagnosis and Intercomparison, Lawrence Livermore National Laboratory, Livermore, CA94550
| | - Ivan Mitevski
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY10027
| | - Piers M. Forster
- Priestley International Centre for Climate, University of Leeds, LeedsLS2 9JT, United Kingdom
| | - Jonathan M. Gregory
- Met Office Hadley Centre, ExeterEX1 3PB, United Kingdom
- National Centre for Atmospheric Science, University of Reading, ReadingRG6 6ET, United Kingdom
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Feldman C, Fredericks-Younger J, Desjardins P, Malmstrom H, Miloro M, Warburton G, Ward B, Ziccardi V, Fine D, Greenberg P, Andrews T, Matheson P, Lu SE. The Opioid Analgesic Reduction Study (OARS) Pilot: A Double-Blind Randomized Multicenter Trial. JDR Clin Trans Res 2024; 9:72-84. [PMID: 36680313 PMCID: PMC10850879 DOI: 10.1177/23800844221144031] [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] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With addiction rates and opioid deaths increasing, health care providers are obligated to help stem the opioid crisis. As limited studies examine the comparative effectiveness of fixed-dose combination nonopioid analgesia to opioid-containing analgesia, a comparative effectiveness study was planned and refined by conducting a pilot study. METHODS The Opioid Analgesic Reduction Study (OARS) pilot, a stratified, randomized, multisite, double-blind clinical trial, was designed to test technology and procedures to be used in the full OARS trial. Participants engaged in the full protocol, enabling the collection of OARS outcome data. Eligible participants reporting to 1 of 5 sites for partial or full bony impacted mandibular third molar extraction were stratified by biologic sex and randomized to 1 of 2 treatment groups, OPIOID or NONOPIOID. OPIOID participants were provided 20 doses of hydrocodone 5 mg/acetaminophen 300 mg. NONOPIOID participants were provided 20 doses of ibuprofen 400 mg/acetaminophen 500 mg. OARS outcomes data, including pain experience, adverse effects, sleep quality, pain interference, overall satisfaction, and remaining opioid tablets available for diversion, were collected via surveys, electronic medication bottles, eDiary, and activity/sleep monitor. RESULTS Fifty-three participants were randomized with 50 completing the OARS pilot protocol. Across all outcome pain domains, in all but 1 time period, NONOPIOID was better in managing pain than OPIOID (P < 0.05 level). Other outcomes suggest less pain interference, less adverse events, better sleep quality, better overall satisfaction, and fewer opioid-containing tablets available for diversion. DISCUSSION Results suggest patients requiring impacted mandibular third molar extraction would benefit from fixed-dose combination nonopioid analgesia. KNOWLEDGE TRANSFER STATEMENT Study results suggest fixed-dose nonopioid combination ibuprofen 400 mg/acetaminophen 500 mg is superior to opioid-containing analgesic (hydrocodone 5 mg/acetaminophen 500 mg). This knowledge should inform surgeons and patients in the selection of postsurgical analgesia.
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Affiliation(s)
- C.A. Feldman
- School of Dental Medicine, Rutgers University, Newark, NJ, USA
- School of Public Health, Rutgers University, Newark, NJ, USA
| | | | - P.J. Desjardins
- School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - H. Malmstrom
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - M. Miloro
- College of Dentistry, University of Illinois, IL, USA
| | - G. Warburton
- School of Dentistry, University of Maryland, MD, USA
| | - B. Ward
- School of Dentistry, University of Michigan, MI, USA
| | - V. Ziccardi
- School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - D.H. Fine
- School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - P. Greenberg
- School of Public Health, Rutgers University, Newark, NJ, USA
| | - T. Andrews
- School of Public Health, Rutgers University, Newark, NJ, USA
| | - P.B. Matheson
- School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - S.-E. Lu
- School of Public Health, Rutgers University, Newark, NJ, USA
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Andrews T. Hypersensitivity to Ibuprofen: Real-Life Experience in Children With History of Suspected Immediate Reactions. Pediatrics 2023; 152:S18-S19. [PMID: 38038512 DOI: 10.1542/peds.2023-064344fd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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Eijwoudt S, Andrews T, McErlain-Naylor SA, Stewart T, Spencer K. Internal and external workload in national and international netball competition. J Sports Sci 2023; 41:1573-1579. [PMID: 38078436 DOI: 10.1080/02640414.2023.2283661] [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: 05/31/2022] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Differences in workload exist between netball playing positions and competition levels, but no research has compared workloads experienced by the same elite players during national and international competitions. This study collected internal (heart rate) and external (PlayerLoad·min-1) workload data per match quarter from 44 players during a national competition and 12 players during an international competition. Nine players played in both competitions. Linear mixed models compared percentage of match quarter in each heart rate zone and PlayerLoad·min-1 between competitions for each playing position. Workloads against low- and high-ranked international opponents were also compared. Internal workloads were greater in national compared to international competition for GD and WD positions. PlayerLoad·min-1 was significantly higher by 8-13% in the national competition for positions WD and C, and by 5-8% in the international competition for GD and GA. Positional differences may indicate a role of the team's tactical style of play. Workloads were generally greater against higher- rather than lower-ranked international opponents. These results indicate that tactical factors in combination with playing position and opposition characteristics should be considered when preparing physically for matches.
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Affiliation(s)
- S Eijwoudt
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Andrews
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S A McErlain-Naylor
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - T Stewart
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - K Spencer
- School of Sport and Recreation, Sport Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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7
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Jones RP, Mielgo A, Schmid M, Bury D, Andrews T, Burdak-Rothkamm S, Shackcloth M, J. S. Cross T, Fenwick S, Malik HZ, Diaz-Nieto R, Ottensmeier C, Palmer DH, Vimalachandran D. PINCER (A Platform Study for solId orgaN CancERs): an agile pan-network platform study to deliver high-quality translational research. Br J Surg 2023; 110:1108-1111. [PMID: 37075549 PMCID: PMC10805525 DOI: 10.1093/bjs/znad097] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Robert P Jones
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ainhoa Mielgo
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Michael Schmid
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Danielle Bury
- Department of Pathology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Timothy Andrews
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Cellular Pathology, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Susanne Burdak-Rothkamm
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Cellular Pathology, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Michael Shackcloth
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Timothy J. S. Cross
- Department of Hepatology, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Fenwick
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hassan Z Malik
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rafa Diaz-Nieto
- Department of Hepatobiliary Surgery, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christian Ottensmeier
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Oncology, Clatterbridge Cancer Centre, Liverpool, UK
| | - Daniel H Palmer
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Oncology, Clatterbridge Cancer Centre, Liverpool, UK
| | - Dale Vimalachandran
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Colorectal Surgery, Countess of Chester NHS Foundation Trust, Chester, UK
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8
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Quinn LM, Haldenby S, Antzcak P, Fowler A, Bullock K, Kenny J, Gilbert T, Andrews T, Diaz-Nieto R, Fenwick S, Jones R, Costello-Goldring E, Poston G, Greenhalf W, Palmer D, Malik H, Goldring C. Genomic profiling of idiopathic peri-hilar cholangiocarcinoma reveals new targets and mutational pathways. Sci Rep 2023; 13:6681. [PMID: 37095160 PMCID: PMC10126102 DOI: 10.1038/s41598-023-33096-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Peri-hilar cholangiocarcinoma (pCCA) is chemorefractory and limited genomic analyses have been undertaken in Western idiopathic disease. We undertook comprehensive genomic analyses of a U.K. idiopathic pCCA cohort to characterize its mutational profile and identify new targets. Whole exome and targeted DNA sequencing was performed on forty-two resected pCCA tumors and normal bile ducts, with Gene Set Enrichment Analysis (GSEA) using one-tailed testing to generate false discovery rates (FDR). 60% of patients harbored one cancer-associated mutation, with two mutations in 20%. High frequency somatic mutations in genes not typically associated with cholangiocarcinoma included mTOR, ABL1 and NOTCH1. We identified non-synonymous mutation (p.Glu38del) in MAP3K9 in ten tumors, associated with increased peri-vascular invasion (Fisher's exact, p < 0.018). Mutation-enriched pathways were primarily immunological, including innate Dectin-2 (FDR 0.001) and adaptive T-cell receptor pathways including PD-1 (FDR 0.007), CD4 phosphorylation (FDR 0.009) and ZAP70 translocation (FDR 0.009), with overlapping HLA genes. We observed cancer-associated mutations in over half of our patients. Many of these mutations are not typically associated with cholangiocarcinoma yet may increase eligibility for contemporary targeted trials. We also identified a targetable MAP3K9 mutation, in addition to oncogenic and immunological pathways hitherto not described in any cholangiocarcinoma subtype.
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Affiliation(s)
- Leonard M Quinn
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK.
| | - Sam Haldenby
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - Philip Antzcak
- Computational Biology Facility, University of Liverpool, Liverpool, UK
| | - Anna Fowler
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Katie Bullock
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK
| | - John Kenny
- Centre for Genomic Research, University of Liverpool, Liverpool, UK
| | - Timothy Gilbert
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK
| | - Timothy Andrews
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Stephen Fenwick
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Robert Jones
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Eithne Costello-Goldring
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK
| | - Graeme Poston
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - William Greenhalf
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK
| | - Daniel Palmer
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK
| | - Hassan Malik
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Chris Goldring
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Sherrington Building, University of Liverpool, Liverpool, UK.
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Perera B, Steward C, Courtenay K, Andrews T, Shankar R. Pharmacogenomics: an opportunity for personalised psychotropic prescribing in adults with intellectual disabilities. BJPsych Open 2022; 8:e157. [PMID: 35975635 PMCID: PMC9438475 DOI: 10.1192/bjo.2022.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
There is growing evidence for the use of pharmacogenomics in psychotropic prescribing. People with intellectual disabilities are disproportionately prescribed psychotropics and are at risk of polypharmacy. There is an urgent need for safeguards to prevent psychotropic overprescribing but it is equally crucial that this population is not left behind in such exciting initiatives. Understanding how genetic variations affect medications is a step towards personalised medicine. This may improve personalised prescribing for people with intellectual disabilities, especially given the high rate of psychiatric and behavioural problems in this population. Our editorial explores opportunities and challenges that pharmacogenomics offers for the challenges of polypharmacy and overprescribing of psychotropics in people with intellectual disabilities.
