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Wallace T, Heath J, Koebbel C. The impact of flash glucose monitoring on adults with type 1 Diabetes' eating habits and relationship with food. Diabetes Res Clin Pract 2023; 196:110230. [PMID: 36563881 DOI: 10.1016/j.diabres.2022.110230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
AIM To gain a better understanding of how the FreeStyle Libre (FSL) flash glucose monitor influences the eating habits and relationship with food of adults with type 1 diabetes (T1D). METHODS Reflexive thematic analysis was conducted on fifteen semi-structured interviews conducted with adults with T1D, exploring their experiences of at least one year of FSL use. RESULTS Four themes were constructed from the qualitative data: (1) Personal Food Story (what food represented before and after diabetes diagnosis), (2) New Opportunities (the FSL offered novel discoveries and increased self-confidence regarding food choices), (3) Body as a Machine (participants viewed their bodies as a collection of complex processes requiring continuous maintenance), and (4) re-evaluating Diabetes (participants expressed a shift in their expectations of themselves and their diabetes management). Although the FSL offered participants more freedom and flexibility with their eating, this was constrained by feeling forever under scrutiny from the data. CONCLUSIONS Findings suggest the FSL influences users' eating habits, including when, why, what and how much they eat. Participants described both the positive and negative impact of these changes on their emotional wellbeing and relationship with diabetes, arguing for a need to address patients' relationship with food in routine clinic care.
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Affiliation(s)
- T Wallace
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
| | - J Heath
- Doctoral Programme in Clinical Psychology, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK; Bedford Hospital Adult Diabetes Service, Bedfordshire Hospitals NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road, Bedford MK42 9DJ, UK.
| | - C Koebbel
- Luton and Bedfordshire Eating Disorders Service, East London NHS Foundation Trust, Mountbatten House, 56 High Street South, Dunstable, Bedfordshire LU6 3HD, UK
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2
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Spence A, Wallace T, Barracks E. FT-IR spectroscopy analysis of HF-treated mineral soils, a direct approach for deciphering organo-mineral interactions. MethodsX 2023; 10:102088. [PMID: 36926266 PMCID: PMC10011482 DOI: 10.1016/j.mex.2023.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Soil organic matter (SOM) constitutes roughly 60% organic carbon (OC) and therefore plays a crucial role in regulating global climate. However, our understanding of the long-term dynamics of the soil carbon pool remains constrained by limitations in analytical approaches capable of providing high resolution molecular-level information from arguably the most complex biomaterial on the planet. In this contribution, we combine hydrofluoric acid (HF) treatment with a spectroscopic approach as a strategy to provide refined molecular-level information on the interactions between soil minerals and SOM. Critically, we have not seen the use of this combined approach anywhere in the literature and strongly believe that it could allow us to improve our overall understanding to the mechanisms and pathways that regulate SOM transformation. Results clearly illustrates which organic structures are preferentially adsorbed to soil minerals and are likely to be protected from degradation, as well as spatial co-variations of SOM with specific mineral components such as Al3+, Si4+ and dibasic cations such as Mg2+as a function of their importance in the interaction process.•Soil samples were collected from different land-use types in rural farming communities of the Upper Rio Grande Valley.•Samples were oven dried, disaggregated, sieved, treated with 10% HF, rinsed and oven dried.•Oven dried samples were subjected to Mid-infrared (4000-400 cm-1), XRD and ED-XRF analyses.
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Affiliation(s)
- A Spence
- International Centre for Environmental and Nuclear Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - T Wallace
- International Centre for Environmental and Nuclear Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - E Barracks
- International Centre for Environmental and Nuclear Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
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Cara K, Beauchesne A, Wallace T, Chung M. Effects of 100% Orange Juice on Markers of Inflammation and Oxidative Stress: A Systematic Review and Meta-analysis. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith GE, Long J, Wallace T, Carradice D, Chetter IC. Identifying the research priorities of healthcare professionals in UK vascular surgery: modified Delphi approach. BJS Open 2020; 5:6054052. [PMID: 33688955 PMCID: PMC7944495 DOI: 10.1093/bjsopen/zraa025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Vascular Research Collaborative was established to develop a national research strategy for patients with vascular disease in the UK. This project aimed to establish national research priorities in this patient group. Methods A modified Delphi approach, an established method for reaching a consensus opinion among a group of experts in a particular field, was used to survey national multidisciplinary vascular clinical specialists. Two rounds of online surveys were conducted involving the membership of the Vascular Society, Society of Vascular Nurses, Society for Vascular Technology, and the Rouleaux Club (vascular surgical trainees). The first round invited any suggestions for vascular research topics. A steering group then collated and rationalized the suggestions, categorizing them by consensus into pathological topics and research categories, and amalgamating the various questions relating to the same fundamental issue into a single question. The second round involved recirculating these questions to the same participants for priority scoring. Results Round 1 resulted in 1231 suggested research questions from 481 respondents. Steering group collation and rationalization resulted in 83 questions for ranking in round 2. The second round resulted in a hierarchical list of vascular research priorities. The highest scoring priorities addressed topics related to critical lower-limb ischaemia, diabetic foot disease, amputation, wound healing, carotid plaque morphology, and service organization/delivery. Conclusion It is anticipated that these results will drive the UK national vascular research agenda for the next 5–10 years. It will facilitate focused development and funding of new research projects in current clinical areas of unmet need where potential impact is greatest.
