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Smith S, Ravikumar R, Carvalho C, Normahani P, Lane T, Davies AH. Neuromuscular electrical stimulation for the treatment of diabetic sensorimotor polyneuropathy: A prospective, cohort, proof-of-concept study. Neurophysiol Clin 2024; 54:102943. [PMID: 38422719 DOI: 10.1016/j.neucli.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess a potential efficacy signal, safety and feasibility of neuromuscular electrical stimulation (NMES) therapy as an adjunct to standard care in patients with diabetic sensorimotor polyneuropathy (DSPN). METHODS In this single-centre, prospective, cohort, proof-of-concept study, 25 patients with DSPN consented to at least one daily 30-minute NMES therapy session (Revitive® IX) for 10 weeks, with 20 patients completing the study. The primary outcome measure was nerve conductivity assessed using a nerve conduction study of the sural, superficial peroneal, common peroneal and tibial nerves at 10 weeks compared to baseline. Secondary outcomes included superficial femoral artery (SFA) haemodynamics during NMES therapy compared to rest and quality-of-life at 10 weeks compared to baseline. RESULTS At 10 weeks, there were significant increases in sural sensory nerve action potential amplitude and conduction velocity (p < 0.001), superficial peroneal sensory nerve action potential amplitude (p = 0.001) and conduction velocity (p = 0.002), common peroneal nerve conduction velocity (p = 0.004) and tibial nerve compound muscle action potential amplitude (p = 0.002) compared to baseline. SFA volume flow and time-averaged mean velocity significantly increased (p ≤ 0.003) during NMES compared to rest. Patient-reported Michigan Neuropathy Screening Instrument scores significantly decreased (p = 0.028) at 10 weeks compared to baseline. Three unrelated adverse events occurred, and 15 participants adhered to treatment. CONCLUSIONS NMES therapy as an adjunct to standard care for 10 weeks significantly increased lower limb nerve conductivity in patients with DSPN and may be beneficial in the treatment of DSPN.
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Affiliation(s)
- Sasha Smith
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Raveena Ravikumar
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Catarina Carvalho
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Pasha Normahani
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RF, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, United Kingdom.
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Nimura M, Lane T, Rawashdeh M, Onida S, Javed A, Sritharan G, Reese G, Hrouda D, Davies AH. Study protocol for neuromuscular stimulation for rehabilitation after general and vascular surgery: a pilot randomised clinical study. BMJ Open 2023; 13:e061800. [PMID: 36797015 PMCID: PMC9936270 DOI: 10.1136/bmjopen-2022-061800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVES To investigate the acceptability and safety of neuromuscular stimulation (NMES) as an adjunct for rehabilitation after vascular and general surgery. METHODS AND ANALYSIS Prospective, single-centre, single-blind, parallel group, randomised controlled study. This study will be conducted in a single-centre, secondary care setting (National Healthcare Service Hospital) in the UK. All patients aged over 18 years undergoing vascular or general surgery with Rockwood Frailty Score of 3 or above on admission. Exclusion is inability or unwillingness to participate in trial, implanted electrical device, pregnancy and acute deep vein thrombosis. Target number of recruitment is 100. Participants will be randomly assigned to active NMES group (group A) or placebo NMES group (group B) prior to surgery. Participants will be blinded and asked to use the NMES device, 1-6 sessions daily (30 min per session) after surgery in addition to standard National Health Service rehabilitation care until discharge. The primary study outcomes are acceptability and safety of NMES assessed by the device satisfaction questionnaire on discharge and adverse events recorded during hospital stay. The secondary outcomes are the postoperative recovery and cost-effectiveness compared between two groups, assessed by various activity tests, mobility and independence measures and questionnaires. ETHICS AND DISSEMINATION Ethical approvals were provided by London-Harrow Research Ethics Committee (REC) and the Health Research Authority (HRA), Ref: 21/PR/0250. Findings will be published in a peer-reviewed journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT04784962.
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Affiliation(s)
- Megumi Nimura
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Majd Rawashdeh
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Azfar Javed
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ganan Sritharan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - George Reese
- Section of Colorectal Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Hrouda
- Section of Urological Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Hampson A, Sharaf A, Tamhankar A, Lane T, Adshead J, Vasdev N. Post-operative outcomes following robotic assisted laparoscopic radical prostatectomy in patients between the ages of 65 and 69 and between the ages of 70 and 75 years. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lane T. Can we witness proteins traversing conical intersections via FEL-based crystallography? Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322095614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AH. Prevention and Management Strategies for Diabetic Neuropathy. Life (Basel) 2022; 12:life12081185. [PMID: 36013364 PMCID: PMC9410148 DOI: 10.3390/life12081185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed.
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Affiliation(s)
- Sasha Smith
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Pasha Normahani
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - David Hohenschurz-Schmidt
- Pain Research Group, Department of Surgery and Cancer, Imperial College London, London SW10 9NH, UK;
| | - Nick Oliver
- Section of Metabolic Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W2 1PG, UK;
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Alun Huw Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
- Correspondence:
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Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AH. Pathogenesis of Distal Symmetrical Polyneuropathy in Diabetes. Life (Basel) 2022; 12:life12071074. [PMID: 35888162 PMCID: PMC9319251 DOI: 10.3390/life12071074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022]
Abstract
Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects.
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Affiliation(s)
- Sasha Smith
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Pasha Normahani
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - David Hohenschurz-Schmidt
- Pain Research Group, Department of Surgery and Cancer, Imperial College London, London SW10 9NH, UK;
| | - Nick Oliver
- Section of Metabolic Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London W2 1PG, UK;
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Alun Huw Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK; (S.S.); (P.N.); (T.L.)
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W6 8RF, UK
- Correspondence:
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Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) clinical practice guidelines (CPGs) provide evidence-based information on patient management; however, methodological differences exist in the development of CPGs. This study examines the methodological quality of AAA CPGs using a validated assessment tool. METHODS Medline, EMBASE and online CPG databases were searched from 1946 to 31 October 2021. Full-text, English language, evidence-based AAA CPGs were included. Consensus-based CPGs, summaries of CPGs or CPGs which were only available on purchase were excluded. Five reviewers assessed their quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered as the threshold to recommend CPG use in clinical practice. RESULTS Seven CPGs were identified. Scores showed good inter-reviewer reliability (intraclass correlation coefficient 0.943, 95% CI 0.915 to 0.964). On average, CPGs performed adequately with mean scaled scores of over 50% in all domains. However, between CPGs, significant methodological heterogeneity was observed in all domains. Four CPGs scored ≥80% (European Society of Cardiology, the Society of Vascular Surgery, the European Society of Vascular Surgery and the National Institute of Health and Care Excellence), supporting their use in clinical practice. CONCLUSIONS Four CPGs were considered of adequate methodological quality to recommend their use in clinical practice; nonetheless, these still showed areas for improvement, potentially through performing economic analysis and trial application of recommendations. A structured approach employing validated CPG creation tools should be used to improve rigour of AAA CPGs. Future work should also evaluate recommendation accuracy using validated appraisal tools.