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Affiliation(s)
- Bhathika Perera
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | - Ken Courtenay
- Barnet, Enfield and Haringey Mental Health NHS Trust, London, UK
| | | | - Rohit Shankar
- Peninsula School of Medicine, University of Plymouth, UK; and Cornwall Partnership NHS Foundation Trust, Truro, UK
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10
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Bloch-Johnson J, Rugenstein M, Gregory J, Cael BB, Andrews T. Climate impact assessments should not discount 'hot' models. Nature 2022; 608:667. [PMID: 35999296 DOI: 10.1038/d41586-022-02241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Stephens GL, Hakuba MZ, Kato S, Gettleman A, Dufresne JL, Andrews T, Cole JNS, Willem U, Mauritsen T. The changing nature of Earth's reflected sunlight. Proc Math Phys Eng Sci 2022. [DOI: 10.1098/rspa.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increased rate of sea-level rise suggests that Earth's energy imbalance is also increasing over time. This study assesses whether 20 years of direct observations of this energy imbalance from Earth-orbiting satellites support the existence of a real trend in this imbalance and the components of it and finds. Changes to the imbalance observed are found to be consistent across multiple sources of observations. The majority of recent studies now clearly point to this energy imbalance being positive, while forced by increasing greenhouse gas concentrations in the atmosphere, being amplified significantly by decreases to the amount of sunlight reflected by Earth to space. Here, we show that the global changes observed appear largely from reductions in the amount of sunlight scattered by Earth's atmosphere. These reductions, in turn, are found to be almost equally split between reduced reflection from the cloudy and clear regions of the atmosphere, with the latter being suggestive of reduced scattering by aerosol particles over the observational period. Climate models, however, show an almost exclusive response from clouds, and a slightly exaggerated darkening of the surface. Thus, models that match the global shortwave change do so for the wrong reasons.
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Affiliation(s)
- Graeme L. Stephens
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
- Department of Physics, University of Oxford, Oxford, UK
| | - Maria Z. Hakuba
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - Seiji Kato
- Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | | | - Jean-Louis Dufresne
- Laboratoire de Meteorologie Dynamique, Institut Pierre et Simon Laplace, Paris, France
| | | | - Jason N. S. Cole
- Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change Canada, Victoria, British Columbia, Canada
| | - Ulrika Willem
- Rossby Centre, Swedish Meteorological and Hydrological Institute, Norrkoping, Sweden
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12
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Aslan J, Conley TE, Campbell F, Smith PJ, McNicol F, Andrews T, Subramanian S. Recurrent colonic polyps. Gut 2022; 71:888-960. [PMID: 33208406 DOI: 10.1136/gutjnl-2020-323133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Joseph Aslan
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Thomas E Conley
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Fiona Campbell
- Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Philip J Smith
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Frances McNicol
- Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sreedhar Subramanian
- Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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13
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Martin A, Andrews T, Goldbart J, Landers M. Reconciling communication repertoires: navigating interactions involving persons with severe/profound intellectual disability, a classic grounded theory study. J Intellect Disabil Res 2022; 66:332-352. [PMID: 35194869 PMCID: PMC9305890 DOI: 10.1111/jir.12921] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A rights-based agenda, informed by the UNCRPD, that advocates person-centredness, inclusion, empowerment and self-determination is shaping service provision to people with intellectual disability (ID). Listening to their perspectives is fundamental to meeting these goals. However, communication with people with severe/profound ID is challenging and difficult. Therefore, this study aims to generate a theory that explains how people communicate with and understand each other in these interactions. METHODS Classic grounded theory (CGT) methodology was used as it recognises that knowledge can be captured rather than interpreted. According to CGT, capturing rather than interpreting experiences strengthens findings, particularly in relation to participants with severe/profound ID. Concurrent theoretical sampling, data collection and analysis were undertaken. Twenty-two individuals participated in the study: 3 people with severe/profound ID and 19 people with whom they interact. Data were collected over a 9-month period and involved video recordings, field notes, individual and group interviews. Data were analysed using CGT methods of coding, constant comparison and memoing. RESULTS The Theory of Reconciling Communication Repertoires was generated. Nurturing a sense of belonging emerged as the main concern and core category that is resolved by reconciling communication repertoires. A communication repertoire refers to the cache of communication skills a person has available to them. To reconcile repertoires is to harmonise or make them compatible with each other in order to communicate. Interactions are navigated through five stages: motivation to interact, connection establishment, reciprocally engaging, navigating understanding and confusion resolution. CONCLUSIONS The Theory of Reconciling Communication Repertoires explains how interactions involving people with severe/profound ID are navigated. While this is a substantive rather than formal theory, it has the potential to inform practice, policy, management, education and research as it outlines how communication with people with severe/profound ID can take place to design, inform and plan person-centred care.
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Affiliation(s)
- A.‐M. Martin
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
| | - T. Andrews
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
| | - J. Goldbart
- Department of PsychologyManchester Metropolitan UniversityManchesterUK
| | - M. Landers
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
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14
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Altaf K, Slawik S, Sochorova D, Gahunia S, Andrews T, Kehoe A, Ahmed S. Long-term outcomes of open versus closed rectal defect after transanal endoscopic microscopic surgery. Colorectal Dis 2021; 23:2904-2910. [PMID: 34288314 DOI: 10.1111/codi.15830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 07/10/2021] [Indexed: 12/13/2022]
Abstract
AIM Management of the rectal defect after transanal endoscopic microsurgery (TEM) is a matter of debate. Data are lacking on long term outcomes and continence of patients with open or closed rectal defect. We sought to analyse these in a retrospective cohort study. METHODS Patients undergoing TEM via the Specialist Early Rectal Cancer (SERC) MDT between 2012 and 2019 were included from a prospectively maintained database. These were divided into two groups - open and closed, based on management of rectal defect. Patient demographics and outcomes, including pre- and postoperative oncological staging, morbidity, mortality, length of stay and faecal incontinence severity score (FISI) scores were assessed. RESULTS A total of 170 matched patients were included (70-open, 100-closed rectal defects). Short-term complications (bleeding, infection, urinary retention and infection, length of stay and pain) were 18.8% with no significant difference between the two groups (22% vs. 16%). Most of the defects were well healed upon endoscopic follow-up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus (p = 0.87) or stricture (p = 0.79) but a significant difference in post-TEMS FISI scores in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02). CONCLUSION There are pros and cons associated with both rectal defect management approaches. Long-term complications should be expected and actively followed up. Patients should be thoroughly counselled about these and possible deterioration in continence post-TEM.
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Affiliation(s)
- Kiran Altaf
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Simone Slawik
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Dana Sochorova
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Sukhpreet Gahunia
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Ashley Kehoe
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Shakil Ahmed
- Department of Surgery, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
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15
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Altaf K, Gahunia S, Sochorova D, Andrews T, Sarkar S, Ahmed S. EP.TU.393Management of Suspicious Neoplastic Rectal Lesions in Octogenarians by a Specialist Early Rectal Cancer MDT. Br J Surg 2021. [DOI: 10.1093/bjs/znab311.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
To assess management of early rectal cancers in octogenarians going through a regional Small and Early Rectal Cancer MDT observing oncological outcomes, morbidity, mortality and quality of life after treatment
Methods
Consecutive octogenarian patients treated via the SERC MDT between Dec 2013 and Dec 2019 were examined retrospectively from a prospectively maintained database. Patients underwent transanal endoscopic microsurgery (TEMS), endoscopic submucosal dissection (ESD), contact radiotherapy or hybrid combinations. Patient demographics were recorded and outcomes assessed including pre and post-operative oncological staging, morbidity, mortality, length of stay and FISI scores
Results
85 patients were assessed. 38 had TEMS, 40 had EMR, ESD or hybrid procedures and 7 had contact radiotherapy. Of the 38 patients who underwent TEMS, there was minor morbidity in 5 patients, one cancer recurrence and no cancer related mortality. FISI scores pre- and post-procedure were markedly different with deterioration in control of flatus and mucus, but no faecal incontinence. Of the 40 patients who underwent EMR, ESD or hybrid procedures, 2 had minor morbidity and 3 had adenocarcinomas detected requiring further treatment
Conclusions
Management of octogenarians with early rectal cancer via a specialist MDT provides a safe option with minimal morbidity and no mortality in a subgroup of patients who would otherwise constitute a high risk cohort for surgical intervention. A deterioration in continence in this group highlights the need for careful counselling of patients to achieve the optimal balance between oncological outcomes and quality of life
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Affiliation(s)
- Kiran Altaf
- Royal Liverpool University Hospitals NHS Foundation Trust
| | | | - Dana Sochorova
- Royal Liverpool University Hospitals NHS Foundation Trust
| | | | - Sanchoy Sarkar
- Royal Liverpool University Hospitals NHS Foundation Trust
| | - Shakil Ahmed
- Royal Liverpool University Hospitals NHS Foundation Trust
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16
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Altaf K, Gahunia S, Slawik S, Andrews T, Kehoe A, Ahmed S. SP1.1.15Long-term Outcomes of Open Verses Closed Rectal Defect After Transanal Endoscopic Microscopic Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Management of rectal defect after TEMS is a matter of debate. Data are lacking on the effect of these techniques on long term outcomes and continence of patients. We sought to analyse these in our patient cohort.
Methods
Patients who underwent TEMS between 2012 and 2019 were examined retrospectively from a prospectively maintained database. These were divided into two groups – open and closed rectal defect. Patient demographics were recorded and outcomes assessed including oncological staging, morbidity, mortality, length of stay and FISI scores.