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Affiliation(s)
- G E Smith
- Correspondence to: Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK (e-mail: )
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Wallace T, El-Sheikha J, Nandhra S, Leung C, Mohamed A, Harwood A, Smith G, Carradice D, Chetter I. Correspondence. Br J Surg 2019; 106:800-801. [PMID: 30973991 DOI: 10.1002/bjs.11183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 11/10/2022]
Affiliation(s)
- T Wallace
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - J El-Sheikha
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - S Nandhra
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - C Leung
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - A Mohamed
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - A Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - G Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - D Carradice
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - I Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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6
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Carradice D, Forsyth J, Mohammed A, Leung C, Hitchman L, Harwood AE, Wallace T, Smith GE, Campbell B, Chetter I. Compliance with NICE guidelines when commissioning varicose vein procedures. BJS Open 2018; 2:419-425. [PMID: 30511042 PMCID: PMC6253791 DOI: 10.1002/bjs5.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 01/13/2023] Open
Abstract
Background Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - J Forsyth
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A Mohammed
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - C Leung
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - L Hitchman
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - A E Harwood
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - T Wallace
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - G E Smith
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
| | - B Campbell
- Department of Vascular Surgery Royal Devon and Exeter Hospital (Wonford) Exeter UK
| | - I Chetter
- Academic Vascular Surgical Unit Hull York Medical School and Hull Royal Infirmary Hull UK
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7
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Wallace T, El-Sheikha J, Nandhra S, Leung C, Mohamed A, Harwood A, Smith G, Carradice D, Chetter I. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg 2018; 105:1759-1767. [PMID: 30132797 DOI: 10.1002/bjs.10961] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/26/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Clinical guidelines recommend endovenous laser ablation (EVLA) over surgery based on short-term evidence, yet there are few studies reporting mid- to long-term outcomes. The aim of this study was to report the 5-year outcomes from an RCT of surgery versus EVLA for treatment of symptomatic great saphenous varicose veins. METHODS Patients with symptomatic varicose veins due to great saphenous vein (GSV) incompetence were followed up 5 years after enrolment in a randomized trial of either surgery (saphenofemoral junction ligation, GSV strip to the knee and multiple avulsions of varicosities) or EVLA plus multiple avulsions. Outcomes included: clinical recurrence, defined as new varicose veins greater than 3 mm in diameter; Venous Clinical Severity Score (VCSS); quality of life measured by means of Short Form 36, EuroQol Five Dimensions (EQ-5D™) and Aberdeen Varicose Vein Questionnaire (AVVQ); patient satisfaction; and duplex ultrasound examination (DUS) findings. RESULTS Some 218 of the 276 patients enrolled in the trial (79·0 per cent) were available for follow-up. Clinical recurrence was more frequent following surgery than EVLA at 5 years (34·3 versus 20·9 per cent; P = 0·010). Both groups demonstrated sustained significant improvements at 5 years over baseline in VCSS (surgery: median (i.q.r.) 1 (0-2) from 4 (3-5), P < 0·001; EVLA: 0 (0-1) from 4 (3-5), P < 0·001), AVVQ (surgery: 4·59 (0·56-9·78) from 13·69 (9·81-18·11), P < 0·001; EVLA: 3·35 (0·17 to 6·55) from 12·73 (9·41-17·32), P < 0·001) and EQ-5D™ (surgery: 1·000 (0·796-1·000) from 0·859 (0·796-1·000), P = 0·002; EVLA: 1·000 (0·796-1·000) from 0·808 (0·796-1·000), P = 0·002). VCSS was better for EVLA than surgery at 5 years (P = 0·031). Technical success assessed by DUS remained high at 5 years (85·4 per cent for surgery and 93·2 per cent for EVLA; P = 0·074). DUS-detected anatomical patterns of recurrence differed between the groups. CONCLUSION EVLA was more effective than surgery in preventing clinical recurrence 5 years after treatment of great saphenous varicose veins. Patient-reported outcome measures were similar. Registration number: NCT00759434 (http://www.clinicaltrials.gov).
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Affiliation(s)
- T Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - J El-Sheikha
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - S Nandhra
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - C Leung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - A Mohamed
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - A Harwood
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - G Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - D Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - I Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
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Totty J, Bua N, Smith G, Harwood A, Carradice D, Wallace T, Chetter I. Dialkylcarbamoyl chloride (DACC)-coated dressings in the management and prevention of wound infection: a systematic review. J Wound Care 2017; 26:107-114. [DOI: 10.12968/jowc.2017.26.3.107] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J.P. Totty
- Clinical Research Fellow, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - N. Bua
- Academic Foundation Doctor, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - G.E. Smith
- Clinical Lecturer, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - A.E. Harwood
- Research Fellow, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - D. Carradice
- Consultant Vascular Surgeon, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - T. Wallace
- Clinical Lecturer, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - I.C. Chetter
- Professor of Vascular Surgery and Consultant Vascular Surgeon, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
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Carceller F, Jerome NP, Miyazaki K, Collins DJ, Orton MR, d'Arcy JA, Wallace T, Moreno L, Pearson ADJ, Zacharoulis S, Leach MO, Marshall LV, Koh DM. Feasibility and applicability of diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in routine assessments of children with high-grade gliomas. Pediatr Blood Cancer 2017; 64:279-283. [PMID: 27615273 DOI: 10.1002/pbc.26216] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/28/2022]
Abstract
Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) have been used as imaging biomarkers in adults with high-grade gliomas (HGGs). We incorporated free-breathing DW-MRI and DCE-MRI, at a single time point, in the routine follow-up of five children (median age 9 years, range 8-15) with histologically confirmed HGG within a prospective imaging study. It was feasible to incorporate DW-MRI and DCE-MRI in routine assessments of children with HGG. DW and DCE parameters were repeatable in paediatric HGG. Higher median ADC100-1000 significantly correlated with longer survival in our sample.
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Affiliation(s)
- Fernando Carceller
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Neil P Jerome
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Keiko Miyazaki
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - James A d'Arcy
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Toni Wallace
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucas Moreno
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- Clinical Trials Unit, Paediatric Oncology Department, Hospital Niño Jesús, Madrid, Spain
| | - Andrew D J Pearson
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Stergios Zacharoulis
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Lynley V Marshall
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Jerome NP, Miyazaki K, Collins DJ, Orton MR, d'Arcy JA, Wallace T, Moreno L, Pearson ADJ, Marshall LV, Carceller F, Leach MO, Zacharoulis S, Koh DM. Repeatability of derived parameters from histograms following non-Gaussian diffusion modelling of diffusion-weighted imaging in a paediatric oncological cohort. Eur Radiol 2017; 27:345-353. [PMID: 27003140 PMCID: PMC5127877 DOI: 10.1007/s00330-016-4318-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 08/10/2015] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine repeatability of parameters derived from non-Gaussian diffusion models in data acquired in children with solid tumours. METHODS Paediatric patients (<16 years, n = 17) were scanned twice, 24 h apart, using DWI (6 b-values, 0-1000 mm-2 s) at 1.5 T in a prospective study. Tumour ROIs were drawn (3 slices) and all data fitted using IVIM, stretched exponential, and kurtosis models; percentage coefficients of variation (CV) calculated for each parameter at all ROI histogram centiles, including the medians. RESULTS The values for ADC, D, DDCα, α, and DDCK gave CV < 10 % down to the 5th centile, with sharp CV increases below 5th and above 95th centile. K, f, and D* showed increased CV (>30 %) over the histogram. ADC, D, DDCα, and DDCK were strongly correlated (ρ > 0.9), DDCα and α were not correlated (ρ = 0.083). CONCLUSION Perfusion- and kurtosis-related parameters displayed larger, more variable CV across the histogram, indicating observed clinical changes outside of D/DDC in these models should be interpreted with caution. Centiles below 5th for all parameters show high CV and are unreliable as diffusion metrics. The stretched exponential model behaved well for both DDCα and α, making it a strong candidate for modelling multiple-b-value diffusion imaging data. KEY POINTS • ADC has good repeatability as low 5th centile of the histogram distribution. • High CV was observed for all parameters at extremes of histogram. • Parameters from the stretched exponential model showed low coefficients of variation. • The median ADC, D, DDC α , and DDC K are highly correlated and repeatable. • Perfusion/kurtosis parameters showed high CV variations across their histogram distributions.