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Affiliation(s)
- Kia Hau Matthew Tan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Safa Salim
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew Machin
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Aurélien Geroult
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Noël J, Spencer N, Lodia S, Karim S, Taneja S, Moghanchizadeh D, Nayak A, Tamhankar A, Swamy R, Agarwal S, Narula A, Lane T, Adshead J, Vasdev N. Neurovascular Structure-Adjacent Frozen-section Examination (NeuroSAFE) Robotic Radical Prostatectomy: Functional outcomes from the first 500 consecutive cases. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION The increasing prevalence of diabetes mellitus and advances in endovascular therapies continue to have an impact on the epidemiology and management of lower extremity arterial disease. This study describes trends in lower extremity revascularisation and major lower limb amputation in NHS England over the past two decades (2000-2019). METHODS Numbers of lower extremity endovascular interventions, open surgical procedures and major lower limb amputations performed in NHS England between 2000 and 2019 were extracted from publicly available hospital admitted patient care activity reports. Trends in intervention were assessed with linear regression models and chi-square tests for trend. RESULTS Over this period, 527,131 revascularisations and 92,053 amputations were performed. The mean age of patients was 67.5 years (standard deviation 1.6 years) and 65.3% were male. The number of lower limb revascularisation procedures increased by 402.4 units/year (95% confidence interval, CI, 290.1-514.6, p < 0.001). The number of endovascular interventions rose by 43.5% (10,912 in 2000 vs 15,657 in 2019; β = 359.5.0, 95% CI 279.3-439.8, p < 0.001) compared with no significant increase in the number of open surgical procedures (8,483 in 2000 vs 7,872 in 2019; β = 42.8, 95% CI -8.3 to 94.0, p = 0.095). The number of major lower limb amputations has decreased by 9.4% (5,418 in 2000 vs 4,907 in 2019; β = -31.0; 95% CI -49.6 to -12.5, R2 = 0.42, p = 0.003). CONCLUSIONS There has been a significant increase in the rate of lower limb revascularisation procedures associated with decreased numbers of major lower limb amputations over the past two decades. These changes in overall trends may affect both service provision and vascular surgery training planning.
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Affiliation(s)
- A Staniszewska
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Gimzewska
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Lane
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Onida S, Heatley F, Peerbux S, Bolton L, Lane T, Epstein D, Gohel M, Poskitt K, Cullum N, Norrie J, Lee RJ, Bradbury A, Dhillon K, Chandrasekar A, Lomas R, Davies AH. Study protocol for a multicentre, randomised controlled trial to compare the use of the decellularised dermis allograft in addition to standard care versus standard care alone for the treatment of venous leg ulceration: DAVE trial. BMJ Open 2021; 11:e041748. [PMID: 33811051 PMCID: PMC8023724 DOI: 10.1136/bmjopen-2020-041748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Venous leg ulceration (VLU), the most common type of chronic ulcer, can be difficult to heal and is a major cause of morbidity and reduced quality of life. Although compression bandaging is the principal treatment, it is time-consuming and bandage application requires specific training. There is evidence that intervention on superficial venous incompetence can help ulcer healing and recurrence, but this is not accessible to all patients. Hence, new treatments are required to address these chronic wounds. One possible adjuvant treatment for VLU is human decellularised dermis (DCD), a type of skin graft derived from skin from deceased tissue donors. Although DCD has the potential to promote ulcer healing, there is a paucity of data for its use in patients with VLU. METHODS AND ANALYSIS This is a multicentre, parallel group, pragmatic randomised controlled trial. One hundred and ninety-six patients with VLU will be randomly assigned to receive either the DCD allograft in addition to standard care or standard care alone. The primary outcome is the proportion of participants with a healed index ulcer at 12 weeks post-randomisation in each treatment arm. Secondary outcomes include the time to index ulcer healing and the proportion of participants with a healed index ulcer at 12 months. Changes in quality of life scores and cost-effectiveness will also be assessed. All analyses will be carried out on an intention-to-treat (ITT) basis. A mixed-effects, logistic regression on the outcome of the proportion of those with the index ulcer healed at 12 weeks will be performed. Secondary outcomes will be assessed using various statistical models appropriate to the distribution and nature of these outcomes. ETHICS AND DISSEMINATION Ethical approval was granted by the Bloomsbury Research Ethics Committee (19/LO/1271). Findings will be published in a peer-reviewed journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN21541209.
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Affiliation(s)
- Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francine Heatley
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarrah Peerbux
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Layla Bolton
- Vascular Surgery Research Department, Imperial College Healthcare NHS Trust, London, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David Epstein
- Faculty of Economic and Business Sciences, University of Granada, Granada, Andalucía, Spain
| | - Manjit Gohel
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Keith Poskitt
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Nicky Cullum
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Clinical Trials Unit, University of Edinburgh No 9, Bioquarter, Edinburgh, UK
| | - Robert J Lee
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Clinical Trials Unit, University of Edinburgh No 9, Bioquarter, Edinburgh, UK
| | - Andrew Bradbury
- Birmingham University, Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karen Dhillon
- Vascular Surgery Research Department, Imperial College Healthcare NHS Trust, London, UK
| | - Akila Chandrasekar
- Tissue and Eye Services, NHS Blood and Transplant, Liverpool, Merseyside, UK
| | - Richard Lomas
- Tissue and Eye Services, NHS Blood and Transplant, Liverpool, Merseyside, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Chacko L, Martinez-Naharro A, Kotecha T, Martone R, Hutt D, Lane T, Knight D, Moon J, Kellman P, Hawkins P, Gillmore J, Fontana M. Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis.
Methods and results
Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline.
Conclusions
These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Chacko
- University College Hospital, London, United Kingdom
| | | | - T Kotecha
- University College Hospital, London, United Kingdom
| | - R Martone
- Careggi University Hospital, Florence, Italy
| | - D Hutt
- University College Hospital, London, United Kingdom
| | - T Lane
- University College Hospital, London, United Kingdom
| | - D Knight
- University College Hospital, London, United Kingdom
| | - J Moon
- Barts Heart Centre, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - P Hawkins
- University College Hospital, London, United Kingdom
| | - J Gillmore
- University College Hospital, London, United Kingdom
| | - M Fontana
- University College Hospital, London, United Kingdom
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Bandera F, Martone R, Chacko L, Ganesananthan S, Lane T, Martinez-Naharro A, Whelan C, Quarta C, Rowczenio D, Gilbertson J, Lachmann H, Guazzi M, Hawkins P, Gillmore J, Fontana M. Atrial strain in cardiacATTR amyloidosis from pathophysiology to prognosis: is it time to rethink our approach to disease? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left atrial (LA) involvement in cardiac ATTR amyloidosis (ATTR-CM) has never being explored. The aim of the study is to characterize the spectrum of changes in LA structure in ATTR-CM, the functional consequences on LA mechanics and the association with mortality.