Results
170 matched patients were included, with 70 patients in the open and 100 in the closed rectal defect group. Short-term complications were 18.8% with no significant difference between the two groups. Most of the defects were well healed upon endoscopic follow-up; more unhealed/sinus formation was noticed in the open group (p = 0.01); more strictures were encountered in the closed group (p = 0.04). Overall, there was a significant difference in pre and post TEMS FISI scores in all three groups (p < 0.00001, p < 0.00001, p = 0.02). Comparing the open and closed defect groups, there was no difference in the functional outcome of patients in those who developed sinus or stricture but a significant difference in those with healed scar, with those in closed rectal defect group with worsening function (p = 0.02)
Conclusion
Both the approaches of rectal defect management are associated with pros and cons. Long term complications should be expected and actively followed up for. Patients should be thoroughly counselled about these and possible deterioration in continence post-TEMS
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Affiliation(s)
- Kiran Altaf
- Liverpool University Hospitals NHS Foundation Trust
| | | | | | | | - Ashley Kehoe
- Liverpool University Hospitals NHS Foundation Trust
| | - Shakil Ahmed
- Liverpool University Hospitals NHS Foundation Trust
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17
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Javed MA, Shamim S, Slawik S, Andrews T, Montazeri A, Ahmed S. Long-term outcomes of patients with poor prognostic factors following transanal endoscopic microsurgery for early rectal cancer. Colorectal Dis 2021; 23:1953-1960. [PMID: 33900004 DOI: 10.1111/codi.15693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/24/2021] [Accepted: 03/23/2021] [Indexed: 12/11/2022]
Abstract
AIM Management of early rectal cancer following transanal microscopic anal surgery poses a management dilemma when the histopathology reveals poor prognostic features, due to high risk of local recurrence. The aim of this study is to evaluate the oncological outcomes of such patients who undergo surgery with total mesorectal excision (TME), receive adjuvant chemo/radiotherapy (CRDT/RT) or receive close surveillance only (no further treatment). METHODS We identified patients with poor prognostic factors-pT2 adenocarcinoma, poor differentiation, deep submucosal invasion (Kikuchi SM3), lymphovascular invasion, tumour budding or R1 resection margin-between 1 September 2012 and 31 January 2020 and report their oncological outcomes. RESULTS Of the 53 patients, 18 had TME, 14 had CRDT and 14 had RT; seven patients did not have any further treatment. The median follow-up was 48 months, 12 developed recurrence and six died. Overall, 5-year survival (OS) was 88.9% and disease-free survival (DFS) was 79.2%. Compared to the surgical group, in which there were eight recurrences and two deaths, there were zero recurrences or deaths in the CRDT group, log-rank test P = 0.206 for OS and P = 0.005 for DFS. The 5-year survival rates in the RT and surveillance only groups were OS 78.6%, DFS 85.7% and OS 71.5%, DFS 71% respectively. TME assessment in the surgical group revealed Grade 3 quality in seven of the 16 available reports. CONCLUSION These findings support the strategy of adjuvant CRDT as first line treatment for patients undergoing transanal endoscopic microsurgery for early rectal cancer with poor prognostic factors on initial histological assessment.
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Affiliation(s)
- Muhammad A Javed
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarah Shamim
- Health Education England-North West, Manchester, UK
| | - Simone Slawik
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Timothy Andrews
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Amir Montazeri
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Shakil Ahmed
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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18
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Sherwood SC, Webb MJ, Annan JD, Armour KC, Forster PM, Hargreaves JC, Hegerl G, Klein SA, Marvel KD, Rohling EJ, Watanabe M, Andrews T, Braconnot P, Bretherton CS, Foster GL, Hausfather Z, von der Heydt AS, Knutti R, Mauritsen T, Norris JR, Proistosescu C, Rugenstein M, Schmidt GA, Tokarska KB, Zelinka MD. An Assessment of Earth's Climate Sensitivity Using Multiple Lines of Evidence. Rev Geophys 2020; 58:e2019RG000678. [PMID: 33015673 PMCID: PMC7524012 DOI: 10.1029/2019rg000678] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/22/2020] [Accepted: 06/24/2020] [Indexed: 05/10/2023]
Abstract
We assess evidence relevant to Earth's equilibrium climate sensitivity per doubling of atmospheric CO2, characterized by an effective sensitivity S. This evidence includes feedback process understanding, the historical climate record, and the paleoclimate record. An S value lower than 2 K is difficult to reconcile with any of the three lines of evidence. The amount of cooling during the Last Glacial Maximum provides strong evidence against values of S greater than 4.5 K. Other lines of evidence in combination also show that this is relatively unlikely. We use a Bayesian approach to produce a probability density function (PDF) for S given all the evidence, including tests of robustness to difficult-to-quantify uncertainties and different priors. The 66% range is 2.6-3.9 K for our Baseline calculation and remains within 2.3-4.5 K under the robustness tests; corresponding 5-95% ranges are 2.3-4.7 K, bounded by 2.0-5.7 K (although such high-confidence ranges should be regarded more cautiously). This indicates a stronger constraint on S than reported in past assessments, by lifting the low end of the range. This narrowing occurs because the three lines of evidence agree and are judged to be largely independent and because of greater confidence in understanding feedback processes and in combining evidence. We identify promising avenues for further narrowing the range in S, in particular using comprehensive models and process understanding to address limitations in the traditional forcing-feedback paradigm for interpreting past changes.
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Affiliation(s)
- S C Sherwood
- Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes University of New South Wales Sydney Sydney New South Wales Australia
| | - M J Webb
- Met Office Hadley Centre Exeter UK
| | | | | | - P M Forster
- Priestley International Centre for Climate University of Leeds Leeds UK
| | | | - G Hegerl
- School of Geosciences University of Edinburgh Edinburgh UK
| | | | - K D Marvel
- Department of Applied Physics and Applied Math Columbia University New York NY USA
- NASA Goddard Institute for Space Studies New York NY USA
| | - E J Rohling
- Research School of Earth Sciences Australian National University Canberra ACT Australia
- Ocean and Earth Science, National Oceanography Centre University of Southampton Southampton UK
| | - M Watanabe
- Atmosphere and Ocean Research Institute The University of Tokyo Tokyo Japan
| | | | - P Braconnot
- Laboratoire des Sciences du Climat et de l'Environnement, unité mixte CEA-CNRS-UVSQ Université Paris-Saclay Gif sur Yvette France
| | | | - G L Foster
- Ocean and Earth Science, National Oceanography Centre University of Southampton Southampton UK
| | | | - A S von der Heydt
- Institute for Marine and Atmospheric Research, and Centre for Complex Systems Science Utrecht University Utrecht The Netherlands
| | - R Knutti
- Institute for Atmospheric and Climate Science Zurich Switzerland
| | - T Mauritsen
- Department of Meteorology Stockholm University Stockholm Sweden
| | - J R Norris
- Scripps Institution of Oceanography La Jolla CA USA
| | - C Proistosescu
- Department of Atmospheric Sciences and Department of Geology University of Illinois at Urbana-Champaign Urbana IL USA
| | - M Rugenstein
- Max Planck Institute for Meteorology Hamburg Germany
| | - G A Schmidt
- NASA Goddard Institute for Space Studies New York NY USA
| | - K B Tokarska
- School of Geosciences University of Edinburgh Edinburgh UK
- Institute for Atmospheric and Climate Science Zurich Switzerland
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19
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Pendyala P, Almeldin D, Andrews T, Maloney-Patel N, August D, Anderson C, Jabbour S, Chundury A. Exploring the Dose-response Relationship in Locally Advanced Rectal Cancer Utilizing Dosimetric Parameters. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1900] [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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20
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Senior CA, Jones CG, Wood RA, Sellar A, Belcher S, Klein‐Tank A, Sutton R, Walton J, Lawrence B, Andrews T, Mulcahy JP. U.K. Community Earth System Modeling for CMIP6. J Adv Model Earth Syst 2020; 12:e2019MS002004. [PMID: 33042388 PMCID: PMC7539988 DOI: 10.1029/2019ms002004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 06/01/2023]
Abstract
We describe the approach taken to develop the United Kingdom's first community Earth system model, UKESM1. This is a joint effort involving the Met Office and the Natural Environment Research Council (NERC), representing the U.K. academic community. We document our model development procedure and the subsequent U.K. submission to CMIP6, based on a traceable hierarchy of coupled physical and Earth system models. UKESM1 builds on the well-established, world-leading HadGEM models of the physical climate system and incorporates cutting-edge new representations of aerosols, atmospheric chemistry, terrestrial carbon, and nitrogen cycles and an advanced model of ocean biogeochemistry. A high-level metric of overall performance shows that both models, HadGEM3-GC3.1 and UKESM1, perform better than most other CMIP6 models so far submitted for a broad range of variables. We point to much more extensive evaluation performed in other papers in this special issue. The merits of not using any forced climate change simulations within our model development process are discussed. First results from HadGEM3-GC3.1 and UKESM1 include the emergent climate sensitivity (5.5 and 5.4 K, respectively) which is high relative to the current range of CMIP5 models. The role of cloud microphysics and cloud-aerosol interactions in driving the climate sensitivity, and the systematic approach taken to understand this role, is highlighted in other papers in this special issue. We place our findings within the broader modeling landscape indicating how our understanding of key processes driving higher sensitivity in the two U.K. models seems to align with results from a number of other CMIP6 models.