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Affiliation(s)
- Neil P Jerome
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Keiko Miyazaki
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK
| | - David J Collins
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Matthew R Orton
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK
| | - James A d'Arcy
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Toni Wallace
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Lucas Moreno
- Paediatric Drug Development Team, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Hospital Niño Jesus, Av Menendez Pelayo 65, Madrid, Spain
- Paediatric Drug Development Unit, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Andrew D J Pearson
- Paediatric Drug Development Team, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Paediatric Drug Development Unit, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Lynley V Marshall
- Paediatric Drug Development Team, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Paediatric Drug Development Unit, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Fernando Carceller
- Paediatric Drug Development Team, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Paediatric Drug Development Unit, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Martin O Leach
- Division of Radiotherapy & Imaging, The Institute of Cancer Research, Cancer Research UK Cancer Imaging Centre, 123 Old Brompton Road, London, SW7 3RP, UK.
| | - Stergios Zacharoulis
- Paediatric Drug Development Team, Division of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- Paediatric Drug Development Unit, Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5PT, UK
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok 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S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, 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Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
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- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Hornsby
- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
| | | | | | | | | | - J Varghase
- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
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- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
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- Mid Staffordshire NHS Foundation Trust
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- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
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- Tunbridge Wells and Maidstone NHS Trust
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- Tunbridge Wells and Maidstone NHS Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Birmingham NHS Foundation Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital Coventry and Warwickshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital of North Staffordshire NHS Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital Southampton NHS Foundation Trust
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- University Hospital South Manchester NHS Foundation Trust
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- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
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- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
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- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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Carceller F, Jerome N, Miyazaki K, Orton M, d'Arcy J, Wallace T, Moreno L, Pearson A, Marshall L, Leach M, Zacharoulis S, Koh DM. RA-02DIFFUSION-WEIGHTED AND DYNAMIC CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING AS MARKERS OF CLINICAL BEHAVIOUR IN PAEDIATRIC HIGH GRADE GLIOMAS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now083.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ledger AEW, Scurr ED, Hughes J, Macdonald A, Wallace T, Thomas K, Wilson R, Leach MO, Schmidt MA. Comparison of Dixon Sequences for Estimation of Percent Breast Fibroglandular Tissue. PLoS One 2016; 11:e0152152. [PMID: 27011312 PMCID: PMC4806997 DOI: 10.1371/journal.pone.0152152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/09/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate sources of error in the Magnetic Resonance Imaging (MRI) measurement of percent fibroglandular tissue (%FGT) using two-point Dixon sequences for fat-water separation. METHODS Ten female volunteers (median age: 31 yrs, range: 23-50 yrs) gave informed consent following Research Ethics Committee approval. Each volunteer was scanned twice following repositioning to enable an estimation of measurement repeatability from high-resolution gradient-echo (GRE) proton-density (PD)-weighted Dixon sequences. Differences in measures of %FGT attributable to resolution, T1 weighting and sequence type were assessed by comparison of this Dixon sequence with low-resolution GRE PD-weighted Dixon data, and against gradient-echo (GRE) or spin-echo (SE) based T1-weighted Dixon datasets, respectively. RESULTS %FGT measurement from high-resolution PD-weighted Dixon sequences had a coefficient of repeatability of ±4.3%. There was no significant difference in %FGT between high-resolution and low-resolution PD-weighted data. Values of %FGT from GRE and SE T1-weighted data were strongly correlated with that derived from PD-weighted data (r = 0.995 and 0.96, respectively). However, both sequences exhibited higher mean %FGT by 2.9% (p < 0.0001) and 12.6% (p < 0.0001), respectively, in comparison with PD-weighted data; the increase in %FGT from the SE T1-weighted sequence was significantly larger at lower breast densities. CONCLUSION Although measurement of %FGT at low resolution is feasible, T1 weighting and sequence type impact on the accuracy of Dixon-based %FGT measurements; Dixon MRI protocols for %FGT measurement should be carefully considered, particularly for longitudinal or multi-centre studies.
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Affiliation(s)
- Araminta E. W. Ledger
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Erica D. Scurr
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julie Hughes
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Macdonald
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Toni Wallace
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin Wilson
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Maria A. Schmidt
- CR-UK Cancer Imaging Centre, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
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Wallace T, Hewitt EJ. Studies in Iron Deficiency of Crops. I. Problems of Iron Deficiency and the Interrelationships of Mineral Elements in Iron Nutrition. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/03683621.1946.11513640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wallace T. Investigations on Chlorosis of Fruit Trees.: II.—The Composition of Leaves, Bark and Wood of Current Season’s Shoots in Cases of Lime-Induced Chlorosis. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/03683621.1928.11513337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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18
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Wallace T, Leung C, Carradice D, Chetter I. Prospective cohort study of concomitant phlebectomy or sclerotherapy of varicosities. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Wallace T, Leung C, Carradice D, Chetter I. Cohort study of buffered versus unbuffered tumescent anaesthesia in the treatment of varicose veins with endovenous laser ablation. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.638] [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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Miyazaki K, Jerome NP, Collins DJ, Orton MR, d’Arcy JA, Wallace T, Moreno L, Pearson ADJ, Marshall LV, Carceller F, Leach MO, Zacharoulis S, Koh DM. Demonstration of the reproducibility of free-breathing diffusion-weighted MRI and dynamic contrast enhanced MRI in children with solid tumours: a pilot study. Eur Radiol 2015; 25:2641-50. [PMID: 25773937 PMCID: PMC4529450 DOI: 10.1007/s00330-015-3666-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/05/2014] [Revised: 01/30/2015] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The objectives are to examine the reproducibility of functional MR imaging in children with solid tumours using quantitative parameters derived from diffusion-weighted (DW-) and dynamic contrast enhanced (DCE-) MRI. METHODS Patients under 16-years-of age with confirmed diagnosis of solid tumours (n = 17) underwent free-breathing DW-MRI and DCE-MRI on a 1.5 T system, repeated 24 hours later. DW-MRI (6 b-values, 0-1000 sec/mm(2)) enabled monoexponential apparent diffusion coefficient estimation using all (ADC0-1000) and only ≥100 sec/mm(2) (ADC100-1000) b-values. DCE-MRI was used to derive the transfer constant (K(trans)), the efflux constant (kep), the extracellular extravascular volume (ve), and the plasma fraction (vp), using a study cohort arterial input function (AIF) and the extended Tofts model. Initial area under the gadolinium enhancement curve and pre-contrast T1 were also calculated. Percentage coefficients of variation (CV) of all parameters were calculated. RESULTS The most reproducible cohort parameters were ADC100-1000 (CV = 3.26%), pre-contrast T1 (CV = 6.21%), and K(trans) (CV = 15.23%). The ADC100-1000 was more reproducible than ADC0-1000, especially extracranially (CV = 2.40% vs. 2.78%). The AIF (n = 9) derived from this paediatric population exhibited sharper and earlier first-pass and recirculation peaks compared with the literature's adult population average. CONCLUSIONS Free-breathing functional imaging protocols including DW-MRI and DCE-MRI are well-tolerated in children aged 6 - 15 with good to moderate measurement reproducibility. KEY POINTS • Diffusion MRI protocol is feasible and well-tolerated in a paediatric oncology population. • DCE-MRI for pharmacokinetic evaluation is feasible and well tolerated in a paediatric oncology population. • Paediatric arterial input function (AIF) shows systematic differences from the adult population-average AIF. • Variation of quantitative parameters from paired functional MRI measurements were within 20%.