Methods
We studied 936 patients with ATTR-CM who underwent prospective protocolized evaluations comprising ECG, full echocardiographic assessment, 6MWT, blood biomarkers sampling and survival assessment between 2000 and 2019. Reservoir (LAr), conduit (LAcd) and booster (LAcont) function were assessed according to current guidelines. LA stiffness (LAstiff) was estimated as the ratio between E/e' and LAr. The presence and extent of amyloid infiltration was assessed in two autopsied hearts from patients ATTR-CM with congo red staining and TTR antibodies.
Results
936 patients with ATTR-CM were included, 567 with wtATTR-CM and 346 with hATTR-CM, of whom 246 had the V122I variant and 100 the T60A variant. LA indexed area was similar across the 3 genotypes, whilst LAr, LAcd and LAcont were significantly reduced in V122I patients compared to Wt and T60A patients (LAr: 10.4±6.4 vs 12.8±8.5 vs 8.59±5.7%, p<0.0001; LAcd: 5.6±5.0 vs 6.9±5.7 vs 4.0±3.6%, p<0.0001; LAcont 7.5±4.1 vs 8.2±4.9 vs 6.7±4.2%, p=0.023; in Wt, T60 and V122I respectively). Similarly, LAstiff was significantly worse in V122I compared to Wt and T60A (LAstiff: 2.39±2.62 vs 2.59±4.83 vs 2.96±2.88, p<0.0001, in Wt, T60 and V122I respectively). In the overall population, LAstiff remained independently associated with mortality, after adjusting for rhythm, systolic and diastolic functional parameters, ventricular longitudinal strain, genotypes, clinical variables and NAC staging system (lnLA stiff: HR=1.26, CI: 1.07–1.57; p=0.009). In the overall population, 584 patients were in sinus rhythm and 344 in atrial fibrillation, atrial flutter or atrial tachycardia (non-sinus rhythm group – NSR). Among patients in SR, 21.6% did not show a measurable LA mechanical contraction on strain analysis (LAcont). Patients in SR without LAcont on strain analysis showed similar structural and functional LA changes, NTproBNP, NYHA class, and 6MWT to NSR patients. Mortality of patients in SR with no LAcont was significantly reduced compared to patients in SR with LAcont and similar to patients in AF (Figure 1). On the two autopsies hearts there was extensive amyloid infiltration of TTR type in the atrial wall as confirmed with CR and TTR antibodies (Figure 1).
Conclusions
ATTR-CM is characterized by primary infiltration of the atrial walls with progressive loss of atrial function and increased stiffness. LA stiffness is a strong independent predictor of mortality after adjusting for known predictors. Atrial electro-mechanical dissociation emerged as a distinctive functional phenotype identifying patients in SR with worse prognosis.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Bandera
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - R Martone
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - L Chacko
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - S Ganesananthan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - T Lane
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - A Martinez-Naharro
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - C Whelan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - C Quarta
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - D Rowczenio
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - J.A Gilbertson
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - H Lachmann
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - M Guazzi
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - P.N Hawkins
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - J.D Gillmore
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - M Fontana
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
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Dattani N, Shalhoub J, Nandhra S, Lane T, Abu-Own A, Elbasty A, Jones A, Duncan A, Garnham A, Thapar A, Murray A, Baig A, Saratzis A, Sharif A, Huasen B, Dawkins C, Nesbitt C, Carradice D, Morrow D, Bosanquet D, Kavanagh E, Shaikh F, Gosi G, Ambler G, Fulton G, Singh G, Travers H, Moore H, Olivier J, Hitchman L, O’Donohoe M, Popplewell M, Medani M, Jenkins M, Goh MA, Lyons O, McBride O, Moxey P, Stather P, Burns P, Forsythe R, Sam R, Brar R, Brightwell R, Benson R, Onida S, Paravastu S, Lambracos S, Vallabhaneni SR, Walsh S, Aktar T, Moloney T, Mzimba Z, Nyamekye I. Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study. Phlebology 2020; 35:706-714. [DOI: 10.1177/0268355520936420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. Methods A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively. Results Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements. Conclusions The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
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Affiliation(s)
- Nikesh Dattani
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sandip Nandhra
- Northern Vascular Centre, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tristan Lane
- Department of Surgery and Cancer, Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Abdulsalam Abu-Own
- Colchester Hospital University NHS Foundation Trust, Colchester, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ahmed Elbasty
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Aled Jones
- Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Duncan
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Andrew Garnham
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ankur Thapar
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anna Murray
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Anzar Baig
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Athanasios Saratzis
- University Hospitals of Leicester NHS Trust, Leicester, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Atif Sharif
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Bella Huasen
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Claire Dawkins
- Sunderland Royal Hospital, Sunderland, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Craig Nesbitt
- Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Daniel Carradice
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Darren Morrow
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - David Bosanquet
- Southmead Hospital, Bristol, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Eamon Kavanagh
- University of Limerick Hospitals Group, Vascular Surgery, Limerick, Ireland
- University of Limerick Graduate Entry Medical School, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Faisal Shaikh
- Heartlands Hospital, Birmingham, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gergely Gosi
- University Hospital Waterford, Vascular Surgery, Waterford, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Graeme Ambler
- Royal Gwent Hospital, Newport, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gregory Fulton
- Cork University Hospital Group, Cork, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Gurdas Singh
- Guy’s Hospital, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hannah Travers
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Hayley Moore
- Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - James Olivier
- Musgrove Park Hospital, Taunton, Somerset, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Louise Hitchman
- Hull Royal Infirmary, Hull, Kingston upon Hull, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Martin O’Donohoe
- Mater Misericordiae University Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Matthew Popplewell
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mekki Medani
- Beaumont Hospital, Dublin, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Michael Jenkins
- Imperial College Healthcare NHS Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Mingzheng A Goh
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Oliver Lyons
- Basildon University Hospital, Basildon, Essex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Olivia McBride
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Paul Moxey
- St George’s Hospital, Vascular Surgery, London, Tooting, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Philip Stather
- Addenbrooke’s Hospital, Cambridge, Cambridgeshire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Phillipa Burns
- Edinburgh Royal Infirmary, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Forsythe
- Royal Infirmary of Edinburgh, Edinburgh, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Rachel Sam
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ranjeet Brar
- Royal Free London NHS Foundation Trust, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Robert Brightwell
- Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Ruth Benson
- University of Birmingham Institute of Cancer and Genomic Sciences, Birmingham, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sarah Onida
- Imperial College London, Academic Section of Vascular Surgery, London, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Sharath Paravastu
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Simon Lambracos
- Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Srinivasa R Vallabhaneni
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Stewart Walsh
- Lambe Institute for Translational Discipline of Surgery, National University of Ireland, Galway, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tasleem Aktar
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Tony Moloney
- University of Limerick Hospitals Group, Dooradoyle, Limerick, Ireland
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Zola Mzimba
- Altnagelvin Hospitals Health and Social Services Trust, Londonderry, UK
- *The Vascular and Endovascular Research Network (VERN) collaborators
| | - Isaac Nyamekye
- Worcestershire Acute Hospitals NHS Trust, The Vascular Surgery Unit, Worcester, Worcestershire, UK
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Tamhankar A, Spencer N, Hampson A, Noel J, El-Taji O, Arianayagam R, McNicholas T, Boustead G, Lane T, Adshead J, Vasdev N. Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy. Ann R Coll Surg Engl 2020; 102:717-725. [PMID: 32538121 DOI: 10.1308/rcsann.2020.0139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases. METHODS We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases. RESULTS A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D'Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins. CONCLUSIONS It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.