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Affiliation(s)
| | - Colin G. Jones
- NCAS, School of Earth and the EnvironmentUniversity of LeedsLeedsUK
| | | | | | | | | | - Rowan Sutton
- NCAS, Department of MeteorologyUniversity of ReadingReadingUK
| | | | - Bryan Lawrence
- NCAS, Department of MeteorologyUniversity of ReadingReadingUK
- Department of Computer ScienceUniversity of ReadingReadingUK
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21
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Udeh-Momoh C, Price G, Ropacki MT, Ketter N, Andrews T, Arrighi HM, Brashear HR, Robb C, Bassil DT, Cohn M, Curry LK, Su B, Perera D, Giannakopoulou P, Car J, Ward HA, Perneczky R, Novak G, Middleton L. Prospective Evaluation of Cognitive Health and Related Factors in Elderly at Risk for Developing Alzheimer's Dementia: A Longitudinal Cohort Study. J Prev Alzheimers Dis 2020; 6:256-266. [PMID: 31686098 DOI: 10.14283/jpad.2019.31] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The CHARIOT PRO Main study is a prospective, non-interventional study evaluating cognitive trajectories in participants at the preclinical stage of Alzheimer's disease (AD) classified by risk levels for developing mild cognitive impairment due to AD (MCI-AD). OBJECTIVES The study aimed to characterize factors and markers influencing cognitive and functional progression among individuals at-risk for developing MCI-AD, and examine data for more precise predictors of cognitive change, particularly in relation to APOE ε4 subgroup. DESIGN This single-site study was conducted at the Imperial College London (ICL) in the United Kingdom. Participants 60 to 85 years of age were classified as high, medium (amnestic or non-amnestic) or low risk for developing MCI-AD based on RBANS z-scores. A series of clinical outcome assessments (COAs) on factors influencing baseline cognitive changes were collected in each of the instrument categories of cognition, lifestyle exposure, mood, and sleep. Data collection was planned to occur every 6 months for 48 months, however the median follow-up time was 18.1 months due to early termination of study by the sponsor. RESULTS 987 participants were screened, among them 690 participants were actively followed-up post baseline, of whom 165 (23.9%) were APOE ε4 carriers; with at least one copy of the allele. The mean age was 68.73 years, 94.6% were white, 57.4% were female, and 34.8% had a Family History of Dementia with a somewhat larger percentage in the APOE ε4 carrier group (42.4%) compared to the non-carrier group (32.4%). Over half of the participants were married and 53% had a Bachelor's or higher degree. Most frequently, safety events typical for this population consisted of upper respiratory tract infection (10.4%), falls (5.2%), hypertension (3.5%) and back pain (3.0%). Conclusion (clinical relevance): AD-related measures collected during the CHARIOT PRO Main study will allow identification and evaluation of AD risk factors and markers associated with cognitive performance from the pre-clinical stage. Evaluating the psycho-biological characteristics of these pre-symptomatic individuals in relation to their natural neurocognitive trajectories will enhance current understanding on determinants of the initial signs of cognitive changes linked to AD.
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Affiliation(s)
- C Udeh-Momoh
- Gerald Novak, MD, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd., Titusville, NJ 08560, USA, Tel.:+1 609 730 4416, Fax: +1 908 730 2069,
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22
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Barrera LN, Evans A, Lane B, Brumskill S, Oldfield FE, Campbell F, Andrews T, Lu Z, Perez-Mancera PA, Liloglou T, Ashworth M, Jalali M, Dawson R, Nunes Q, Phillips PA, Timms JF, Halloran C, Greenhalf W, Neoptolemos JP, Costello E. Fibroblasts from Distinct Pancreatic Pathologies Exhibit Disease-Specific Properties. Cancer Res 2020; 80:2861-2873. [PMID: 32393661 DOI: 10.1158/0008-5472.can-19-3534] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/14/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
Although fibrotic stroma forms an integral component of pancreatic diseases, whether fibroblasts programmed by different types of pancreatic diseases are phenotypically distinct remains unknown. Here, we show that fibroblasts isolated from patients with pancreatic ductal adenocarcinoma (PDAC), chronic pancreatitis (CP), periampullary tumors, and adjacent normal (NA) tissue (N = 34) have distinct mRNA and miRNA profiles. Compared with NA fibroblasts, PDAC-associated fibroblasts were generally less sensitive to an antifibrotic stimulus (NPPB) and more responsive to positive regulators of activation such as TGFβ1 and WNT. Of the disease-associated fibroblasts examined, PDAC- and CP-derived fibroblasts shared greatest similarity, yet PDAC-associated fibroblasts expressed higher levels of tenascin C (TNC), a finding attributable to miR-137, a novel regulator of TNC. TNC protein and transcript levels were higher in PDAC tissue versus CP tissue and were associated with greater levels of stromal activation, and conditioned media from TNC-depleted PDAC-associated fibroblasts modestly increased both PDAC cell proliferation and PDAC cell migration, indicating that stromal TNC may have inhibitory effects on PDAC cells. Finally, circulating TNC levels were higher in patients with PDAC compared with CP. Our characterization of pancreatic fibroblast programming as disease-specific has consequences for therapeutic targeting and for the manner in which fibroblasts are used in research. SIGNIFICANCE: Primary fibroblasts derived from various types of pancreatic diseases possess and retain distinct molecular and functional characteristics in culture, providing a series of cellular models for treatment development and disease-specific research.
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Affiliation(s)
- Lawrence N Barrera
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Anthony Evans
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Brian Lane
- School of Medical Sciences, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Brumskill
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Frances E Oldfield
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Fiona Campbell
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Timothy Andrews
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Zipeng Lu
- Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Pedro A Perez-Mancera
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Triantafillos Liloglou
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Milton Ashworth
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mehdi Jalali
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca Dawson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Quentin Nunes
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Phoebe A Phillips
- Pancreatic Cancer Translational Research Group, Lowy Cancer Research Centre, School of Medical Sciences, University of New South Wales (UNSW Sydney), Sydney, Australia
| | - John F Timms
- Institute for Women's Health, University College London, London, United Kingdom
| | - Christopher Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Eithne Costello
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
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23
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Conley TE, Andrews T, Arumainathan A, O'Toole P, Smith PJ, Subramanian S. An unexpected cause of iron deficiency. Gut 2020; 70:gutjnl-2020-321830. [PMID: 32546471 DOI: 10.1136/gutjnl-2020-321830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Thomas Edward Conley
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Timothy Andrews
- Histopathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | | | - Paul O'Toole
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Philip J Smith
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Sreedhar Subramanian
- Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
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24
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Richardson TB, Forster PM, Smith CJ, Maycock AC, Wood T, Andrews T, Boucher O, Faluvegi G, Fläschner D, Hodnebrog Ø, Kasoar M, Kirkevåg A, Lamarque J, Mülmenstädt J, Myhre G, Olivié D, Portmann RW, Samset BH, Shawki D, Shindell D, Stier P, Takemura T, Voulgarakis A, Watson‐Parris D. Efficacy of Climate Forcings in PDRMIP Models. J Geophys Res Atmos 2019; 124:12824-12844. [PMID: 32025453 PMCID: PMC6988499 DOI: 10.1029/2019jd030581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 05/04/2023]
Abstract
Quantifying the efficacy of different climate forcings is important for understanding the real-world climate sensitivity. This study presents a systematic multimodel analysis of different climate driver efficacies using simulations from the Precipitation Driver and Response Model Intercomparison Project (PDRMIP). Efficacies calculated from instantaneous radiative forcing deviate considerably from unity across forcing agents and models. Effective radiative forcing (ERF) is a better predictor of global mean near-surface air temperature (GSAT) change. Efficacies are closest to one when ERF is computed using fixed sea surface temperature experiments and adjusted for land surface temperature changes using radiative kernels. Multimodel mean efficacies based on ERF are close to one for global perturbations of methane, sulfate, black carbon, and insolation, but there is notable intermodel spread. We do not find robust evidence that the geographic location of sulfate aerosol affects its efficacy. GSAT is found to respond more slowly to aerosol forcing than CO2 in the early stages of simulations. Despite these differences, we find that there is no evidence for an efficacy effect on historical GSAT trend estimates based on simulations with an impulse response model, nor on the resulting estimates of climate sensitivity derived from the historical period. However, the considerable intermodel spread in the computed efficacies means that we cannot rule out an efficacy-induced bias of ±0.4 K in equilibrium climate sensitivity to CO2 doubling when estimated using the historical GSAT trend.
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Affiliation(s)
- T. B. Richardson
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - P. M. Forster
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - C. J. Smith
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - A. C. Maycock
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - T. Wood
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | | | - O. Boucher
- Institut Pierre‐Simon LaplaceCNRS/Sorbonne UniversitéParisFrance
| | - G. Faluvegi
- NASA Goddard Institute for Space Studies and Center for Climate Systems ResearchColumbia UniversityNew YorkNYUSA
| | - D. Fläschner
- Atmosphere in the Earth SystemMax‐Planck‐Institut für MeteorologieHamburgGermany
| | - Ø. Hodnebrog
- CICERO Center for International Climate and Environmental ResearchOsloNorway
| | - M. Kasoar
- Department of PhysicsImperial College LondonLondonUK
| | - A. Kirkevåg
- Research and Development DepartmentNorwegian Meteorological InstituteOsloNorway
| | | | - J. Mülmenstädt
- Clouds and Global ClimateUniversität LeipzigLeipzigGermany
| | - G. Myhre
- CICERO Center for International Climate and Environmental ResearchOsloNorway
| | - D. Olivié
- Research and Development DepartmentNorwegian Meteorological InstituteOsloNorway
| | - R. W. Portmann
- Earth System Research LaboratoryNational Oceanic and Atmospheric AdministrationBoulderCOUSA
| | - B. H. Samset
- CICERO Center for International Climate and Environmental ResearchOsloNorway
| | - D. Shawki
- Department of PhysicsImperial College LondonLondonUK
| | - D. Shindell
- Earth & Ocean SciencesDuke UniversityDurhamNCUSA
| | - P. Stier
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - T. Takemura
- Center for Oceanic and Atmospheric ResearchKyushu UniversityFukuokaJapan
| | | | - D. Watson‐Parris
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
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25
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Ondhia M, Tamvakeras P, O'Toole P, Montazerri A, Andrews T, Farrell C, Ahmed S, Slawik S, Ahmed S. Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience. Colorectal Dis 2019; 21:1164-1174. [PMID: 31207005 PMCID: PMC6900238 DOI: 10.1111/codi.14730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
AIM Organ-preserving local excision by transanal endoscopic microsurgery (TEM) for early rectal cancer offers significantly lower morbidity as compared to formal rectal cancer resection with acceptable outcomes. This study presents our 6-year experience of TEM for rectal lesions referred to a specialist early rectal cancer centre in the UK. METHOD Data were collected for all patients referred for TEM of suspected early rectal cancer to a regional specialist early rectal cancer multidisciplinary team (MDT) over a 6-year period. RESULTS One hundred and forty-one patients who underwent full-thickness TEM for suspected or confirmed early rectal cancer were included. Thirty patients were referred for TEM following incomplete endoscopic polypectomy. Final pathology was benign in 77 (54.6%) cases and malignant in 64 (45.4%). Of the 61 confirmed adenocarcinomas, TEM resections were pT0 in 17 (27.9%), pT1 in 32 (51.7%), pT2 in 11 (18.0%) and pT3 in 1 (1.6%). Thirty-eight of 61 patients (62.3%) had one or more poor histological prognostic features and these patients were offered further treatment. Twenty-three of 61 (37.7%) patients with rectal adenocarcinoma required no further treatment following TEM. Forty-three cases of rectal adenocarcinoma were available for establishing recurrence rates. Two of 43 patients (4.7%) developed a recurrence at a median follow-up of 28.7 months (12.1-66.5 months). The overall estimated 5-year overall survival rate was 87.9% and the disease-free survival rate was 82.9%. CONCLUSION Acceptable outcomes are possible for TEM surgery with appropriate patient selection, effective technique, expert histopathology, appropriate referral for adjuvant treatment and meticulous follow-up. This can be achieved through an early rectal cancer MDT in a dedicated specialist regional centre.
