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Gartrell BD, Hunter S, Collen R, Jolly M, McInnes K, Richardson A, Reed C, Ward R, Pita A. Health impacts of poor water quality on an endangered shorebird breeding programme in Aotearoa New Zealand. N Z Vet J 2024; 72:103-111. [PMID: 37752889 DOI: 10.1080/00480169.2023.2263425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
CASE HISTORY Two clusters of mortality among endangered tūturuatu/tchūriwat'/shore plover (Thinornis novaeseelandiae) have occurred at captive breeding facilities around New Zealand in recent years. In the first, four chicks died at Pūkaha National Wildlife Centre (Mount Bruce, NZ) in February 2016, and in the second five adult birds at the Cape Sanctuary (Cape Kidnappers, NZ) died in 2022. CLINICAL FINDINGS In 2016, four chicks were noted to become weak, have increased vocalisations and closed eyes prior to death. The remaining chicks were treated for 5 days with amoxycillin/clavulanate orally twice daily. Water containers and brooders were cleaned and disinfected with chlorhexidine. No further mortality was seen.In the 2022 cluster, three adult breeding birds died acutely and five others showed inappetence, weight loss and diarrhoea approximately 10 days after heavy rains flooded the local river. The five birds were treated with amoxycillin/clavulanate orally twice daily and oral fluids for 5 days. Two birds died and three survived. No breeding occurred in the aviaries in the following season. PATHOLOGICAL FINDINGS In 2016, the chicks showed pulmonary changes ranging from congestion and oedema to heterophilic inflammation consistent with septicaemia.In 2022, the adult birds showed proliferation of bacteria in the distal small intestine associated with mucosal ulceration and heterophilic infiltration. Acid-fast staining of the caecal contents in one bird showed organisms consistent with Cryptosporidium spp. LABORATORY FINDINGS Aerobic bacterial cultures of the lung and liver of two affected chicks carried out in 2016 showed heavy growth of Plesiomonas shigelloides. The same organism was cultured from water trays and holding tanks containing water boatmen (Sigara arguta) on which the chicks were fed.In 2022, cultures from the livers of three dead birds each showed a mixed bacterial growth with differing dominant organisms (Aeromonas sobria, Hafnia alvei, Citrobacter freundii and an Enterococcus sp.). PCR and sequencing confirmed Cryptosporidium parvum in the caecum of one bird. Fresh faeces from 24 breeding birds from the captive breeding facilities were negative by PCR for Cryptosporidium spp.The captive breeding facilities obtain water for the aviaries and aquatic invertebrates to feed to the chicks from local freshwater sources. Water quality testing at the Cape Sanctuary revealed concentrations of faecal indicator bacteria in excess of safe drinking water guidelines, with peaks following heavy rainfall. CLINICAL RELEVANCE Fluctuations in water quality associated with mammalian faecal bacteria can adversely affect bird health and impact on captive rearing of endangered wildlife.
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Affiliation(s)
- B D Gartrell
- Wildbase, Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - S Hunter
- Wildbase, Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - R Collen
- Department of Conservation, Invercargill, New Zealand
| | - M Jolly
- Wildbase, Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - K McInnes
- Department of Conservation, Wellington, New Zealand
| | - A Richardson
- The Isaac Conservation and Wildlife Trust, Harewood, Christchurch, New Zealand
| | - C Reed
- Pūkaha National Wildlife Centre, Mount Bruce, New Zealand
| | - R Ward
- The Cape Sanctuary, Cape Kidnappers, Hawkes Bay, New Zealand
| | - A Pita
- Molecular Epidemiology and Public Health Laboratory, Hopkirk Research Institute, Massey University, Palmerston North, New Zealand
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Ng SK, Shiue K, Shah M, Richardson A, Miller JC, Yue Y. Dosimetric Impact of Seed Segmentation in GammaTile Surgically Targeted Radiation Therapy for Gliomas and Brain Metastases Cases. Int J Radiat Oncol Biol Phys 2023; 117:e140. [PMID: 37784712 DOI: 10.1016/j.ijrobp.2023.06.