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Affiliation(s)
| | | | - A Hampson
- East and North Hertfordshire NHS Trust, UK
| | - J Noel
- East and North Hertfordshire NHS Trust, UK
| | - O El-Taji
- East and North Hertfordshire NHS Trust, UK
| | | | | | - G Boustead
- East and North Hertfordshire NHS Trust, UK
| | - T Lane
- East and North Hertfordshire NHS Trust, UK
| | - J Adshead
- East and North Hertfordshire NHS Trust, UK
| | - N Vasdev
- East and North Hertfordshire NHS Trust, UK.,University of Hertfordshire, UK
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Papa R, Lane T, Bovis F, Minden K, Touitou I, Cantarini L, Cattalini M, Obici L, Jansson A, Belot A, Woska-Kuśnierz B, Berendes R, Remesal A, Jelusic M, Espada G, Nikishina I, Hoppenreijs E, Maggio MC, Youngstein T, Rezk T, Papadopoulou C, Brogan P, Hawkins PN, Woo P, Ruperto N, Gattorno M, Lachmann HJ. FRI0457 LONG-TERM OUTCOMES AND TREATMENT EFFICACY IN PATIENTS WITH TNF RECEPTOR-ASSOCIATED AUTOINFLAMMATORY SYNDROME (TRAPS) FROM THE EUROFEVER INTERNATIONAL REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Tumour necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is one of the best-known monogenic auto-inflammatory disorders resulting from an autosomal dominant variation in the TNF super family receptor 1A (TNFRSF1A) gene (1).Objectives:To define best treatment approach in patients with TRAPS and effect on long-term outcomes.Methods:We reviewed all data on patients with TRAPS enrolled in the Eurofever international registry according the INSAID gene variant classification and the new Eurofever/PRINTO classification criteria (EPCC).Results:Data on 226 patients were available. Patients not fulfilling the EPCC carrying likely benign/benign variants (21 patients, 9%) or VOUS/not classified variants (40 patients, 18%) displayed a milder disease than the patients fulfilling the EPCC with VOUS/not classified variants (38 patients, 17%) or pathogenic/likely pathogenic variants (127 patients, 56%). In particular, in patients not fulfilling the EPCC, less frequent abdominal pain and skin rashes, higher efficacy rate of colchicine and no development of AA amyloidosis have been reported. Almost 90% of patients fulfilling the EPCC required maintenance therapy and anti-interleukin (IL)-1 drugs were the most frequently used, with the highest efficacy rate (>85% complete response), while Etanercept was less effectively used and discontinued in 65% of patients.Conclusion:Anti-IL-1 drugs are the best maintenance treatment in TRAPS with potential to reverse the most serious disease complications of AA amyloidosis and infertility. The diagnosis of TRAPS should be considered very carefully in patients carrying VOUS/not classified variants not fulfilling the EPCC.References:[1]Lachmann HJ, Papa R, Gerhold K, Obici L, Touitou I, Cantarini L, et al. The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry. Annals of the rheumatic diseases 2014;73:2160-7.Acknowledgments:RP would like to thank the European Federation of Immunology (EFIS) for the short-term bursary and HL for her continuous support and guidance during the fellowship at the National Amyloidosis Centre in London.Disclosure of Interests:Riccardo Papa: None declared, Thirusha Lane: None declared, Francesca Bovis: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Isabelle Touitou: None declared, Luca Cantarini: None declared, Marco Cattalini: None declared, Laura Obici: None declared, Annette Jansson: None declared, Alexander Belot: None declared, Beata Woska-Kuśnierz: None declared, Rainer Berendes: None declared, Agustin Remesal: None declared, Marija Jelusic: None declared, Graciela Espada: None declared, Irina Nikishina: None declared, Esther Hoppenreijs: None declared, Maria Cristina Maggio: None declared, Taryn Youngstein: None declared, Tamer Rezk: None declared, Charalampia Papadopoulou: None declared, Paul Brogan Grant/research support from: Roche, Novartis, SOBI, Chemocentryx, Novimmune, Consultant of: Roche, SOBI, UCB, Novartis, Speakers bureau: Roche, SOBI, UCB, Novartis, Philip N Hawkins: None declared, Patricia Woo: None declared, Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Marco Gattorno Consultant of: Sobi, Novartis, Speakers bureau: Sobi, Novartis, Helen J. Lachmann: None declared
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Goodall R, Langridge B, Onida S, Ellis M, Lane T, Davies AH. Median arcuate ligament syndrome. J Vasc Surg 2020; 71:2170-2176. [DOI: 10.1016/j.jvs.2019.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022]
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17
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Tan M, Salim S, Beshr M, Guni A, Onida S, Lane T, Davies AH. A methodologic assessment of lymphedema clinical practice guidelines. J Vasc Surg Venous Lymphat Disord 2020; 8:1111-1118.e3. [PMID: 32454237 DOI: 10.1016/j.jvsv.2020.05.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this review was to determine the methodologic quality of current lymphedema clinical practice guidelines (CPGs) to assist health care professionals in selecting accessible, high-quality guidance and to identify areas for improvement in future CPGs. METHODS MEDLINE, Embase, online CPG databases, and reference lists of included guidelines were searched up to January 31, 2020. Full-text CPGs reporting on evidence-based recommendations in lymphedema diagnosis or management in English were included. CPGs based on expert consensus, CPG summaries, or CPGs that were not freely available were excluded. Two reviewers identified eligible CPGs, extracted data, and assessed their quality independently using the Appraisal of Guidelines for Research and Evaluation II instrument. Significant scoring discrepancies were discussed with a third reviewer. An overall scaled quality score of ≥80% was the threshold to recommend guideline use. RESULTS Six relevant CPGs were identified. One was subsequently excluded as its full text could not be obtained. Overall, there was very good inter-reviewer reliability of scores with intraclass correlation coefficient of 0.952 (95% confidence interval, 0.921-0.974). No single CPG scored highest in all domains, with methodologic heterogeneity observed. Poor performance was noted in domain 5 (mean scaled score, 23.8% ± 17.1%) and domain 6 (22.9% ± 26.7%). No CPG achieved an overall scaled quality score of ≥80%, with the top CPG scoring 79.2%. CONCLUSIONS According to the defined threshold, no lymphedema CPG was considered adequate for use in clinical practice. All current lymphedema CPGs have areas for improvement with elements of methodologic quality lacking, particularly with respect to rigor of development. A structured approach, guided by the use of CPG creation tools and checklists such as the Appraisal of Guidelines for Research and Evaluation II instrument, should help CPG development groups in improving the quality of future CPGs. This is of particular importance in a complex, multidisciplinary condition such as lymphedema.