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Affiliation(s)
- Keiko Miyazaki
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - Neil P. Jerome
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - Matthew R. Orton
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - James A. d’Arcy
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - Toni Wallace
- Department of Radiology, Royal Marsden Hospital, London, England UK
| | - Lucas Moreno
- Paediatric Drug Development Team, Divisions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, London, SM2 5NG UK
- Clinical Research Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernandez Almagro 3, 28029 Madrid, Spain
- Paediatric Drug Development Unit, Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT UK
| | - Andrew D. J. Pearson
- Paediatric Drug Development Team, Divisions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, London, SM2 5NG UK
- Paediatric Drug Development Unit, Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT UK
| | - Lynley V. Marshall
- Paediatric Drug Development Team, Divisions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, London, SM2 5NG UK
- Paediatric Drug Development Unit, Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT UK
| | - Fernando Carceller
- Paediatric Drug Development Team, Divisions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, London, SM2 5NG UK
- Paediatric Drug Development Unit, Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT UK
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre at The Institute of Cancer Research, London, SM2 5NG UK
| | - Stergios Zacharoulis
- Paediatric Drug Development Team, Divisions of Cancer Therapeutics and Clinical Studies, The Institute of Cancer Research, London, SM2 5NG UK
- Paediatric Drug Development Unit, Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT UK
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, London, England UK
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Simons D, Pearson N, Evans P, Wallace T, Eke M, Wright D. Improving access to dental care for vulnerable children; further development of the Back2School programme in 2013. Community Dent Health 2015; 32:68-71. [PMID: 26263597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper describes a service evaluation of a dental treatment programme providing care to children not normally taken to the dentist. It explains the extension of the Back2School programme from the pilot phase and assesses if a mobile dental unit (MDU) can provide a high quality service. The public health competencies it illustrates include oral health improvement, developing and monitoring quality dental services, and collaborative working.
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Burmester G, Bao M, Reiss W, Wallace T, Lacey S, Kivitz A. FRI0153 Immunogenicity, Safety and Efficacy of Subcutaneous Tocilizumab in Patients Who Missed Doses. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Kivitz A, Olech E, Borofsky M, Devenport J, Pei J, Wallace T, Michalska M. SAT0180 A Multicenter, Open-Label, Long-Term Extension Study of Summacta and Brevacta to Evaluate Safety and Efficacy of Tocilizumab SC in Patients with Moderate to Severe RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Harris LM, Tunariu N, Messiou C, Hughes J, Wallace T, DeSouza NM, Leach MO, Payne GS. Evaluation of lactate detection using selective multiple quantum coherence in phantoms and brain tumours. NMR Biomed 2015; 28:338-43. [PMID: 25586623 PMCID: PMC4681317 DOI: 10.1002/nbm.3255] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 05/28/2023]
Abstract
Lactate is a product of glucose metabolism. In tumour tissues, which exhibit enhanced glycolytic metabolism, lactate signals may be elevated, making lactate a potential useful tumour biomarker. Methods of lactate quantitation are complicated because of overlap between the lactate methyl doublet CH3 resonance and a lipid resonance at 1.3 ppm. This study presents the use of a selective homonuclear multiple quantum coherence transfer sequence (SelMQC-CSI), at 1.5 T, to better quantify lactate in the presence of lipids. Work performed on phantoms showed good lactate detection (49%) and lipid suppression (98%) efficiencies. To evaluate the method in the brain, the sequence was tested on a group of 23 patients with treated brain tumours, either glioma (N=20) or secondary metastases in the brain (N=3). Here it was proved to be of use in determining lactate concentrations in vivo. Lactate was clearly seen in SelMQC spectra of glioma, even in the presence of lipids, with high grade glioma (7.3 ± 1.9 mM, mean ± standard deviation) having higher concentrations than low grade glioma (1.9 ± 1.5 mM, p=0.048). Lactate was not seen in secondary metastases in the brain. SelMQC-CSI is shown to be a useful technique for measuring lactate in tumours whose signals are otherwise contaminated by lipid.
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Affiliation(s)
- L M Harris
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - N Tunariu
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - C Messiou
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - J Hughes
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - T Wallace
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - N M DeSouza
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - M O Leach
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
| | - G S Payne
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation TrustSutton, Surrey, UK
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25
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Ledger AEW, Borri M, Pope RJE, Scurr ED, Wallace T, Richardson C, Usher M, Allen S, Wilson RM, Thomas K, deSouza NM, Leach MO, Schmidt MA. Investigating the influence of flip angle and k-space sampling on dynamic contrast-enhanced MRI breast examinations. Acad Radiol 2014; 21:1394-401. [PMID: 25179563 PMCID: PMC4234081 DOI: 10.1016/j.acra.2014.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/18/2014] [Accepted: 06/27/2014] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively investigate the effect of flip angle (FA) and k-space sampling on the performance of dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) breast sequences. MATERIALS AND METHODS Five DCE-MRI breast sequences were evaluated (10°, 14°, and 18° FAs; radial or linear k-space sampling), with 7-10 patients in each group (n = 45). All sequences were compliant with current technical breast screening guidelines. Contrast agent (CA) uptake curves were constructed from the right mammary artery for each examination. Maximum relative enhancement, E(max), and time-to-peak enhancement, T(max), were measured and compared between protocols (analysis of variance and Mann-Whitney). For each sequence, calculated values of maximum relative enhancement, E(calc), were derived from the Bloch equations and compared to E(max). Fat suppression performance (residual bright fat and chemical shift artifact) was rated for each examination and compared between sequences (Fisher exact tests). RESULTS Significant differences were identified between DCE-MRI sequences. E(max) increased significantly at higher FAs and with linear k-space sampling (P < .0001; P = .001). Radial protocols exhibited greater T(max) than linear protocols at FAs of both 14° (P = .025) and 18° (P < .0001), suggesting artificially flattened uptake curves. Good correlation was observed between E(calc) and E(max) (r = 0.86). Fat suppression failure was more pronounced at an FA of 18° (P = .008). CONCLUSIONS This retrospective approach is validated as a tool to compare and optimize breast DCE-MRI sequences. Alterations in FA and k-space sampling result in significant differences in CA uptake curve shape which could potentially affect diagnostic interpretation. These results emphasize the need for careful parameter selection and greater standardization of breast DCE-MRI sequences.
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Affiliation(s)
- Araminta E W Ledger
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Marco Borri
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Romney J E Pope
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Erica D Scurr
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Toni Wallace
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Cheryl Richardson
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Marianne Usher
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Steven Allen
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Robin M Wilson
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
| | - Nandita M deSouza
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
| | - Martin O Leach
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom.
| | - Maria A Schmidt
- Cancer Research - United Kingdom (CR-UK) Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom
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El-Sheikha J, Nandhra S, Carradice D, Wallace T, Samuel N, Smith GE, Chetter IC. Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. Br J Surg 2014; 101:1093-7. [DOI: 10.1002/bjs.9565] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/16/2014] [Accepted: 04/17/2014] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Endovenous laser ablation (EVLA) is a popular treatment for superficial venous insufficiency. Debate continues regarding the optimal management of symptomatic varicose tributaries following ablation of the main saphenous trunk. This randomized trial compared the 5-year outcomes of endovenous laser therapy with ambulatory phlebectomy (EVLTAP) with concomitant ambulatory phlebectomy, and EVLA alone with sequential treatment if required following a delay of at least 6 weeks.