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the variability of dose reporting variability due to uncertainty in segmentation of Cs-131 seeds in GammaTile therapy for gliomas and brain metastases. MATERIALS/METHODS Ten patients with either glioma or brain metastases had 4-11 GammaTiles placed along resection bed during craniotomy. A dose of 60 Gy is prescribed to 5 mm depth. Each GammaTile has four Cs-131 seeds imbedded in a biodegradable collagen sponge. GammaTile Post-Op workflow in MIM Symphony software is used for post-implant dose evaluation and reporting. This workflow requires a post-surgery CT to identify seeds, and a post-surgery MR for residual disease and OAR contours. Seeds are segmented using a threshold tool. Threshold levels may change depending on the CT used, thus users need to manually change the HU threshold value in each data set. Since GammaTiles are lined along the resection bed, PTVs are generated automatically by adding 8 mm expansion on the seed contours and later combined with residual disease contours. We simulate the seed contour uncertainty by applying -0.5 mm, -1.0 mm, +0.5 mm & +1.0 mm concentric margins to the current seed contours to create 4 new seed contours per patient. New PTVs are generated by adding 8 mm expansion on the new seed contours combined with residual disease contours. PTV volume, PTV volume receiving 100% and 150% of prescription dose (V100, V150), and percentage of the prescription dose received by 90% of the PTV (D90) are calculated to evaluate dose reporting variability due to seed segmentation uncertainty. RESULTS Mean PTV volume decreases by 8.4 cc & 10.2 cc for PTVs generated from seed contours with -0.5 mm & -1.0 mm margin, respectively, and increases by 5.8 cc & 8.2 cc, respectively, when +0.5 mm & +1 mm margins are applied to the original seed contours. We observe up to 10% change in V100 due to seed segmentation uncertainty. Mean V100 increases by 4.0% (range: 0.2% - 8.9%) & 4.9% (range: 0.5% - 11.0%) for cases with -0.5 m & -1.0 mm seed margin, respectively, and reduces by 4.2% (range: 0.5% - 6.7%) & 5.9% (range: 0.6% - 10.4%) for cases with +0.5 mm and +1.0 mm seed margin, respectively. Mean D90 increases by 7.7% (range: 4.0% - 12.6%) & 9.9% (range: 4.0% - 17.4%) for cases with -0.5 m & -1.0 mm seed margin, respectively, and reduces by 5.5% (range: 3.6% - 7.8%) & 7.4% (range: 5.2% - 9.6%) for cases with +0.5 mm and +1.0 mm seed margin, respectively. We also observe up to 8.0% changes in mean V150 when margins are applied to the seed contours. CONCLUSION Our results show significant impact of seed segmentation uncertainty on dose reporting in GammaTile therapy. Variability in dose reporting parameters highlight the need for a more standardized and automated approach to seed segmentation to ensure consistent and accurate dose reporting. The current manual threshold adjustment method is subject to user dependence and therefore unreliable. Development of a more robust tool could help to minimize variability and improve reliability of dose reporting.
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Affiliation(s)
- S K Ng
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - K Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - M Shah
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - A Richardson
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - J C Miller
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Y Yue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
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Pollock N, Macpherson PC, Staunton CA, Hemmings K, Davis CS, Owen ED, Vasilaki A, Van Remmen H, Richardson A, McArdle A, Brooks SV, Jackson MJ. Deletion of Sod1 in Motor Neurons Exacerbates Age-Related Changes in Axons and Neuromuscular Junctions in Mice. eNeuro 2023; 10:ENEURO.0086-22.2023. [PMID: 36810149 PMCID: PMC10026931 DOI: 10.1523/eneuro.0086-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/23/2023] Open
Abstract
Whole-body knock-out of Cu,Zn superoxide dismutase (Sod1KO) results in accelerated, age-related loss of muscle mass and function associated with neuromuscular junction (NMJ) breakdown similar to sarcopenia. In order to determine whether altered redox in motor neurons underlies this phenotype, an inducible neuron-specific deletion of Sod1 (i-mnSod1KO) was compared with wild-type (WT) mice of different ages (adult, mid-age, and old) and whole-body Sod1KO mice. Nerve oxidative damage, motor neuron numbers and structural changes to neurons and NMJ were examined. Tamoxifen-induced deletion of neuronal Sod1 from two months of age. No specific effect of a lack of neuronal Sod1 was seen on markers of nerve oxidation (electron paramagnetic resonance of an in vivo spin probe, protein carbonyl, or protein 3-nitrotyrosine contents). i-mnSod1KO mice showed increased denervated NMJ, reduced numbers of large axons and increased number of small axons compared with old WT mice. A large proportion of the innervated NMJs in old i-mnSod1KO mice displayed a simpler structure than that seen in adult or old WT mice. Thus, previous work showed that neuronal deletion of Sod1 induced exaggerated loss of muscle in old mice, and we report that this deletion leads to a specific nerve phenotype including reduced axonal area, increased proportion of denervated NMJ, and reduced acetyl choline receptor complexity. Other changes in nerve and NMJ structure seen in the old i-mnSod1KO mice reflect aging of the mice.