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Affiliation(s)
- Matthew Tan
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Safa Salim
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Mostafa Beshr
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Ahmad Guni
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Sarah Onida
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Tristan Lane
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
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Lane T, Onida S, Davies A. Comment on: Strength of public preferences for endovascular or open aortic aneurysm repair. Br J Surg 2020; 107:613. [PMID: 32187677 DOI: 10.1002/bjs.11515] [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: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 11/06/2022]
Affiliation(s)
- T Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London and Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - S Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London and Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - A Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London and Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Staniszewska A, Onida S, Lane T, Davies A. Clinicians’ Opinion on the ATTRACT Trial—Results of an International Survey. J Vasc Surg Venous Lymphat Disord 2020. [DOI: 10.1016/j.jvsv.2019.12.038] [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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20
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Goodall RJ, Langridge B, Lane T, Davies AH, Shalhoub J. A Narrative Review of the Use of Neuromuscular Electrical Stimulation in Individuals With Diabetic Foot Ulceration. INT J LOW EXTR WOUND 2020; 19:242-250. [DOI: 10.1177/1534734619898978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This review aims to summarize the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU). A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, 7 met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use; however, in each study, only 3 of the included participants had DFU and subgroup analyses based on ulcer etiology was omitted. The remaining 5 studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in nondiabetic wounds of a similar grade (healing rate: 70.0 ± 32.3% in DFU vs 38.4 ± 22.3% in nondiabetic ulcers [ P < .01]). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data support a potential role for NMES in individuals with DFU; however, the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
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Affiliation(s)
- Richard James Goodall
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Benjamin Langridge
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Tristan Lane
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Alun Huw Davies
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Mirmilstein G, Noel J, Gbolahan O, Vasdev N, Lane T, Adshead J. The Lister AirSeal® port closure technique - Initial patient outcomes. Ann R Coll Surg Engl 2019; 101:606-608. [PMID: 31672035 DOI: 10.1308/rcsann.2019.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The 12-mm AirSeal® port is widely used in robotically assisted laparoscopic prostatectomy due to its ability to maintain stable pneumoperitoneal pressures and smoke evacuation. However, it creates a potential risk of port site hernia. We have traditionally used EndoClose™ to perform full thickness closure of this port, but noted that patients experienced increased pain related to this procedure, which sometimes persisted for several months. Using the Da Vinci Si we performed peritoneal closure with 2-0 vicryl by switching the fourth arm to the right master controller. The external oblique sheath was closed outside with 1 Ethibond. MATERIALS AND METHODS We performed this closure in 20 consecutive patients (group 1). Postoperative day 1, 2 and post-discharge telephone consultation pain scores (1-10) were recorded and compared with the previous 20 consecutive patients who had the EndoClose closure (group 2). RESULTS We recorded an instructional video to enable reproduction of the new technique. The mean length of stay was 1.5 days for patients in group 1 and 1.9 days for those in group 2 (P = 0.04). There was no difference in operating time or average day 1 pain scores. Post-discharge follow-up call revealed 1 of 20 patients who had AirSeal port site pain in group 1 and 5 of 17 in group 2 (P = 0.04). Pain scores also tended to be higher for group 2. CONCLUSIONS Our preliminary analysis of this novel technique to close the AirSeal port in two separate layers improves postoperative pain related to this port site.
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Affiliation(s)
- G Mirmilstein
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - J Noel
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - O Gbolahan
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - N Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - T Lane
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
| | - J Adshead
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre at Lister Hospital, Stevenage, UK
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Gwilym BL, Saratzis A, Benson R, Forsythe R, Dovell G, Dattani N, Lane T, Preece R, Shalhoub J, Bosanquet DC. Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study. Int J Surg Protoc 2019; 16:9-13. [PMID: 31897443 PMCID: PMC6921153 DOI: 10.1016/j.isjp.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/27/2019] [Accepted: 06/02/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSIs) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units' practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres. METHODS AND ANALYSIS This international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according to the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer. ETHICS AND DISSEMINATION This study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.
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Affiliation(s)
- Brenig Llwyd Gwilym
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Athanasios Saratzis
- NIHR Leicester Biomedical Research Centre (BRC), Leicester, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ruth Benson
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Vascular Surgery, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Rachael Forsythe
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - George Dovell
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Nikesh Dattani
- Department of Vascular Surgery, Russels Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ryan Preece
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - David Charles Bosanquet
- Gwent Vascular Institute, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
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Saratzis A, Jaspers NEM, Gwilym B, Thomas O, Tsui A, Lefroy R, Parks M, Htun V, Mera Z, Thatcher A, Bosanquet D, Forsythe R, Benson R, Dattani N, Dovell G, Lane T, Shalhoub J, Sidloff D, Visseren FLJ, Dorresteijn JAN, Richards T. Observational study of the medical management of patients with peripheral artery disease. Br J Surg 2019; 106:1168-1177. [PMID: 31259387 DOI: 10.1002/bjs.11214] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification. METHODS The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. RESULTS Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44-62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20-38) per cent with 6·3 (4·0-9·3) cardiovascular disease-free years gained. CONCLUSION The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.