Methods
Patients undergoing EVLA for great saphenous vein insufficiency were randomized to receive EVLTAP or EVLA alone with sequential phlebectomy, if required. Outcomes included disease-specific quality of life (QoL) (Aberdeen Varicose Vein Questionnaire; AVVQ), requirement for secondary procedures, clinical severity (Venous Clinical Severity Score; VCSS), residual and recurrent varicose tributaries, and generic QoL. Patients were followed up for 5 years.
Results
Fifty patients were randomized equally into two parallel groups. The EVLTAP group had lower VCSS scores at 12 weeks (median 0 (i.q.r. 0–1) versus 2 (0–2); P <0·001), and lower AVVQ scores at 6 weeks (median 7·9 (i.q.r. 4·1–10·7) versus 13·5 (10·9–18·1); P < 0·001) and 12 weeks (2·0 (0·4–7·7) versus 9·6 (2·2–13·8); P = 0·015). VCSS and AVVQ scores were equivalent by 1 year, but only after 16 of 24 patients in the EVLA group, compared with one of 25 in the EVLTAP group (P < 0·001), had received a secondary intervention. From 1 to 5 years both groups had equivalent outcomes.
Conclusion
EVLA with either concomitant or sequential management of tributaries is acceptable treatment for symptomatic varicose veins, with both treatments achieving excellent results at 5 years. Concomitant treatment of varicosities is associated with optimal improvement in both clinical disease severity and QoL.
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Affiliation(s)
- J El-Sheikha
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - S Nandhra
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - D Carradice
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - T Wallace
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - N Samuel
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - G E Smith
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
| | - I C Chetter
- Academic Vascular Surgery Unit, Hull Royal Infirmary, Hull, UK
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El-Sheikha J, Nandhra S, Wallace T, Samuel N, Carradice D, Chetter I. Five-Year Results of a Randomised Clinical Trial Comparing Concomitant and Sequential Phlebectomy Following Endovenous Laser Ablation. J Vasc Surg Venous Lymphat Disord 2014; 2:104. [DOI: 10.1016/j.jvsv.2013.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Samuel N, Carradice D, Wallace T. Randomized Clinical Trial of Endovenous Laser Ablation Versus Conventional Surgery for Small Saphenous Varicose Veins. J Vasc Surg 2013. [DOI: 10.1016/j.jvs.2013.01.012] [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: 10/27/2022]
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Wallace T, Avital I, Stojadinovic A, Brücher BLDM, Cote E, Yu J. Multi-Parametric MRI-Directed Focal Salvage Permanent Interstitial Brachytherapy for Locally Recurrent Adenocarcinoma of the Prostate: A Novel Approach. J Cancer 2013; 4:146-51. [PMID: 23412660 PMCID: PMC3572406 DOI: 10.7150/jca.5419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/15/2013] [Indexed: 11/15/2022] Open
Abstract
Even with the technological advances of dose-escalated IMRT with the addition of the latest image guidance technologies, local failures still occur. The combination of MRI-based imaging techniques can yield quantitative information that reflects on the biological properties of prostatic tissues. These techniques provide unique information that can be used for tumor detection in the treated gland. With the advent of these improved imaging modalities, it has become possible to more effectively image local recurrences within the prostate gland. With better imaging, these focal recurrences can be differentially targeted with salvage brachytherapy minimizing rectal and bladder toxicity. Here we report a novel use of MRI-directed focal brachytherapy after local recurrence. This technique offers a unique opportunity to safely and successfully treat recurrent prostate cancer, previously treated with definitive radiation therapy. The use of multi-parametric MRI-directed focal salvage permanent interstitial brachytherapy for locally recurrent adenocarcinoma of the prostate is a promising strategy to avoid more aggressive and expensive treatments that are associated with increased morbidity, potentially improving survival at potentially lower costs.
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Affiliation(s)
- T Wallace
- 1. Bon Secours Cancer Institute, Bon Secours Health System, Richmond VA, USA; ; 2. Division of Radiation Oncology, Bon Secours Health system, Richmond VA, USA
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Andreou A, Koh DM, Collins DJ, Blackledge M, Wallace T, Leach MO, Orton MR. Measurement reproducibility of perfusion fraction and pseudodiffusion coefficient derived by intravoxel incoherent motion diffusion-weighted MR imaging in normal liver and metastases. Eur Radiol 2013; 23:428-34. [PMID: 23052642 DOI: 10.1007/s00330-012-2604-1] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [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: 03/28/2012] [Accepted: 07/01/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the measurement reproducibility of perfusion fraction f, pseudodiffusion coefficient D and diffusion coefficient D in colorectal liver metastases and normal liver. METHODS Fourteen patients with known colorectal liver metastases were examined twice using respiratory-triggered echo-planar DW-MRI with eight b values (0 to 900 s/mm(2)) 1 h apart. Regions of interests were drawn around target metastasis and normal liver in each patient to derive ADC (all b values), ADC(high) (b values ≥ 100 s/mm(2)) and intravoxel incoherent motion (IVIM) parameters f, D and D by least squares data fitting. Short-term measurement reproducibility of median ADC, ADC(high), f, D and D values were derived from Bland-Altman analysis. RESULTS The measurement reproducibility for ADC, ADC(high) and D was worst in colorectal liver metastases (-21 % to +25 %) compared with liver parenchyma (-6 % to +8 %). Poor measurement reproducibility was observed for the perfusion-sensitive parameters of f (-75 % to +241 %) and D (-89 % to +2,120 %) in metastases, and to a lesser extent the f (-24 % to +25 %) and D (-31 % to +59 %) of liver. CONCLUSIONS Estimates of f and D derived from the widely used least squares IVIM fitting showed poor measurement reproducibility. Efforts should be made to improve the measurement reproducibility of perfusion-sensitive IVIM parameters.