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Affiliation(s)
- N Pollock
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - P C Macpherson
- Molecular and Integrative Physiology, University of Michigan, Ann Arbor, 48109 MI
| | - C A Staunton
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - K Hemmings
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - C S Davis
- Molecular and Integrative Physiology, University of Michigan, Ann Arbor, 48109 MI
| | - E D Owen
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - A Vasilaki
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - H Van Remmen
- Oklahoma Medical Research Foundation (OMRF), Oklahoma City, 73104, OK
| | - A Richardson
- University of Oklahoma Health Science Center (OUHSC), Oklahoma City, 73104, OK
| | - A McArdle
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
| | - S V Brooks
- Molecular and Integrative Physiology, University of Michigan, Ann Arbor, 48109 MI
| | - M J Jackson
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, and MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Liverpool, L7 8TX, UK
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Richardson A, Maini A, Richardson K, Shah K, Brent H, Boateng J, Bokhari A, Kumar J, Jalaeian H, Bhatia S. Abstract No. 288 Prostate Artery Embolization in Prostate Glands Greater than 80 g: A Single Center Experience. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.355] [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: 02/26/2023] Open
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Richardson A, Richardson K, Shah K, Maini A, Aldajani M, Romeus L, Hall D, Bhatia A, Kumar J, Jalaeian H, Bhatia S. Abstract No. 284 Comparison of PAE for BPH on Prostate Gland Size <80 g versus >80 g: Retrospective Review of Short-Term to Mid-Term Outcomes in a Single Center. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.351] [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: 02/27/2023] Open
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Richardson A, Shah K, Maini A, Richardson K, Aldajani M, Boateng J, Bhatia A, Sanan A, Jalaeian H, Bhatia S. Abstract No. 599 Comparison of Safety and Feasibility of Prostate Artery Embolization via Transradial Access versus Transfemoral Access: A Single-Center Experience. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.457] [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: 02/26/2023] Open
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Richardson A, Maini A, Richardson K, Shah K, Bhatia A, Reddy R, Sanan A, Kumar J, Jalaeian H, Bhatia S. Abstract No. 3 ▪ ABSTRACT OF THE YEAR Prostate Artery Embolization—Single-Center Experience of 1,000 Patients with Short-, Mid- and Long-Term Follow-Up. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.041] [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: 02/27/2023] Open
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Paniccia A, Polanco PM, Boone BA, Wald AI, McGrath K, Brand RE, Khalid A, Kubiliun N, O'Broin-Lennon AM, Park WG, Klapman J, Tharian B, Inamdar S, Fasanella K, Nasr J, Chennat J, Das R, DeWitt J, Easler JJ, Bick B, Singh H, Fairley KJ, Sarkaria S, Sawas T, Skef W, Slivka A, Tavakkoli A, Thakkar S, Kim V, Vanderveldt HD, Richardson A, Wallace MB, Brahmbhatt B, Engels M, Gabbert C, Dugum M, El-Dika S, Bhat Y, Ramrakhiani S, Bakis G, Rolshud D, Millspaugh G, Tielleman T, Schmidt C, Mansour J, Marsh W, Ongchin M, Centeno B, Monaco SE, Ohori NP, Lajara S, Thompson ED, Hruban RH, Bell PD, Smith K, Permuth JB, Vandenbussche C, Ernst W, Grupillo M, Kaya C, Hogg M, He J, Wolfgang CL, Lee KK, Zeh H, Zureikat A, Nikiforova MN, Singhi AD. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology 2023; 164:117-133.e7. [PMID: 36209796 PMCID: PMC9844531 DOI: 10.1053/j.gastro.2022.09.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Next-generation sequencing (NGS) of pancreatic cyst fluid is a useful adjunct in the assessment of patients with pancreatic cyst. However, previous studies have been retrospective or single institutional experiences. The aim of this study was to prospectively evaluate NGS on a multi-institutional cohort of patients with pancreatic cyst in real time. METHODS The performance of a 22-gene NGS panel (PancreaSeq) was first retrospectively confirmed and then within a 2-year timeframe, PancreaSeq testing was prospectively used to evaluate endoscopic ultrasound-guided fine-needle aspiration pancreatic cyst fluid from 31 institutions. PancreaSeq results were correlated with endoscopic ultrasound findings, ancillary studies, current pancreatic cyst guidelines, follow-up, and expanded testing (Oncomine) of postoperative specimens. RESULTS Among 1933 PCs prospectively tested, 1887 (98%) specimens from 1832 patients were satisfactory for PancreaSeq testing. Follow-up was available for 1216 (66%) patients (median, 23 months). Based on 251 (21%) patients with surgical pathology, mitogen-activated protein kinase/GNAS mutations had 90% sensitivity and 100% specificity for a mucinous cyst (positive predictive value [PPV], 100%; negative predictive value [NPV], 77%). On exclusion of low-level variants, the combination of mitogen-activated protein kinase/GNAS and TP53/SMAD4/CTNNB1/mammalian target of rapamycin alterations had 88% sensitivity and 98% specificity for advanced neoplasia (PPV, 97%; NPV, 93%). Inclusion of cytopathologic evaluation to PancreaSeq testing improved the sensitivity to 93% and maintained a high specificity of 95% (PPV, 92%; NPV, 95%). In comparison, other modalities and current pancreatic cyst guidelines, such as the American Gastroenterology Association and International Association of Pancreatology/Fukuoka guidelines, show inferior diagnostic performance. The sensitivities and specificities