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Affiliation(s)
- M. Ondhia
- Royal Liverpool and Broadgreen University Hospital NHS TrustLiverpoolUK
| | - P. Tamvakeras
- Aintree University Hospital NHS Foundation TrustLiverpoolUK
| | - P. O'Toole
- Royal Liverpool and Broadgreen University Hospital NHS TrustLiverpoolUK
| | - A. Montazerri
- Clatterbridge Cancer Centre NHS Foundation TrustWirralUK
| | - T. Andrews
- Royal Liverpool and Broadgreen University Hospital NHS TrustLiverpoolUK
| | - C. Farrell
- Royal Liverpool and Broadgreen University Hospital NHS TrustLiverpoolUK
| | - S. Ahmed
- Aintree University Hospital NHS Foundation TrustLiverpoolUK
| | - S. Slawik
- Aintree University Hospital NHS Foundation TrustLiverpoolUK
| | - S. Ahmed
- Royal Liverpool and Broadgreen University Hospital NHS TrustLiverpoolUK
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26
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Gorelik M, Lee Y, Abe M, Andrews T, Davis L, Patterson J, Chen S, Crother TR, Aune GJ, Noval Rivas M, Arditi M. IL-1 receptor antagonist, anakinra, prevents myocardial dysfunction in a mouse model of Kawasaki disease vasculitis and myocarditis. Clin Exp Immunol 2019; 198:101-110. [PMID: 31099056 PMCID: PMC6718290 DOI: 10.1111/cei.13314] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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] [Accepted: 04/26/2019] [Indexed: 12/11/2022] Open
Abstract
Kawasaki disease (KD) vasculitis is an acute febrile illness of childhood characterized by systemic vasculitis of unknown origin, and is the most common cause of acquired heart disease among children in the United States. While histological evidence of myocarditis can be found in all patients with acute KD, only a minority of patients are clinically symptomatic and a subset demonstrate echocardiographic evidence of impaired myocardial function, as well as increased left ventricular mass, presumed to be due to myocardial edema and inflammation. Up to a third of KD patients fail to respond to first-line therapy with intravenous immunoglobulin (IVIG), and the use of interleukin (IL)-1 receptor antagonist (IL-1Ra, anakinra) is currently being investigated as an alternative therapeutic approach to treat IVIG-resistant patients. In this study, we sought to investigate the effect of IL-1Ra on myocardial dysfunction and its relation to myocarditis development during KD vasculitis. We used the Lactobacillus casei cell-wall extract (LCWE)-induced murine model of KD vasculitis and investigated the effect of IL-1Ra pretreatment on myocardial dysfunction during KD vasculitis by performing histological, magnetic resonance imaging (MRI) and echocardiographic evaluations. IL-1Ra pretreatment significantly reduced KD-induced myocardial inflammation and N-terminal pro B-type natriuretic peptide (NT-proBNP) release. Both MRI and echocardiographic studies on LCWE-injected KD mice demonstrated that IL-1Ra pretreatment results in an improved ejection fraction and a normalized left ventricular function. These findings further support the potential beneficial effects of IL-1Ra therapy in preventing the cardiovascular complications in acute KD patients, including the myocarditis and myocardial dysfunction associated with acute KD.
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Affiliation(s)
- M Gorelik
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA.,Pediatric Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Y Lee
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Abe
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - T Andrews
- Division of Pediatric Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA
| | - L Davis
- Division of Pediatric Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA
| | - J Patterson
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - S Chen
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - T R Crother
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - G J Aune
- Division of Pediatric Hematology and Oncology, University of Texas Health Science Center, San Antonio, TX, USA
| | - M Noval Rivas
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M Arditi
- Division of Pediatric Infectious Diseases and Immunology, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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27
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Bodas‐Salcedo A, Mulcahy JP, Andrews T, Williams KD, Ringer MA, Field PR, Elsaesser GS. Strong Dependence of Atmospheric Feedbacks on Mixed-Phase Microphysics and Aerosol-Cloud Interactions in HadGEM3. J Adv Model Earth Syst 2019; 11:1735-1758. [PMID: 31598189 PMCID: PMC6774284 DOI: 10.1029/2019ms001688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 05/13/2023]
Abstract
We analyze the atmospheric processes that explain the large changes in radiative feedbacks between the two latest climate configurations of the Hadley Centre Global Environmental model. We use a large set of atmosphere-only climate change simulations (amip and amip-p4K) to separate the contributions to the differences in feedback parameter from all the atmospheric model developments between the two latest model configurations. We show that the differences are mostly driven by changes in the shortwave cloud radiative feedback in the midlatitudes, mainly over the Southern Ocean. Two new schemes explain most of the differences: the introduction of a new aerosol scheme and the development of a new mixed-phase cloud scheme. Both schemes reduce the strength of the preexisting shortwave negative cloud feedback in the midlatitudes. The new aerosol scheme dampens a strong aerosol-cloud interaction, and it also suppresses a negative clear-sky shortwave feedback. The mixed-phase scheme increases the amount of cloud liquid water path (LWP) in the present day and reduces the increase in LWP with warming. Both changes contribute to reducing the negative radiative feedback of the increase of LWP in the warmer climate. The mixed-phase scheme also enhances a strong, preexisting, positive cloud fraction feedback. We assess the realism of the changes by comparing present-day simulations against observations and discuss avenues that could help constrain the relevant processes.
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Affiliation(s)
| | | | | | | | | | | | - G. S. Elsaesser
- Goddard Institute for Space StudiesColumbia University/NASANew YorkNYUSA
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28
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Smith CJ, Kramer RJ, Myhre G, Forster PM, Soden BJ, Andrews T, Boucher O, Faluvegi G, Fläschner D, Hodnebrog Ø, Kasoar M, Kharin V, Kirkevåg A, Lamarque J, Mülmenstädt J, Olivié D, Richardson T, Samset BH, Shindell D, Stier P, Takemura T, Voulgarakis A, Watson‐Parris D. Understanding Rapid Adjustments to Diverse Forcing Agents. Geophys Res Lett 2018; 45:12023-12031. [PMID: 30686845 PMCID: PMC6334512 DOI: 10.1029/2018gl079826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 05/04/2023]
Abstract
Rapid adjustments are responses to forcing agents that cause a perturbation to the top of atmosphere energy budget but are uncoupled to changes in surface warming. Different mechanisms are responsible for these adjustments for a variety of climate drivers. These remain to be quantified in detail. It is shown that rapid adjustments reduce the effective radiative forcing (ERF) of black carbon by half of the instantaneous forcing, but for CO2 forcing, rapid adjustments increase ERF. Competing tropospheric adjustments for CO2 forcing are individually significant but sum to zero, such that the ERF equals the stratospherically adjusted radiative forcing, but this is not true for other forcing agents. Additional experiments of increase in the solar constant and increase in CH4 are used to show that a key factor of the rapid adjustment for an individual climate driver is changes in temperature in the upper troposphere and lower stratosphere.