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Affiliation(s)
- A Andreou
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5 PT, UK
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Ledger AEW, Borri M, Schmidt M, Pope R, Scurr E, Wallace T, Richardson C, Usher M, Allen S, Wilson R, Thomas K, deSouza N, Leach MO. Assessment of the dynamic range in dynamic contrast-enhanced magnetic resonance imaging breast examinations. Breast Cancer Res 2012. [PMCID: PMC3542682 DOI: 10.1186/bcr3294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Aine CJ, Sanfratello L, Ranken D, Best E, MacArthur JA, Wallace T, Gilliam K, Donahue CH, Montaño R, Bryant JE, Scott A, Stephen JM. MEG-SIM: a web portal for testing MEG analysis methods using realistic simulated and empirical data. Neuroinformatics 2012; 10:141-58. [PMID: 22068921 DOI: 10.1007/s12021-011-9132-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
MEG and EEG measure electrophysiological activity in the brain with exquisite temporal resolution. Because of this unique strength relative to noninvasive hemodynamic-based measures (fMRI, PET), the complementary nature of hemodynamic and electrophysiological techniques is becoming more widely recognized (e.g., Human Connectome Project). However, the available analysis methods for solving the inverse problem for MEG and EEG have not been compared and standardized to the extent that they have for fMRI/PET. A number of factors, including the non-uniqueness of the solution to the inverse problem for MEG/EEG, have led to multiple analysis techniques which have not been tested on consistent datasets, making direct comparisons of techniques challenging (or impossible). Since each of the methods is known to have their own set of strengths and weaknesses, it would be beneficial to quantify them. Toward this end, we are announcing the establishment of a website containing an extensive series of realistic simulated data for testing purposes ( http://cobre.mrn.org/megsim/ ). Here, we present: 1) a brief overview of the basic types of inverse procedures; 2) the rationale and description of the testbed created; and 3) cases emphasizing functional connectivity (e.g., oscillatory activity) suitable for a wide assortment of analyses including independent component analysis (ICA), Granger Causality/Directed transfer function, and single-trial analysis.
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Affiliation(s)
- C J Aine
- Department of Radiology, MSC10 5530, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
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Samuel N, Wallace T, Carradice D, Shahin Y, Mazari FAK, Chetter IC. Endovenous Laser Ablation in the Treatment of Small Saphenous Varicose Veins. Vasc Endovascular Surg 2012; 46:310-4. [DOI: 10.1177/1538574412443316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nehemiah Samuel
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - T. Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - D. Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - Y. Shahin
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - F. A. K. Mazari
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
| | - I. C. Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, UK
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Abstract
Objective: We aimed to assess the evolution of an endovenous laser ablation (EVLA) practice in the management of varicose veins in a university teaching hospital vascular surgical unit, over five years. Methods: This was a retrospective review of a prospectively collected database of patients undergoing EVLA for great saphenous vein incompetence and followed up for a year. For inter- and intragroup comparison, patients were divided into three groups: group A: endovenous access generally established at the perigenicular level ( n = 105); group B: when practice changed to gain access at lowest point of demonstrable reflux ( n = 70); and group C: when tumescence delivery changed from manual injections to delivery via peristaltic pump ( n = 49). Outcomes including pain scores, time taken to return to normal functioning, quality of life (QoL), venous clinical severity scores (VCSS) and complication rates were evaluated. Results: Intergroup analysis: increase in the length of vein treated and laser density delivered was observed over time, even as median procedure duration decreased ( P < 0.001). An increase in sensory disturbance was noticed in group C ( P = 0.047) while better Aberdeen Varicose Vein Questionnaire (AVVQ) ( P = 0.004), SF-36® physical domains ( P < 0.05) and patient satisfaction with treatment ( P = 0.025) were recorded in the same group at 52 weeks. No significant difference was observed in technical failure, pain scores, return to normal functioning, VCSS and recurrence rates post-intervention. Intragroup analysis: QoL measures (AVVQ, SF-36®, EQ-5D) and VCSS scores demonstrated significant improvement at 12 and 52 weeks compared with baseline ( P < 0.05). Conclusions: Increase in length of vein treated and energy delivery seems to improve short-term outcomes; however, operators need to be wary of a possible concurrent increase in paraesthetic complications.
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Affiliation(s)
- N Samuel
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - T Wallace
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - D Carradice
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - G Smith
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - F Mazari
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
| | - I Chetter
- Hull York Medical School/University of Hull – Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull HU3 2JZ, UK
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Samuel N, Carradice D, Wallace T, Smith GE, Mazari FAK, Chetter I. Saphenopopliteal ligation and stripping of small saphenous vein: does extended stripping provide better results? Phlebology 2012; 27:390-7. [PMID: 22267488 DOI: 10.1258/phleb.2011.011063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Saphenopopliteal ligation (SPL) for venous insufficiency is a challenging procedure, with mixed results being reported. The role of stripping of the small saphenous vein (SSV) is contentious. This prospective observational study aimed to assess the risks and benefits of this procedure. METHODS Fifty patients underwent SPL under general anaesthesia by a single surgeon in a tertiary referral vascular centre. The aim was to perform inversion stripping in each case, but in a proportion this was not possible. Patients were grouped into SPL with short segment excision ≤5 cm (n = 23) and SPL with extended stripping >5 cm (n = 27). Outcome measures included venous clinical severity scores (VCSS), quality of life (QoL), Aberdeen varicose vein questionnaire (AVVQ), patient satisfaction, recurrence and complication rates. RESULTS Intragroup analysis demonstrated statistically significant improvements in VCSS (P < 0.001), and QoL measures (generic and disease-specific AVVQ) (P < 0.050) with both treatments. Intergroup analysis demonstrated statistically significant superior VCSS scores at one year (P = 0.001), AVVQ at three months and one year (P < 0.05), and cosmetic satisfaction at one year (P = 0.011) in the SPL extended stripping group. There was no difference in clinical recurrence 1/23 (4.3%) versus 1/27 (3.7%) (P = 0.900) or complication rates (P > 0.050). CONCLUSIONS SPL with or without stripping is an effective procedure improving clinical severity and QoL in the short term. Early outcomes favour SPL with extended stripping to offer greater improvement in disease-specific QoL, venous severity and cosmesis. With this small sample, there is no evidence of increased complications following stripping, or increased short-term recurrence without it. Greater numbers and follow-up are required to make firm conclusions.
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Affiliation(s)
- N Samuel
- Academic Vascular Surgical Unit, Tower Block, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK.
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Koh DM, Collins DJ, Wallace T, Chau I, Riddell AM. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol 2011; 85:980-9. [PMID: 22167501 DOI: 10.1259/bjr/91771639] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare the diagnostic accuracy of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, diffusion-weighted MRI (DW-MRI) and a combination of both techniques for the detection of colorectal hepatic metastases. METHODS 72 patients with suspected colorectal liver metastases underwent Gd-EOB-DTPA MRI and DW-MRI. Images were retrospectively reviewed with unenhanced T(1) and T(2) weighted images as Gd-EOB-DTPA image set, DW-MRI image set and combined image set by two independent radiologists. Each lesion detected was scored for size, location and likelihood of metastasis, and compared with surgery and follow-up imaging. Diagnostic accuracy was compared using receiver operating characteristics and interobserver agreement by kappa statistics. RESULTS 417 lesions (310 metastases, 107 benign) were found in 72 patients. For both readers, diagnostic accuracy using the combined image set was higher [area under the curve (Az)=0.96, 0.97] than Gd-EOB-DTPA image set (Az=0.86, 0.89) or DW-MRI image set (Az=0.93, 0.92). Using combined image set improved identification of liver metastases compared with Gd-EOB-DTPA image set (p<0.001) or DW-MRI image set (p<0.001). There was very good interobserver agreement for lesion classification (κ=0.81-0.88). CONCLUSIONS Combining DW-MRI with Gd-EOB-DTPA-enhanced T(1) weighted MRI significantly improved the detection of colorectal liver metastases.
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Affiliation(s)
- D-M Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, Sutton, UK.