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Affiliation(s)
- A Saratzis
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - N E M Jaspers
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - B Gwilym
- Vascular and Endovascular Research Network, Birmingham, UK
| | - O Thomas
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Tsui
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Lefroy
- Vascular and Endovascular Research Network, Birmingham, UK
| | - M Parks
- Vascular and Endovascular Research Network, Birmingham, UK
| | - V Htun
- Vascular and Endovascular Research Network, Birmingham, UK
| | - Z Mera
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Thatcher
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Bosanquet
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Forsythe
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Benson
- Vascular and Endovascular Research Network, Birmingham, UK
| | - N Dattani
- Vascular and Endovascular Research Network, Birmingham, UK
| | - G Dovell
- Vascular and Endovascular Research Network, Birmingham, UK
| | - T Lane
- Vascular and Endovascular Research Network, Birmingham, UK
| | - J Shalhoub
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Sidloff
- Vascular and Endovascular Research Network, Birmingham, UK
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - T Richards
- Department of Vascular Surgery, University of Western Australia, Perth, Western Australia, Australia
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Radebe O, Lippman SA, Lane T, Gilmore H, Agnew E, Manyuchi A, McIntyre JA. HIV self-screening distribution preferences and experiences among men who have sex with men in Mpumalanga Province: Informing policy for South Africa. S Afr Med J 2019; 109:227-231. [PMID: 31084686 PMCID: PMC7169947 DOI: 10.7196/samj.2019.v109i4.13818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 11/08/2022] Open
Abstract
Current research suggests that HIV self-screening (HIVSS) is a feasible and acceptable approach to increase HIV testing among men who have sex with men (MSM). However, few data are available to shape policy around dissemination and implementation. Gaps in knowledge include preferences for distribution of HIVSS kits, potential social harms and benefits of their use, and how much test users would be willing to pay for the kits. The aim was to inform policy recommendations to optimise distribution of HIVSS kits to MSM in South Africa (SA), where there is a high HIV incidence and unmet testing needs. MSM in the high-HIV-prevalence Gert Sibande and Ehlanzeni districts of Mpumalanga Province, SA, were enrolled between October 2015 and May 2017. Participants were provided with their choice of blood or oral fluid HIVSS test kits, receiving 5 kits at enrolment and 4 additional kits at the 3-month follow-up visit. Questionnaires were administered at enrolment, 3 months and 6 months. We analysed participants' reported social benefits and harms, and their preferences for kit distribution and pricing. Among 127 MSM screened and enrolled, 114 responded to follow-up questionnaires regarding distribution preferences, 49.3% preferred to acquire HIVSS kits at a community-based organisation (CBO) and 42.7% at a clinic, with 8% preferring a pharmacy. Participants with higher education preferred CBO sites for distribution; in other respects preferences were similar by demographic characteristics. Reported social benefits were common, including knowing one's status, prevention knowledge gained and improved communication with partners. Despite ubiquitous interest in using the kits, the majority of MSM could not afford to purchase test kits. SA guidelines have integrated HIVSS into HIV and testing policy, but little has been published regarding distribution channels of the kits for MSM and other key populations. There is a partnership between the National Department of Health and CBOs that specialise in key population programming to ensure MSM and other populations with unmet testing needs can access affordable test kits. We observed no social harms, and there were multiple social benefits. Consequently, we recommend immediate free or low-cost distribution of HIVSS kits to MSM through community-based initiatives. Future research should continue to assess optimised linkage to care.
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Affiliation(s)
- O Radebe
- Anova Health Institute, Johannesburg, South Africa; and Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, CA, USA.
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Chandran P, Lane T, Flynn C. Patient and Technique Survival for Blind and Sighted Diabetics on Continuous Ambulatory Peritoneal Dialysis: A Ten-Year Analysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889101400503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P.K.G. Chandran
- Nephrology Clinic, University of Iowa College of Medicine, Des Moines, IA - U.S.A
| | - T. Lane
- Nephrology Clinic, University of Iowa College of Medicine, Des Moines, IA - U.S.A
| | - C.T. Flynn
- Nephrology Clinic, University of Iowa College of Medicine, Des Moines, IA - U.S.A
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Hsiao FC, Tsai PJ, Wu CW, Lane T, Lee HC, Chen LC, Lee WK, Lu LH, Yang CM. The neurophysiological basis of sleep perception during sleep onset period. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Roche M, Ozdemir B, Lane T, Uzzaman M, Sinha S. The Use of 'Failure-To-Rescue' ('FTR') as a Quality Metric - Systematic Review of the Literature and Reporting Recommendations. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cope ER, Voy BH, Staton M, Lane T, Davitt J, Mulliniks JT. 106 Effect of β-hydroxybutyrate on gene expression in the hypothalamus and pituitary of sheep. J Anim Sci 2017. [DOI: 10.2527/asasann.2017.106] [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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Bootun R, Lane T, Riga C, Davies A. Randomized Controlled Trial of Compression Therapy After Endothermal Ablation. J Vasc Surg Venous Lymphat Disord 2017. [DOI: 10.1016/j.jvsv.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lane T, Bootun R, Dharmarajah B, Lim CS, Najem M, Renton S, Sritharan K, Davies AH. A multi-centre randomised controlled trial comparing radiofrequency and mechanical occlusion chemically assisted ablation of varicose veins - Final results of the Venefit versus Clarivein for varicose veins trial. Phlebology 2016; 32:89-98. [PMID: 27221810 DOI: 10.1177/0268355516651026] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endovenous thermal ablation has revolutionised varicose vein treatment. New non-thermal techniques such as mechanical occlusion chemically assisted endovenous ablation (MOCA) allow treatment of entire trunks with single anaesthetic injections. Previous non-randomised work has shown reduced pain post-operatively with MOCA. This study presents a multi-centre randomised controlled trial assessing the difference in pain during truncal ablation using MOCA and radiofrequency endovenous ablation (RFA) with six months' follow-up. Methods Patients undergoing local anaesthetic endovenous ablation for primary varicose veins were randomised to either MOCA or RFA. Pain scores using Visual Analogue Scale and number scale (0-10) during truncal ablation were recorded. Adjunctive procedures were completed subsequently. Pain after phlebectomy was not assessed. Patients were reviewed at one and six months with clinical scores, quality of life scores and duplex ultrasound assessment of the treated leg. Results A total of 170 patients were recruited over a 21-month period from 240 screened. Patients in the MOCA group experienced significantly less maximum pain during the procedure by Visual Analogue Scale (MOCA median 15 mm (interquartile range 7-36 mm) versus RFA 34 mm (interquartile range 16-53 mm), p = 0.003) and number scale (MOCA median 3 (interquartile range 1-5) versus RFA 4 mm (interquartile range 3-6.5), p = 0.002). ' Average' pain scores were also significantly less in the MOCA group; 74% underwent simultaneous phlebectomy. Occlusion rates, clinical severity scores, disease specific and generic quality of life scores were similar between groups at one and six months. There were two deep vein thromboses, one in each group. Conclusion Pain secondary to truncal ablation is less painful with MOCA than RFA with similar short-term technical, quality of life and safety outcomes.