of VHL and MEN1/loss of heterozygosity alterations were 71% and 100% for serous cystadenomas (PPV, 100%; NPV, 98%), and 68% and 98% for pancreatic neuroendocrine tumors (PPV, 85%; NPV, 95%), respectively. On follow-up, serous cystadenomas with TP53/TERT mutations exhibited interval growth, whereas pancreatic neuroendocrine tumors with loss of heterozygosity of ≥3 genes tended to have distant metastasis. None of the 965 patients who did not undergo surgery developed malignancy. Postoperative Oncomine testing identified mucinous cysts with BRAF fusions and ERBB2 amplification, and advanced neoplasia with CDKN2A alterations. CONCLUSIONS PancreaSeq was not only sensitive and specific for various pancreatic cyst types and advanced neoplasia arising from mucinous cysts, but also reveals the diversity of genomic alterations seen in pancreatic cysts and their clinical significance.
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Affiliation(s)
- Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Patricio M Polanco
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Brian A Boone
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Abigail I Wald
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Randall E Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Nisa Kubiliun
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne Marie O'Broin-Lennon
- The Sol Goldman Pancreatic Cancer Research Center, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Walter G Park
- Department of Medicine, Stanford University, Stanford, California
| | - Jason Klapman
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Benjamin Tharian
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sumant Inamdar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kenneth Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Nasr
- Department of Medicine, Wheeling Hospital, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Jeffrey J Easler
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Benjamin Bick
- Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kimberly J Fairley
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tarek Sawas
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wasseem Skef
- Department of Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Medical Center, Loma Linda, California
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anna Tavakkoli
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shyam Thakkar
- Department of Medicine, Section of Gastroenterology & Hepatology, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Victoria Kim
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Michael B Wallace
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida; Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Bhaumik Brahmbhatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Megan Engels
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Charles Gabbert
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mohannad Dugum
- Digestive Health Center, Essentia Health-Duluth Clinic, Duluth, Minnesota
| | - Samer El-Dika
- Department of Medicine, Stanford University, Stanford, California
| | - Yasser Bhat
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | - Sanjay Ramrakhiani
- Department of Gastroenterology, Palo Alto Medical Foundation (PAMF), Mountain View, California
| | | | | | | | - Thomas Tielleman
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carl Schmidt
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - John Mansour
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barbara Centeno
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Sara E Monaco
- Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth D Thompson
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Phoenix D Bell
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Katelyn Smith
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer B Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christopher Vandenbussche
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wayne Ernst
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria Grupillo
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Cihan Kaya
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Hogg
- Department of Surgery, NorthShore University Health System, Chicago, Illinois
| | - Jin He
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher L Wolfgang
- The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, Texas
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C, Matthée E, Slootmans CAM, Ultee G, Schouten J, Gisbertz SS, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, van Etten B, Poelmann F, Vuurberg N, van den Berg JW, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TCM, van Esser S, Dekker JWT, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JWA, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CMS, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RPR, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJE, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MAH, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Silviu C, Rodica B, Florin A, Cristian Gelu R, Petre H, Guevara Castro R, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Abdelkarem Ahmed H, Elhadi A, Elnagar FA, Msherghi AAA, Wills V, Campbell C, Perez Cerdeira M, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Adelino Barbosa J, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZL, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler MI, Schofield WA, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Leturio Fernández S, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Abdullah Ben Taher F, Ekheel M, Msherghi AAA. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
Methods