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Carradice D, Samuel N, Wallace T, Mazari FAK, Hatfield J, Chetter I. Comparing the treatment response of great saphenous and small saphenous vein incompetence following surgery and endovenous laser ablation: a retrospective cohort study. Phlebology 2011; 27:128-34. [DOI: 10.1258/phleb.2011.011014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Many venous trials mix patients with great saphenous vein (GSV) and small saphenous vein (SSV) diseases. There is no evidence that both respond similarly to treatment and our aim was to test this assumption. Method This cohort study compares patients with isolated GSV and SSV incompetence following treatment with open surgical ligation or endovenous laser ablation (EVLA). Outcomes included: quality of life (QoL; Aberdeen Varicose Vein Questionnaire [AVVQ]; Short Form 36 [SF36]; Euroqol [EQ5D]; and Venous Clinical Severity Score [VCSS]). Results A total of 370 patients with no differences in baseline QoL, underwent treatment. Despite equivalent morbidity, SSV sufferers had a lower VCSS ( P < 0.001). Following surgery, SSV patients scored higher (worse) on AVVQ ( P = 0.045) than GSV sufferers, but lower (better) following EVLA ( P = 0.042). Conclusion The morbidity associated with SSV incompetence is greater than suggested by its clinical severity and responds differently following treatment to that of the GSV. Trials should consider patients with GSV and SSV reflux separately. EVLA may offer additional benefits to SSV sufferers.
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Affiliation(s)
- D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - T Wallace
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - F A K Mazari
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J Hatfield
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Anderson-Evans C, Wallace T, Toncheva G, Hranitzky E, Hurwitz L, Yoshizumi T. SU-E-I-51: Estimating Effective Dose from Phantom Dose Measurements in Atrial Fibrillation Ablation Procedures. Med Phys 2011. [DOI: 10.1118/1.3611624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tam HH, Collins DJ, Wallace T, Brown G, Riddell A, Koh DM. Segmental liver hyperintensity in malignant biliary obstruction on diffusion weighted MRI: associated MRI findings and relationship with serum alanine aminotransferase levels. Br J Radiol 2011; 85:22-8. [PMID: 21224301 DOI: 10.1259/bjr/24852804] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Segmental liver hyperintensity can be observed in malignant biliary obstruction on diffusion weighted MRI (DW-MRI). We describe MRI findings associated with this sign and evaluate whether DW-MRI segmental hyperintensity has any relationship with serum alanine aminotransferase (ALT) levels. METHODS The DW-MRI T(1) weighted, T(2) weighted and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced T(1) weighted images obtained in 21 patients with hepatic malignancy, who demonstrated biliary obstruction and segmental hyperintensity on DW-MRI (b=0-750 s mm(-2)), were retrospectively reviewed by 2 readers blinded to clinical results. DW-MRI hyperintense liver segments were recorded as hypointense, isointense or hyperintense relative to normal liver on T(1)/T(2) weighted imaging. It was also noted whether contrast enhancement was similar to that observed in normal liver or diminished in the hepatocellular phase. The mean apparent diffusion coefficient (ADC) value (×10(-3) s mm(-2)) of DW-MRI hyperintense segments, normal liver and tumour were compared using Student's t-test. The frequency of MRI findings was corroborated with serum ALT levels, which reflect hepatocyte injury. RESULTS DW-MRI hyperintense segments frequently showed T(1) hyperintensity (10/21), T(2) hyperintensity (19/21) and/or diminished contrast enhancement (15/21). Tumours showed significantly lower mean ADC values than liver (1.23 ± 0.08 vs 1.43 ± 0.05; p=0.013). Segments showing concomitant T(1) hyperintensity had lower mean ADC values than liver (1.30 ± 0.05 vs 1.43 ± 0.05; p=0.023). The patients (8/10) with concomitant T(1) and DW-MRI segmental hyperintensity showed elevated ALT levels (p=0.030, Fisher's exact test). CONCLUSION Concomitantly high T(1) weighted and DW-MRI signal in liver segments was associated with lower ADC values and abnormal liver function tests, which could reflect underlying cellular swelling and damage.
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Affiliation(s)
- H H Tam
- Department of Radiology, The Royal Marsden, Sutton, UK.
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Garcia-Rill E, Buchanan R, McKeon K, Skinner RD, Wallace T. Smoking during pregnancy: postnatal effects on arousal and attentional brain systems. Neurotoxicology 2007; 28:915-23. [PMID: 17368773 PMCID: PMC3320145 DOI: 10.1016/j.neuro.2007.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/13/2007] [Indexed: 11/25/2022]
Abstract
Prenatal exposure to cigarette smoke is known to produce lasting arousal, attentional and cognitive deficits in humans. The pedunculopontine nucleus (PPN), as the cholinergic arm of the reticular activating system (RAS), is known to modulate arousal, waking and REM sleep. Rapid eye movement (REM) sleep decreases between 10 and 30 days postnatally in the rat, with the greatest decrease occurring at 12-21 days. Pregnant dams were exposed to 150 ml of cigarette smoke for 15 min, three times per day, from day E14 until parturition, and the pups allowed to mature. We analyzed (a) intrinsic membrane properties of PPN neurons in slices from pups aged 12-21 days, and (b) the sleep state-dependent P13 auditory evoked potential, which is generated by PPN outputs, in animals allowed to age to adolescence. We found significant changes in the intrinsic membrane properties of PPN cells in prenatally exposed animals compared to intact ones, rendering these cells more excitable. In addition, we found disturbances in the habituation to repetitive stimulation in adolescent, freely moving animals, suggestive of a deficit in the process of sensory gating. These findings could explain some of the differences seen in individuals whose parents smoked during pregnancy, especially in terms of their hypervigilance and increased propensity for attentional deficits and cognitive/behavioral disorders.
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Affiliation(s)
- E Garcia-Rill
- Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States.
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Affiliation(s)
- M F Bracewell
- The Biochemical Department, Lister Institute, London, and the Agricultural and Horticultural Research Station, Long Ashton, Bristol
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Affiliation(s)
- T Wallace
- The Agricultural and Horticultural Research Station, Long Ashton, Bristol and the Division of Nutrition, Lister Institute, London
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Chung T, Wallace T, Cardinale R, Broaddus W, Benedict S, Ramekrishnan V, Schmidt-Ullrich R. A Phase I Study of Accelerated Radiotherapy for Glioblastoma Multiforme Using Stereotactic Concomitant Boosts for Dose Escalation. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mamiya N, Buchanan R, Wallace T, Skinner RD, Garcia-Rill E. Nicotine suppresses the P13 auditory evoked potential by acting on the pedunculopontine nucleus in the rat. Exp Brain Res 2005; 164:109-19. [PMID: 15754179 DOI: 10.1007/s00221-005-2219-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 06/16/2004] [Accepted: 08/19/2004] [Indexed: 12/23/2022]
Abstract
We identified a potential novel site of action for nicotine (NIC) since (a) systemic injection of NIC led to a dose-dependent decrease in the amplitude of the sleep state-dependent, vertex-recorded, P13 midlatency auditory evoked potential (generated by the reticular activating system, RAS), (b) localized injections of a nicotinic receptor antagonist into the pedunculopontine nucleus (PPN, the cholinergic arm of the RAS) blocked the effects of systemic NIC on the P13 potential (a measure of level of arousal), and (c) localized injection of a nicotinic receptor agonist into the PPN also led to a decrease in the amplitude of the P13 potential, an effect blocked by PPN injection of a nicotinic receptor antagonist. There were minor changes in the manifestation of the startle response (SR) at the concentrations used; however, NIC did decrease the hippocampal N40 potential, although its effects were not affected by antagonist or agonist injections into the PPN. These results suggest a potential mechanism underlying the anxiolytic effects of NIC-suppression of the cholinergic arm of the RAS.