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Affiliation(s)
- Tristan Lane
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.,3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK
| | - Roshan Bootun
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Brahman Dharmarajah
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.,3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK
| | - Chung S Lim
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.,3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK
| | - Mojahid Najem
- 3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK
| | - Sophie Renton
- 3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK
| | - Kaji Sritharan
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Alun H Davies
- 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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Mahmood S, Wassef NL, Salter SJ, Sachchithanantham S, Lane T, Foard D, Whelan CJ, Lachmann HJ, Gillmore JD, Hawkins PN, Wechalekar AD. Comparison of Free Light Chain Assays: Freelite and N Latex in Diagnosis, Monitoring, and Predicting Survival in Light Chain Amyloidosis. Am J Clin Pathol 2016; 146:78-85. [PMID: 27353767 DOI: 10.1093/ajcp/aqw079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Measurement of serum free light chains (FLCs) is critical in diagnosis, prognosis, and monitoring treatment responses in light chain (AL) amyloidosis. We compare the Freelite assay (polyclonal antibodies to hidden light chain epitopes), which is the current gold standard, with a new assay: a mixture of monoclonal antibodies to light chain epitopes (N Latex). METHODS We collected 240 serum samples from 94 consecutive patients with newly diagnosed AL amyloidosis (at least three serial serum samples during the first 6 months) analyzed at the National Amyloidosis Centre, London, from January 2011 to April 2012. Concordance in detecting abnormal light chain components and hematologic response was assessed at 2, 4, and 6 months. RESULTS The κ and λ clonal light chain involvement was 21% and 79%, respectively, with an abnormal κ/λ ratio or detectable protein in 78.7%. Median κ, λ, and difference in involved and uninvolved FLCs by Freelite and N Latex assays were 17.3 vs 16 mg/L (R(2 ) = 0.91), 48.8 vs 52.6 mg/L (R(2) = 0.52), and 43.2 vs 39.1 mg/L, respectively. Discordant κ/λ ratios at presentation were as follows: 10 of 90 abnormal by Freelite/normal by N Latex and 11 of 90 abnormal by N Latex/normal by Freelite. CONCLUSIONS Both FLC assays show good correlation in detecting the abnormal light chain subtype with discordance in absolute values and thus are not interchangeable.
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Affiliation(s)
- Shameem Mahmood
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Nancy L Wassef
- Clinical Biochemistry Department, Royal Free London Foundation Trust, London, United Kingdom
| | - Simon J Salter
- Clinical Biochemistry Department, Royal Free London Foundation Trust, London, United Kingdom
| | - Sajitha Sachchithanantham
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - T Lane
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - D Foard
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Carol J Whelan
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Helen J Lachmann
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Julian D Gillmore
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Philip N Hawkins
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Ashutosh D Wechalekar
- From the National Amyloidosis Centre, University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
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Klassen S, Fine N, Isaac D, Lane T. PS206 The Impact of a Dedicated Heart Failure Clinic in Guyana on Cardiovascular Outcomes. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Parker T, Keddie S, Kidd D, Lane T, Maviki M, Hawkins PN, Lachmann HJ, Ginsberg L. Neurology of the cryopyrin-associated periodic fever syndrome. Eur J Neurol 2016; 23:1145-51. [PMID: 26931528 DOI: 10.1111/ene.12965] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The cryopyrin-associated periodic fever syndrome (CAPS) is an autosomal dominant autoinflammatory disorder caused by mutations in the NLRP3 gene and is typified by recurrent episodes of systemic inflammation resulting in fever, urticarial rash and arthralgia. In addition to these systemic aspects, CAPS has multiple neurological manifestations. The largest case series to date is presented focusing on the neurological features of this disorder. METHODS The case histories of a cohort of 38 UK patients with genetically proven CAPS who were treated with interleukin 1β (IL-1β) inhibition as part of a national treatment programme and underwent detailed neurological assessment were reviewed. RESULTS Across the entire disease course neurological manifestations were present in 95% of patients; 84% had some form of headache; 66% sensorineural hearing loss; 60% myalgia; 34% papilloedema and 26% optic atrophy. Patients with the T348M mutation tended to have a more severe neurological phenotype with an earlier age of onset. Four patients had cerebrospinal fluid examination, three of whom had evidence of aseptic meningitis. There was a marked response to IL-1β inhibition, which has revolutionized management of these patients (29/32 patients with headache responding). CONCLUSION Neurological symptoms are extremely common in CAPS and these results highlight the importance of increasing awareness amongst neurologists, particularly as highly effective therapies are available.
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Affiliation(s)
- T Parker
- Institute of Neurology, UCL, London, UK.,Department of Neurology, Royal Free Hospital, London, UK
| | - S Keddie
- Department of Neurology, Royal Free Hospital, London, UK
| | - D Kidd
- Department of Neurology, Royal Free Hospital, London, UK
| | - T Lane
- National Amyloidosis Centre, UCL, London, UK
| | - M Maviki
- Department of Radiology, Royal Free Hospital, London, UK
| | - P N Hawkins
- National Amyloidosis Centre, UCL, London, UK
| | | | - L Ginsberg
- Institute of Neurology, UCL, London, UK.,Department of Neurology, Royal Free Hospital, London, UK
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Rowczenio D, Iancu D, Trojer H, Gilbertson J, Gillmore J, Wechalekar A, Tekman M, Stanescu H, Kleta R, Lane T, Hawkins P, Lachmann H. Deletion in MEFV resulting in the loss of p.M694 residue as the cause of autosomal dominant familial Mediterranean fever in North Western European Caucasians - a case series and genetic exploration. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596970 DOI: 10.1186/1546-0096-13-s1-o42] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lane T, Rowczenio DM, Gilbertson JA, Gillmore JD, Wechalekar AD, Hawkins PN, Lachmann HJ. Empirical use of anakinra in AA amyloidosis of uncertain aetiology. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596984 DOI: 10.1186/1546-0096-13-s1-o70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mahmood S, Riddle A, Sachchithanantham S, Lane T, Foard D, Youngstein T, Sayed R, Patel K, Fontanna M, Coyne M, Quarta C, Whelan C, Lachmann H, Gillmore J, Hawkins P, Gomez K, Wechalekar A. Bleeding diathesis and prothrombotic tendencies in patients with newly diagnosed systemic light chain Amyloidosis: important clinical implications. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.439] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Youngstein T, Lane T, Rowczenio D, Ozdogan H, Ugurlu S, Hoffmann P, Riminton S, Headley A, Ryan J, Harty L, Roesler J, Blank N, Michler C, Hawkins P, Lachmann H. SAT0553 Anti-Interleukin-1 Therapies and Pregnancy Outcome: an International Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5960] [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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Abstract
BACKGROUND The aim of this study was to systematically review the current evidence and determine whether there is a clinical benefit for using pharmacological agents as adjunctive treatment for chronic venous ulcers. METHOD A systematic review of the MEDLINE and EMBASE (from 1 January 1947 through 15 August 2013) and Cochrane databases (from inception through 15 August 2013) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all randomised controlled trials investigating pharmacological adjuncts for the treatment of venous ulcers with a minimum sample size of 20 patients for each treatment arm. RESULTS Ten relevant articles were identified; one pilot randomised controlled trial and four Cochrane reviews were included. Pentoxifylline, aspirin, sulodexide, mesoglycan, flavonoids, thromboxane A2 antagonist (ifetroban), zinc, prostaglandin and prostacyclin analogues were the drugs reviewed. Pentoxifylline was found to be more effective than placebo in terms of complete ulcer healing or in causing a significant improvement (greater than 60% reduction in ulcer size) (RR 1.70, 95% CI 1.30 to 2.24). Aspirin and flavonoids show potential to be effective adjuncts but methodological shortcomings and issues with bias limit the validity of results from trials involving each of these drugs, respectively. There was no significant difference between placebo and Ifetroban and likewise pooled results from trials investigating sulodexide and zinc showed no benefit in comparison to placebo. CONCLUSION Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.