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Affiliation(s)
- C. J. Smith
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - R. J. Kramer
- Rosenstiel School of Marine and Atmospheric ScienceUniversity of MiamiMiamiFLUSA
| | - G. Myhre
- CICERO Center for International Climate and Environmental Research in OsloOsloNorway
| | - P. M. Forster
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - B. J. Soden
- Rosenstiel School of Marine and Atmospheric ScienceUniversity of MiamiMiamiFLUSA
| | | | - O. Boucher
- Institut Pierre‐Simon Laplace, CNRS/Sorbonne UniversitéParisFrance
| | - G. Faluvegi
- NASA Goddard Institute for Space StudiesNew YorkNYUSA
- Center for Climate Systems ResearchColumbia UniversityNew YorkNYUSA
| | - D. Fläschner
- Max‐Planck‐Institut für MeteorologieHamburgGermany
| | - Ø. Hodnebrog
- CICERO Center for International Climate and Environmental Research in OsloOsloNorway
| | - M. Kasoar
- Department of PhysicsImperial College LondonLondonUK
- Grantham Institute – Climate Change and the EnvironmentImperial College LondonLondonUK
| | - V. Kharin
- Canadian Centre for Climate Modelling and AnalysisVictoriaBritish ColumbiaCanada
| | - A. Kirkevåg
- Norwegian Meteorological InstituteOsloNorway
| | | | - J. Mülmenstädt
- Institute of MeteorologyUniversität LeipzigLeipzigGermany
| | - D. Olivié
- Norwegian Meteorological InstituteOsloNorway
| | - T. Richardson
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - B. H. Samset
- CICERO Center for International Climate and Environmental Research in OsloOsloNorway
| | - D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - P. Stier
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | | | | | - D. Watson‐Parris
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
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29
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Myhre G, Kramer RJ, Smith CJ, Hodnebrog Ø, Forster P, Soden BJ, Samset BH, Stjern CW, Andrews T, Boucher O, Faluvegi G, Fläschner D, Kasoar M, Kirkevåg A, Lamarque J, Olivié D, Richardson T, Shindell D, Stier P, Takemura T, Voulgarakis A, Watson‐Parris D. Quantifying the Importance of Rapid Adjustments for Global Precipitation Changes. Geophys Res Lett 2018; 45:11399-11405. [PMID: 30774164 PMCID: PMC6360531 DOI: 10.1029/2018gl079474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 05/04/2023]
Abstract
Different climate drivers influence precipitation in different ways. Here we use radiative kernels to understand the influence of rapid adjustment processes on precipitation in climate models. Rapid adjustments are generally triggered by the initial heating or cooling of the atmosphere from an external climate driver. For precipitation changes, rapid adjustments due to changes in temperature, water vapor, and clouds are most important. In this study we have investigated five climate drivers (CO2, CH4, solar irradiance, black carbon, and sulfate aerosols). The fast precipitation responses to a doubling of CO2 and a 10-fold increase in black carbon are found to be similar, despite very different instantaneous changes in the radiative cooling, individual rapid adjustments, and sensible heating. The model diversity in rapid adjustments is smaller for the experiment involving an increase in the solar irradiance compared to the other climate driver perturbations, and this is also seen in the precipitation changes.
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Affiliation(s)
- G. Myhre
- CICERO Center for International Climate ResearchOsloNorway
| | - R. J. Kramer
- Rosenstiel School of Marine and Atmospheric ScienceUniversity of MiamiMiamiFLUSA
| | - C. J. Smith
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - Ø. Hodnebrog
- CICERO Center for International Climate ResearchOsloNorway
| | - P. Forster
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - B. J. Soden
- Rosenstiel School of Marine and Atmospheric ScienceUniversity of MiamiMiamiFLUSA
| | - B. H. Samset
- CICERO Center for International Climate ResearchOsloNorway
| | - C. W. Stjern
- CICERO Center for International Climate ResearchOsloNorway
| | | | - O. Boucher
- Institut Pierre‐Simon LaplaceCNRS/Sorbonne UniversitéParisFrance
| | - G. Faluvegi
- NASA Goddard Institute for Space StudiesNew YorkNYUSA
- Center for Climate Systems ResearchColumbia UniversityNew YorkNYUSA
| | - D. Fläschner
- Max‐Planck‐Institut für MeteorologieHamburgGermany
| | - M. Kasoar
- Department of PhysicsImperial College LondonLondonUK
- Grantham Institute‐Climate Change and the EnvironmentImperial College LondonLondonUK
| | - A. Kirkevåg
- Norwegian Meteorological InstituteOsloNorway
| | | | - D. Olivié
- Norwegian Meteorological InstituteOsloNorway
| | - T. Richardson
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - D. Shindell
- Nicholas School of the EnvironmentDuke UniversityDurhamNCUSA
| | - P. Stier
- Atmospheric, Oceanic & Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - T. Takemura
- Research Institute for Applied MechanicsKyushu UniversityFukuokaJapan
| | | | - D. Watson‐Parris
- Atmospheric, Oceanic & Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
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30
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Ogedegbe C, Unawane R, Uceda V, Finefrock D, Zodda D, Andrews T, Admani I, Nierenberg H, Hewitt K, Landers D. 24 The HEART Pathway, Possible Impact of an Emergency Department Stationed Cardiologist on Disposition of Risk Stratified Chest Pain Patients Presenting to the Emergency Department Compared to Standard Emergency Department Care. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.029] [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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31
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Flack T, Harris R, Young A, Andrews T. Symmetrical Viewpoint Representations in Face-Responsive Regions of the Human Brain Convey an Advantage in Face Learning. J Vis 2018. [DOI: 10.1167/18.10.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tessa Flack
- Department of Psychology, Durham University, Durham, UK
| | | | - Andrew Young
- Department of Psychology, University of York, York, UK
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32
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Andrews T, Ulrich P, Smith R, Hoggart R, Gouws A. NEURAL CORRELATES OF GROUP BIAS DURING NATURAL VIEWING. J Vis 2018. [DOI: 10.1167/18.10.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Timothy Andrews
- Department of Psychology, University of York, York, YO10 5DD, United Kingdom
| | | | - Ryan Smith
- Department of Psychology, University of York, York, YO10 5DD, United Kingdom
| | - Richard Hoggart
- Department of Psychology, University of York, York, YO10 5DD, United Kingdom
| | - Andre Gouws
- Department of Psychology, University of York, York, YO10 5DD, United Kingdom
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33
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Martinez-Martin P, Rizos AM, Wetmore J, Antonini A, Odin P, Pal S, Sophia R, Carroll C, Martino D, Falup-Pecurariu C, Kessel B, Andrews T, Paviour D, Trenkwalder C, Chaudhuri KR. First comprehensive tool for screening pain in Parkinson's disease: the King's Parkinson's Disease Pain Questionnaire. Eur J Neurol 2018; 25:1255-1261. [PMID: 29806962 DOI: 10.1111/ene.13691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/04/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Pain is highly prevalent in Parkinson's disease (PD), impacting patients' ability, mood and quality of life. Detecting the presence of pain in its multiple modalities is necessary for adequate personalized management of PD. A 14-item, PD-specific, patient-based questionnaire (the King's Parkinson's Disease Pain Questionnaire, KPPQ) was designed corresponding to the rater-based KPP Scale (KPPS). The present multicentre study was aimed at testing the validity of this screening tool. METHODS First, a comparison between the KPPQ scores of patients and matched controls was performed. Next, convergent validity, reproducibility (test-retest) and diagnostic performance of the questionnaire were analysed. RESULTS Data from 300 patients and 150 controls are reported. PD patients declared significantly more pain symptoms than controls (3.96 ± 2.56 vs. 2.17 ± 1.39; P < 0.0001). The KPPQ convergent validity was high with KPPS total score (rS = 0.80) but weak or moderate with other pain assessments. Test-retest reliability was satisfactory with kappa values ≥0.65 except for item 5, Dyskinetic pains (κ = 0.44), and the intraclass correlation coefficient (ICC) for the KPPQ total score was 0.98. After the scores of the KPPS were adapted for screening (0, no symptom; ≥1, symptom present), a good agreement was found between the KPPQ and the KPPS (ICC = 0.88). A strong correlation (rS = 0.80) between the two instruments was found. The diagnostic parameters of the KPPQ were very satisfactory as a whole, with a global accuracy of 78.3%-98.3%. CONCLUSIONS These results suggest that the KPPQ is a useful, reliable and valid screening instrument for pain in PD to advance patient-related outcomes.
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Affiliation(s)
- P Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - A M Rizos
- Institute of Psychiatry, Psychology & Neuroscience at King's College, King's College Hospital NHS Foundation Trust, London, UK
| | - J Wetmore
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - A Antonini
- Neurology, University of Padua, Venice, Italy
| | - P Odin
- Neurology, University of Lund, Lund, Sweden
| | - S Pal
- Neurology, Forth Valley Royal Hospital, Larbert, Scotland, UK
| | - R Sophia
- Geriatric Medicine, Yeovil Hospital, Somerset, UK
| | - C Carroll
- Neurology, Derriford Hospital, Plymouth, UK
| | - D Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | - B Kessel
- Medicine for the Elderly, Princess Royal University Hospital site, King's College Hospital, Kent, UK
| | - T Andrews
- Neurology, Guy's Hospital, London, UK
| | - D Paviour
- Neurology, St Georges's Hospital, London, UK
| | - C Trenkwalder
- Department of Neurosurgery, University Medical Center, Goettingen, Germany
| | - K R Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience at King's College, King's College Hospital NHS Foundation Trust, London, UK
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34
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Myhre G, Samset BH, Hodnebrog Ø, Andrews T, Boucher O, Faluvegi G, Fläschner D, Forster PM, Kasoar M, Kharin V, Kirkevåg A, Lamarque JF, Olivié D, Richardson TB, Shawki D, Shindell D, Shine KP, Stjern CW, Takemura T, Voulgarakis A. Sensible heat has significantly affected the global hydrological cycle over the historical period. Nat Commun 2018; 9:1922. [PMID: 29765048 PMCID: PMC5954152 DOI: 10.1038/s41467-018-04307-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Received: 06/22/2017] [Accepted: 04/17/2018] [Indexed: 11/15/2022] Open
Abstract
Globally, latent heating associated with a change in precipitation is balanced by changes to atmospheric radiative cooling and sensible heat fluxes. Both components can be altered by climate forcing mechanisms and through climate feedbacks, but the impacts of climate forcing and feedbacks on sensible heat fluxes have received much less attention. Here we show, using a range of climate modelling results, that changes in sensible heat are the dominant contributor to the present global-mean precipitation change since preindustrial time, because the radiative impact of forcings and feedbacks approximately compensate. The model results show a dissimilar influence on sensible heat and precipitation from various drivers of climate change. Due to its strong atmospheric absorption, black carbon is found to influence the sensible heat very differently compared to other aerosols and greenhouse gases. Our results indicate that this is likely caused by differences in the impact on the lower tropospheric stability.