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Affiliation(s)
- N Mamiya
- Center for Translational Neuroscience, Department of Neurobiology & Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
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Smith L, Yonekura ML, Wallace T, Berman N, Kuo J, Berkowitz C. Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. J Dev Behav Pediatr 2003; 24:17-23. [PMID: 12584481 DOI: 10.1097/00004703-200302000-00006] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To determine fetal growth and the incidence of withdrawal symptoms in term infants exposed to methamphetamine in utero, we retrospectively identified neonates whose mothers used methamphetamine during pregnancy and matched them to unexposed newborns. Exclusion criteria included multiple and preterm gestations. Although there were no differences in infant growth parameters between the methamphetamine-exposed and methamphetamine-unexposed neonates, methamphetamine exposure throughout gestation was associated with decreased growth relative to infants exposed only for the first two trimesters. In addition, there were significantly more small for gestational age infants in the methamphetamine group compared with the unexposed group. Methamphetamine-exposed infants whose mothers smoked had significantly decreased growth relative to infants exposed to methamphetamine alone. Withdrawal symptoms (as determined by a previously reported scoring system) requiring pharmacologic intervention were observed in 4% of methamphetamine-exposed infants. These preliminary findings indicate that methamphetamine use is associated with growth restriction in infants born at term.
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Affiliation(s)
- Lynne Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, University of California, Los Angeles School of Medicine, USA.
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Ostrosky-Zeichner L, Bazemore S, Paetznick VL, Rodriguez JR, Chen E, Wallace T, Cossum P, Rex JH. Differential antifungal activity of isomeric forms of nystatin. Antimicrob Agents Chemother 2001; 45:2781-6. [PMID: 11557469 PMCID: PMC90731 DOI: 10.1128/aac.45.10.2781-2786.2001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
When nystatin is placed in RPMI and other biological fluids, there is loss of pure nystatin, with the development of two distinguishable chromatographic peaks, 1 and 2. Peak 1 appears identical to commercially prepared nystatin. By nuclear magnetic resonance (NMR) and mass spectral analysis, peak 2 appears to be an isomer of peak 1. The isomers are quantitatively and fully interconvertible. Formation of peak 2 is accelerated at a pH of >7.0 and ultimately reaches a near 55:45 (peak 1/peak 2 ratio) mixture. We sought to determine the relative activities of peaks 1 and 2 against Candida spp. Peak 2 consistently showed higher MICs when it was the predominant form during the experiment. Time-kill analyses showed that peak 2 required > or =8 x the concentration of peak 1 to produce a modest and delayed killing effect, which was never of the same magnitude as that produced by peak 1. In both types of assays, the activity of peak 2 corresponded with intra-assay formation of peak 1. Both MIC measurements and time-kill analysis suggest that peak 2 has considerably less activity, if any at all, against Candida spp. Peak 2 may serve as a reservoir for peak 1.
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Affiliation(s)
- L Ostrosky-Zeichner
- Laboratory of Mycology Research, Division of Infectious Diseases, Department of Internal Medicine, University of Texas Houston Medical School, 6431 Fannin, Houston, TX 77030, USA.
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Yuan X, Sobolev SV, Kind R, Oncken O, Bock G, Asch G, Schurr B, Graeber F, Rudloff A, Hanka W, Wylegalla K, Tibi R, Haberland C, Rietbrock A, Giese P, Wigger P, Röwer P, Zandt G, Beck S, Wallace T, Pardo M, Comte D. Subduction and collision processes in the Central Andes constrained by converted seismic phases. Nature 2000; 408:958-61. [PMID: 11140679 DOI: 10.1038/35050073] [Citation(s) in RCA: 305] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Central Andes are the Earth's highest mountain belt formed by ocean-continent collision. Most of this uplift is thought to have occurred in the past 20 Myr, owing mainly to thickening of the continental crust, dominated by tectonic shortening. Here we use P-to-S (compressional-to-shear) converted teleseismic waves observed on several temporary networks in the Central Andes to image the deep structure associated with these tectonic processes. We find that the Moho (the Mohorovicić discontinuity--generally thought to separate crust from mantle) ranges from a depth of 75 km under the Altiplano plateau to 50 km beneath the 4-km-high Puna plateau. This relatively thin crust below such a high-elevation region indicates that thinning of the lithospheric mantle may have contributed to the uplift of the Puna plateau. We have also imaged the subducted crust of the Nazca oceanic plate down to 120 km depth, where it becomes invisible to converted teleseismic waves, probably owing to completion of the gabbro-eclogite transformation; this is direct evidence for the presence of kinetically delayed metamorphic reactions in subducting plates. Most of the intermediate-depth seismicity in the subducting plate stops at 120 km depth as well, suggesting a relation with this transformation. We see an intracrustal low-velocity zone, 10-20 km thick, below the entire Altiplano and Puna plateaux, which we interpret as a zone of continuing metamorphism and partial melting that decouples upper-crustal imbrication from lower-crustal thickening.
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Affiliation(s)
- X Yuan
- GeoForschungsZentrum Potsdam, Telegrafenberg, Germany
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50
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Adrales G, Turk P, Wallace T, Bird R, Norton HJ, Greene F. Is surgical excision necessary for atypical ductal hyperplasia of the breast diagnosed by Mammotome? Am J Surg 2000; 180:313-5. [PMID: 11113443 DOI: 10.1016/s0002-9610(00)00451-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Core biopsy findings of atypical ductal hyperplasia (ADH) underestimates the diagnosis of malignancy by 18% to 88%. Using the Mammotome biopsy technique, more accurate assessment of the lesion is possible, making selective excision of these lesions a consideration. METHODS The records of 62 patients who were found to have ADH at Mammotome biopsy and subsequently underwent excision of the lesion were reviewed. Patient data were statistically analyzed for predictors of malignancy at the time of surgical excision. RESULTS Of the 62 patients, 9 (15%) had malignancy at excision. Variables predicting for malignancy included markedly atypical hyperplasia and incomplete removal of calcifications at Mammotome biopsy, a previous contralateral breast cancer, and a family history of breast cancer, with a combined sensitivity of 100% and specificity of 80%. CONCLUSIONS Mild ADH found on Mammotome, not associated with a personal or family history of breast cancer, may not need excision if all calcifications have been removed.
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Affiliation(s)
- G Adrales
- Carolinas Medical Center, Charlotte, North Carolina, USA
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