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Affiliation(s)
| | - Ankur Thapar
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Tristan Lane
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Alex B Munster
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Alun Huw Davies
- Academic Section of Vascular Surgery, Imperial College London, UK
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Yeh SL, Lane T, Zhou J, Lin TY, Kuo CH, Teng CY. Difference between eyes-closed and eyes-open resting state alpha power is an indicator of susceptibility to the rubber hand illusion. J Vis 2014. [DOI: 10.1167/14.10.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Venner CP, Gillmore JD, Sachchithanantham S, Mahmood S, Lane T, Foard D, Rannigan L, Gibbs SDJ, Pinney JH, Whelan CJ, Lachmann HJ, Hawkins PN, Wechalekar AD. A matched comparison of cyclophosphamide, bortezomib and dexamethasone (CVD) versus risk-adapted cyclophosphamide, thalidomide and dexamethasone (CTD) in AL amyloidosis. Leukemia 2014; 28:2304-10. [DOI: 10.1038/leu.2014.218] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/06/2014] [Accepted: 06/18/2014] [Indexed: 11/09/2022]
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Bybee AK, Lachmann H, Omoyinmi E, Nedjai B, Woo P, Lane T, Savic S, Hawkins P, McDermott M. PW02-031 - Genetic and clinical manifestations of CAPS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952365 DOI: 10.1186/1546-0096-11-s1-a172] [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: 11/16/2022] Open
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Rowczenio DM, Trojer H, Wang G, Hawkins PN, Lachmann HJ, Baginska A, Russell T, Al-Nackkash R, Bybee A, Stewart NM, Lane T. PW02-030 - Clinical phenotype in individuals with Q703K. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952438 DOI: 10.1186/1546-0096-11-s1-a171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lachmann HJ, Stewart N, Lane T, Rowczenio DM, Hawkins PN. P03-017 - Health related quality of life in adult with HRFS. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952217 DOI: 10.1186/1546-0096-11-s1-a215] [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: 11/20/2022] Open
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Lane T, Stewart NM, Bybee A, Rowczenio DM, Wynne K, Trojer H, Baginska A, Brogan PA, Hawkins PN, Lachmann HJ. PW03-020 – A decade of ANTI-IL-1 therpay for CAPS in the UK. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952221 DOI: 10.1186/1546-0096-11-s1-a246] [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: 11/15/2022] Open
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Lachmann HJ, Rowczenio DM, Gilbertson JA, Gillmore JD, Wechalekar AD, Lane T, Hawkins PN. PW01-021 – The phenotype of FMF due to deletion M694. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952104 DOI: 10.1186/1546-0096-11-s1-a74] [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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Lachmann H, Gillmore J, Wechalekar A, Gibbs S, Pinney J, Rowczenio D, Trojer H, Lane T, Venner C, Banypersad S, Gilbertson J, Hunt F, Gopaul D, Hutt D, Wassef N, Pepys M, Hawkins P. THU0379 A 20 year single centre experience of aa amyloidosis demonstrating changes in its epidemiology. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2344] [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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Harling L, Sepehripour AH, Ashrafian H, Lane T, Jarral O, Chikwe J, Dion RAE, Athanasiou T. Surgical patch angioplasty of the left main coronary artery. Eur J Cardiothorac Surg 2012; 42:719-27. [PMID: 22677352 DOI: 10.1093/ejcts/ezs324] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Isolated ostial stenosis of the left main coronary artery (LMCA) is rare, occurring in <1% of the patients undergoing coronary angiography. Surgical patch angioplasty (SPA) offers an alternative to conventional coronary artery bypass grafting (CABG) in such cases and is advantageous in restoring more physiological myocardial perfusion, maintaining ostial patency and preserving conduit material. However, a number of early technical failures and high perioperative mortality have limited the generalized uptake of this procedure, and only recently have advances in myocardial protection and novel surgical approaches to the LMCA resulted in a resurgence of the technique. A systematic literature search identified 45 studies incorporating 478 patients undergoing SPA. A variety of patch materials were used, including the pericardium, saphenous vein and internal mammary and pulmonary arteries. Patients were followed up for a mean of 54.4 months. The 30-day mortality was 1.7% and cardiac specific mortality 3.3% at last follow-up. Encouragingly, 92.4% of reported cases (n = 182) showed complete angiographic patency at last follow-up. Our results indicate that SPA may be a viable alternative to CABG in the surgical management of isolated ostial LMCA stenosis. However, no randomized trials have been performed, and it is clear that careful patient selection is essential in minimizing morbidity and mortality in the short- and long-term. Further research is required to allow a direct comparison of SPA to techniques with a more substantial evidence base such as CABG and percutaneous coronary intervention, and to define the optimal patch graft material, elucidating that any beneficial effects arterial patches may have on long-term patency.
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Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer , Imperial College Healthcare NHS Trust, Imperial College London, London, UK.
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Thapar A, Lane T, Nicholas R, Friede T, Ellis M, Assenheim J, Franklin IJ, Davies AH. Systematic review of sonographic chronic cerebrospinal venous insufficiency findings in multiple sclerosis. Phlebology 2011; 26:319-25. [PMID: 22021635 DOI: 10.1258/phleb.2011.011098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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 The sonographic findings of chronic cerebrospinal venous insufficiency (CCSVI) are used by some as selection criteria for venography. We performed a systematic review to establish the prevalence and strength of association between sonographic CCSVI and multiple sclerosis (MS). METHOD Two reviewers searched PubMed and EMBASE from 1948 to date using the keywords 'chronic cerebrospinal venous insufficiency' according to PRISMA guidelines. RESULTS Four cross-sectional studies met the criteria for inclusion. The prevalence of CCSVI ranged from 7% to 100% in MS patients and from 2% to 36% in healthy controls. Diagnostic odds ratios for MS varied between 2 and 26, 499 (I(2) = 94%). Sensitivities of CCSVI for MS varied between 7% and 100% (I(2) = 98%). Specificities varied between 64% and 100% (I(2) = 95%). CONCLUSION There is substantial variation in the strength of association between CCSVI and MS beyond that explained by demographic differences or sonographer training. Reliable evidence on which to base decisions requires sonographic consensus and assessment of the reproducibility of individual criteria between trained sonographers.
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Affiliation(s)
- A Thapar
- Imperial College London, London UK.
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