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Affiliation(s)
- G Myhre
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway.
| | - B H Samset
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - Ø Hodnebrog
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - T Andrews
- Met Office Hadley Centre, Devon, EX1 3PB, United Kingdom
| | - O Boucher
- Institut Pierre-Simon Laplace, CNRS/Sorbonne Université, 75252, Paris, Cedex 05, France
| | - G Faluvegi
- NASA Goddard Institute for Space Studies, New York, NY, 10025, USA
- Center for Climate Systems Research, Columbia University, New York, NY, 10027, USA
| | - D Fläschner
- Max-Planck-Institut für Meteorologie, 20146, Hamburg, Germany
| | - P M Forster
- University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - M Kasoar
- Department of Physics, Imperial College London, London, SW7 2AZ, United Kingdom
| | - V Kharin
- Canadian Centre for Climate Modelling and Analysis, V8P 5C2, Victoria, BC,, Canada
| | - A Kirkevåg
- Norwegian Meteorological Institute, 0313, Oslo, Norway
| | | | - D Olivié
- Norwegian Meteorological Institute, 0313, Oslo, Norway
| | | | - D Shawki
- Department of Physics, Imperial College London, London, SW7 2AZ, United Kingdom
| | | | - K P Shine
- University of Reading, Reading, RG6 6BB, United Kingdom
| | - C W Stjern
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - T Takemura
- Kyushu University, 816-8580, Kasuga, Japan
| | - A Voulgarakis
- Department of Physics, Imperial College London, London, SW7 2AZ, United Kingdom
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35
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Richardson TB, Forster PM, Andrews T, Boucher O, Faluvegi G, Fläschner D, Kasoar M, Kirkevåg A, Lamarque JF, Myhre G, Olivié D, Samset BH, Shawki D, Shindell D, Takemura T, Voulgarakis A. Carbon dioxide physiological forcing dominates projected Eastern Amazonian drying. Geophys Res Lett 2018; 45:2815-2825. [PMID: 33041385 PMCID: PMC7546038 DOI: 10.1002/2017gl076520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Future projections of east Amazonian precipitation indicate drying, but they are uncertain and poorly understood. In this study we analyse the Amazonian precipitation response to individual atmospheric forcings using a number of global climate models. Black carbon is found to drive reduced precipitation over the Amazon due to temperature-driven circulation changes, but the magnitude is uncertain. CO2 drives reductions in precipitation concentrated in the east, mainly due to a robustly negative, but highly variable in magnitude, fast response. We find that the physiological effect of CO2 on plant stomata is the dominant driver of the fast response due to reduced latent heating, and also contributes to the large model spread. Using a simple model we show that CO2 physiological effects dominate future multi-model mean precipitation projections over the Amazon. However, in individual models temperature-driven changes can be large, but due to little agreement, they largely cancel out in the model-mean.
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Affiliation(s)
| | | | - T Andrews
- Met Office Hadley Centre, United Kingdom
| | - O Boucher
- Institut Pierre-Simon Laplace, Université Pierre et Marie Curie / CNRS, Paris, France
| | - G Faluvegi
- NASA Goddard Institute for Space Studies and Center for Climate Systems Research, Columbia University, New York, USA
| | - D Fläschner
- Max-Planck-Institut für Meteorologie, Hamburg, Germany
| | - M Kasoar
- Imperial College London, London, United Kingdom
| | - A Kirkevåg
- Norwegian Meteorological Institute, Oslo, Norway
| | | | - G Myhre
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | - D Olivié
- Norwegian Meteorological Institute, Oslo, Norway
| | - B H Samset
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | - D Shawki
- Imperial College London, London, United Kingdom
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36
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Stjern CW, Samset BH, Myhre G, Forster PM, Hodnebrog Ø, Andrews T, Boucher O, Faluvegi G, Iversen T, Kasoar M, Kharin V, Kirkevåg A, Lamarque JF, Olivié D, Richardson T, Shawki D, Shindell D, Smith CJ, Takemura T, Voulgarakis A. Rapid adjustments cause weak surface temperature response to increased black carbon concentrations. J Geophys Res Atmos 2017; Volume 122:11462-11481. [PMID: 32441705 PMCID: PMC7241673 DOI: 10.1002/2017jd027326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We investigate the climate response to increased concentrations of black carbon (BC), as part of the Precipitation Driver Response Model Intercomparison Project (PDRMIP). A tenfold increase in BC is simulated by 9 global coupled-climate models, producing a model-median effective radiative forcing (ERF) of 0.82 (ranging from 0.41 to 2.91) Wm-2, and a warming of 0.67 (0.16 to 1.66) K globally and 1.24 (0.26 to 4.31) K in the Arctic. A strong positive instantaneous radiative forcing (median of 2.10 Wm-2 based on five of the models) is countered by negative rapid adjustments (-0.64 Wm-2 for the same five models), which dampen the total surface temperature signal. Unlike other drivers of climate change, the response of temperature and cloud profiles to the BC forcing is dominated by rapid adjustments. Low-level cloud amounts increase for all models, while higher-level clouds are diminished. The rapid temperature response is particularly strong above 400 hPa, where increased atmospheric stabilization and reduced cloud cover contrast the response pattern of the other drivers. In conclusion, we find that this substantial increase in BC concentrations does have considerable impacts on important aspects of the climate system. However, some of these effects tend to offset one another, leaving a relatively small global warming of 0.47 K per Wm-2 - about 20 % lower than the response to a doubling of CO2. Translating the tenfold increase in BC to the present-day impact of anthropogenic BC (given the emissions used in this work) would leave a warming of merely 0.07 K.
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Affiliation(s)
- Camilla Weum Stjern
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | | | - Gunnar Myhre
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | | | - Øivind Hodnebrog
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | | | - Olivier Boucher
- Institut Pierre-Simon Laplace, Univ. P et M. Curie / CNRS, Paris, France
| | - Gregory Faluvegi
- Center for Climate Systems Research, Columbia University, New York, USA
- NASA Goddard Institute for Space Studies, New York, USA
| | | | | | - Viatcheslav Kharin
- Canadian Centre for Climate Modelling and Analysis, Victoria, BC, Canada
| | - Alf Kirkevåg
- Norwegian Meteorological Institute, Oslo, Norway
| | | | - Dirk Olivié
- Norwegian Meteorological Institute, Oslo, Norway
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37
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Drevelegkas K, Bangeas P, Paramythiotis D, Andrews T, Zakeri S. Metastatic spread of cutaneous melanoma to the sigmoid colon: a rare but important consideration. Hippokratia 2017; 21:194-196. [PMID: 30944511 PMCID: PMC6441346] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cutaneous melanoma is known for its aggressive tendency for metastasis, most commonly to lymph nodes, lung, liver, and brain. CASE REPORT We present the case of an 80-year-old male, with a history of cutaneous melanoma, found to have biopsy-proven metastatic melanoma deposits in the sigmoid colon. This rare case was initially thought to be a walled-off perforation secondary to diverticulitis. Although, computed tomography, showed features more strongly suggestive of malignancy. We propose early consideration of bowel metastasis in patients with a history of cutaneous melanoma presenting with lower gastrointestinal symptoms. CONCLUSION Once malignancy is included in the differential for any inflammatory type bowel lesion, arranging endoscopy and biopsy is essential to confirm the diagnosis and guide management. Multidisciplinary team discussion is recommended to determine the most appropriate treatment strategy - radical versus palliative, which must always consider the patient's performance status alongside cancer staging. HIPPOKRATIA 2017, 21(4): 194-196.
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Affiliation(s)
- K Drevelegkas
- Radiology Department Royal Liverpool University Hospital, UK
| | - P Bangeas
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Greece
| | - D Paramythiotis
- 1 Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University of Thessaloniki, Greece
| | - T Andrews
- Histopathology Department, Royal Liverpool University Hospital, UK
| | - S Zakeri
- Radiology Department Royal Liverpool University Hospital, UK
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38
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Andrews T, Weibert K, Kramer R, Ritchie K, Burton M. THE IMPORTANCE OF IMAGE PROPERTIES IN THE NEURAL REPRESENTATION OF FAMILIAR FACES. J Vis 2017. [DOI: 10.1167/17.10.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Katja Weibert
- Department of Psychology, University of York, York, UK
| | - Robin Kramer
- Department of Psychology, University of York, York, UK
| | - Kay Ritchie
- Department of Psychology, University of York, York, UK
| | - Mike Burton
- Department of Psychology, University of York, York, UK
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39
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Coggan D, Watson D, Hartley T, Baker D, Andrews T. A data-driven approach to stimulus selection reveals the importance of visual properties in the neural representation of objects. J Vis 2017. [DOI: 10.1167/17.10.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- David Coggan
- Department of Psychology, University of York, UK
| | - David Watson
- Department of Psychology, University of York, UK
| | - Tom Hartley
- Department of Psychology, University of York, UK
| | - Daniel Baker
- Department of Psychology, University of York, UK
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40
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Myhre G, Forster PM, Samset BH, Hodnebrog Ø, Sillmann J, Aalbergsjø SG, Andrews T, Boucher O, Faluvegi G, Fläschner D, Iversen T, Kasoar M, Kharin V, Lamarque JF, Olivié D, Richardson T, Shindell D, Shine KP, Stjern CW, Takemura T, Voulgarakis A, Zwiers F. PDRMIP: A Precipitation Driver and Response Model Intercomparison Project, Protocol and preliminary results. Bull Am Meteorol Soc 2017; 98:1185-1198. [PMID: 32713957 PMCID: PMC7380094 DOI: 10.1175/bams-d-16-0019.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As the global temperature increases with changing climate, precipitation rates and patterns are affected through a wide range of physical mechanisms. The globally averaged intensity of extreme precipitation also changes more rapidly than the globally averaged precipitation rate. While some aspects of the regional variation in precipitation predicted by climate models appear robust, there is still a large degree of inter-model differences unaccounted for. Individual drivers of climate change initially alter the energy budget of the atmosphere leading to distinct rapid adjustments involving changes in precipitation. Differences in how these rapid adjustment processes manifest themselves within models are likely to explain a large fraction of the present model spread and needs better quantifications to improve precipitation predictions. Here, we introduce the Precipitation Driver and Response Model Intercomparison Project (PDRMIP), where a set of idealized experiments designed to understand the role of different climate forcing mechanisms were performed by a large set of climate models. PDRMIP focuses on understanding how precipitation changes relating to rapid adjustments and slower responses to climate forcings are represented across models. Initial results show that rapid adjustments account for large regional differences in hydrological sensitivity across multiple drivers. The PDRMIP results are expected to dramatically improve our understanding of the causes of the present diversity in future climate projections.
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Affiliation(s)
- G Myhre
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | | | - B H Samset
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | - Ø Hodnebrog
- CICERO Center for International Climate and Environmental Research - Oslo Norway
| | - J Sillmann
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | - S G Aalbergsjø
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | - T Andrews
- Met Office Hadley Centre, Exeter, UK
| | - O Boucher
- Laboratoire de Météorologie Dynamique, IPSL, Univ. P et M. Curie / CNRS, Paris, France
| | | | - D Fläschner
- Max-Planck-Institut fur Meteorologie, Hamburg Germany
| | - T Iversen
- Norwegian Meteorological Institute, Oslo, Norway
| | - M Kasoar
- Imperial College London, London, United Kingdom
| | - V Kharin
- Canadian Centre for Climate Modelling and Analysis, Victoria, BC, Canada A. Kirkevåg, Norwegian Meteorological Institute, Oslo, Norway
| | | | - D Olivié
- Norwegian Meteorological Institute, Oslo, Norway
| | | | | | - K P Shine
- University of Reading, Reading, United Kingdom
| | - Camilla W Stjern
- CICERO Center for International Climate and Environmental Research - Oslo, Norway
| | | | | | - F Zwiers
- Pacific Climate Impacts Consortium University of Victoria, Canada
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41
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Abstract
More than 100 cases of sinonasal hemangiopericytoma have been reported in the literature, but only a handful of cases of nasal glomangiopericytoma. In this article, we report a case of a nasal glomangiopericytoma that was treated with endonasal surgical excision. We also attempt to clarify the confusion that attends to the nomenclature surrounding the terms glomangiopericytoma and hemangiopericytoma, which are often used interchangeably. Although glomangiopericytomas are histologically similar to sinonasal hemangiopericytomas, they sometimes behave in a different clinical manner. To further enhance our understanding of nasal glomangiopericytomas, more cases need to be reported. This may improve our ability to establish specific treatment modalities for this type of neoplasm and to predict clinical outcomes.
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Affiliation(s)
- Panagiotis Asimakopoulos
- Corresponding author: Mr. Mohammed Iqbal Syed, Department of Otolaryngology, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd., Edinburgh EH16 4SA, UK. From the Department of Otolaryngology (Mr. Asimakopoulos, Mr. M.I. Syed, and Dr. Williams) and the Department of Pathology (Dr. Andrews and Dr. S. Syed), The Royal Infirmary of Edinburgh, Edinburgh, Scotland
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42
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Coggan D, Andrews T, Baker D. Investigating the temporal properties of visual object processing using a multivariate analysis of EEG data. J Vis 2016. [DOI: 10.1167/16.12.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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43
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Andrews T, Watson D, Hartley T. A DATA DRIVEN ANALYSIS REVEALS THE IMPORTANCE OF IMAGE PROPERTIES IN THE NEURAL REPRESENTATION OF SCENES. J Vis 2016. [DOI: 10.1167/16.12.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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44
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Yan X, Andrews T, Jenkins R, Young A. Cross-cultural differences and similarities uderlying other-race effects for facial identity and expression. J Vis 2016. [DOI: 10.1167/16.12.1397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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45
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Weibert K, Andrews T. The Relative Role of Viewpoint and Identity in the Neural Representation of Faces in Fusiform Gyrus. J Vis 2016. [DOI: 10.1167/16.12.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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46
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Madirrala V, Rooney P, Heath RM, Campbell F, Andrews T, Neal TJ, Subramanian S. Short article: Successful faecal coliform sensitivity-based oral ertapenem therapy for chronic antibiotic-refractory pouchitis: a case series. Eur J Gastroenterol Hepatol 2016; 28:277-80. [PMID: 26657456 DOI: 10.1097/meg.0000000000000549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/10/2022]
Abstract
Pouchitis is a common complication of restorative proctocolectomy for ulcerative colitis, and a proportion of patients develop a refractory course. The treatment of chronic antibiotic-refractory pouchitis (CARP) is challenging, and treatment failure is often a cause of pouch excision. We report on a series of three patients with CARP who were treated with oral ertapenem following faecal coliform sensitivity testing. There was an improvement in the pouchitis disease activity index in all three patients [pretreatment pouch disease activity index, median 13 (range: 10-14); post-treatment pouch disease activity index, median 1 (range: 1-3)]. Identification of faecal coliform sensitivity and treatment with oral ertapenem might be helpful in patients with CARP.
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Affiliation(s)
- Venkata Madirrala
- Departments of aGastroenterology bColorectal Surgery cPathology dMedical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
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47
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Abu-Alainin W, Gana T, Liloglou T, Olayanju A, Barrera LN, Ferguson R, Campbell F, Andrews T, Goldring C, Kitteringham N, Park BK, Nedjadi T, Schmid MC, Slupsky JR, Greenhalf W, Neoptolemos JP, Costello E. UHRF1 regulation of the Keap1-Nrf2 pathway in pancreatic cancer contributes to oncogenesis. J Pathol 2016; 238:423-33. [PMID: 26497117 PMCID: PMC4738372 DOI: 10.1002/path.4665] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/02/2015] [Accepted: 10/19/2015] [Indexed: 12/24/2022]
Abstract
The cellular defence protein Nrf2 is a mediator of oncogenesis in pancreatic ductal adenocarcinoma (PDAC) and other cancers. However, the control of Nrf2 expression and activity in cancer is not fully understood. We previously reported the absence of Keap1, a pivotal regulator of Nrf2, in ∼70% of PDAC cases. Here we describe a novel mechanism whereby the epigenetic regulator UHRF1 suppresses Keap1 protein levels. UHRF1 expression was observed in 20% (5 of 25) of benign pancreatic ducts compared to 86% (114 of 132) of pancreatic tumours, and an inverse relationship between UHRF1 and Keap1 levels in PDAC tumours (n = 124) was apparent (p = 0.002). We also provide evidence that UHRF1-mediated regulation of the Nrf2 pathway contributes to the aggressive behaviour of PDAC. Depletion of UHRF1 from PDAC cells decreased growth and enhanced apoptosis and cell cycle arrest. UHRF1 depletion also led to reduced levels of Nrf2-regulated downstream proteins and was accompanied by heightened oxidative stress, in the form of lower glutathione levels and increased reactive oxygen species. Concomitant depletion of Keap1 and UHRF1 restored Nrf2 levels and reversed cell cycle arrest and the increase in reactive oxygen species. Mechanistically, depletion of UHRF1 reduced global and tumour suppressor promoter methylation in pancreatic cancer cell lines, and KEAP1 gene promoter methylation was reduced in one of three cell lines examined. Thus, methylation of the KEAP1 gene promoter may contribute to the suppression of Keap1 protein levels by UHRF1, although our data suggest that additional mechanisms need to be explored. Finally, we demonstrate that K-Ras drives UHRF1 expression, establishing a novel link between this oncogene and Nrf2-mediated cellular protection. Since UHRF1 over-expression occurs in other cancers, its ability to regulate the Keap1-Nrf2 pathway may be critically important to the malignant behaviour of these cancers.
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Affiliation(s)
- Wafa Abu-Alainin
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Thompson Gana
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Triantafillos Liloglou
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Adedamola Olayanju
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Lawrence N Barrera
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Robert Ferguson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Fiona Campbell
- Department of Pathology, Royal Liverpool University Hospital, UK
| | - Timothy Andrews
- Department of Pathology, Royal Liverpool University Hospital, UK
| | | | - Neil Kitteringham
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Brian K Park
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Taoufik Nedjadi
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Michael C Schmid
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Joseph R Slupsky
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | - Eithne Costello
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, UK
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48
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Gregory JM, Andrews T, Good P. The inconstancy of the transient climate response parameter under increasing CO2. Philos Trans A Math Phys Eng Sci 2015; 373:rsta.2014.0417. [PMID: 26438279 PMCID: PMC4608037 DOI: 10.1098/rsta.2014.0417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In the Coupled Model Intercomparison Project Phase 5 (CMIP5), the model-mean increase in global mean surface air temperature T under the 1pctCO2 scenario (atmospheric CO(2) increasing at 1% yr(-1)) during the second doubling of CO(2) is 40% larger than the transient climate response (TCR), i.e. the increase in T during the first doubling. We identify four possible contributory effects. First, the surface climate system loses heat less readily into the ocean beneath as the latter warms. The model spread in the thermal coupling between the upper and deep ocean largely explains the model spread in ocean heat uptake efficiency. Second, CO(2) radiative forcing may rise more rapidly than logarithmically with CO(2) concentration. Third, the climate feedback parameter may decline as the CO(2) concentration rises. With CMIP5 data, we cannot distinguish the second and third possibilities. Fourth, the climate feedback parameter declines as time passes or T rises; in 1pctCO2, this effect is less important than the others. We find that T projected for the end of the twenty-first century correlates more highly with T at the time of quadrupled CO(2) in 1pctCO2 than with the TCR, and we suggest that the TCR may be underestimated from observed climate change.
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Affiliation(s)
- J M Gregory
- NCAS-Climate, University of Reading, Reading, UK Met Office Hadley Centre, FitzRoy Road, Exeter, UK
| | - T Andrews
- Met Office Hadley Centre, FitzRoy Road, Exeter, UK
| | - P Good
- Met Office Hadley Centre, FitzRoy Road, Exeter, UK
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49
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Flack T, Young A, Andrews T. Neural Representations of Expression and Viewpoint Information in the Temporal Cortex. J Vis 2015. [DOI: 10.1167/15.12.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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50
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Sormaz M, Young A, Watson D, Andrews T. Image properties from the internal and external features of the face differentially predict patterns of neural response to expression and identity in human visual cortex. J Vis 2015. [DOI: 10.1167/15.12.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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