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
Results
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
Conclusion
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT hospital group , Almelo , the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK
| | - Jan W Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands
| | - Renol Koshy
- Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands
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Richardson A, Kumar J, Pennix T, Richardson K, Esses E, Bysani K, Amin A, Sandhu J, Jalaeian H, Bhatia S. Abstract No. 65 Prostate artery embolization: single-center experience of 807 patients with 6 years of follow-up. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.146] [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] Open
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Kumar J, Richardson A, Pennix T, Amin A, Bokhari A, Esses E, Aldajani M, Richardson K, Jalaeian H, Bhatia S. Abstract No. 67 Prostate artery embolization in patients with prostate glands greater than 80 g: a single-center experience with 5 years of follow-up. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kumar J, Richardson A, Pennix T, Aldajani M, Amin A, Sandhu J, Bysani K, Richardson K, Jalaeian H, Bhatia S. Abstract No. 64 Prostate artery embolization in prostate size less than 80 g: a single-center experience with 5 years of follow-up. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.145] [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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Kumar J, Richardson A, Richardson K, Sandhu J, Bysani K, Aldajani M, Esses E, Bokhari A, Jalaeian H, Bhatia S. Abstract No. 68 Comparison of prostate artery embolization for benign prostatic hyperplasia on prostate gland size less than 80 g versus greater than 80 g: retrospective review of short and mid-term outcomes. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.149] [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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Richardson A, Kumar J, Pennix T, Richardson K, Bokhari A, Aldajani M, Bysani K, Esses E, Jalaeian H, Bhatia S. Abstract No. 63 Effect of prostatic artery embolization on reduction or cessation of preprocedural benign prostatic hypertrophy medication: single-center experience. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.144] [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] Open
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Pennix T, Richardson A, Richardson K, Kumar J, Bokhari A, Aldajani M, Amin A, Sandhu J, Jalaeian H, Bhatia S. Abstract No. 70 Radiation exposure reduction with operator experience in prostatic artery embolization: a single-institution study. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.151] [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] Open
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Watson S, Saleem A, Sathianathan V, Richardson A, Lucas N. P.85 Severe SARS-CoV-2 in pregnancy. Int J Obstet Anesth 2022. [PMCID: PMC9060824 DOI: 10.1016/j.ijoa.2022.103381] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Edwards K, Watson S, Lucas N, Vaughan D, Richardson A. P.34 A comparison of physical characteristics of videolaryngoscopes. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103330] [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: 11/25/2022]
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Watson S, Vakil B, Lucas N, Richardson A. P.37 Ten years’ experience of videolaryngoscopy on the labour ward. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103333] [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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Abstract
OBJECTIVES Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. STUDY DESIGN A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. MAIN OUTCOME MEASURES Overall (OS), disease specific (DSS) and progression free (PFS) survival. RESULTS A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. CONCLUSION In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.
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Affiliation(s)
- A Richardson
- Department of Gynaecology, 4490University Hospitals of Leicester NHS Trust, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L Watson
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - M Persic
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - A Phillips
- Derby Gynaecological Cancer Centre, 2102University Hospitals of Derby and Burton NHS Foundation Trust, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Richardson A, Acharya V, Kumar J, Jalaeian H, Kably I, Bhatia S. Abstract No. 59 Prostate artery embolization in prostate size larger than 80 g: a single-center experience with 5-year follow up. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Richardson A, Acharya V, Kumar J, Jalaeian H, Kably I, Bhatia S. Abstract No. 57 ▪ FEATURED ABSTRACT Prostate artery embolization: single-center experience of 576 patients with 5 years’ follow-up. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Richardson A, Acharya V, Kumar J, Jalaeian H, Kably I, Bhatia S. Abstract No. 62 Safety and feasibility of prostate artery embolization via transradial access: a single-center experience. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Diabetes following acute pancreatitis (AP) is becoming increasingly recognized. It is unclear what subtype of diabetes mellitus (DM) occurs; however, type 3c diabetes mellitus (T3cDM) is gaining increasing recognition. T3cDM has differing pathophysiology than other subtypes of DM and therefore differing disease course and treatment. Current studies have examined the incidence and prevalence of DM following AP, and meta-analyses have shown around 15% develop DM at 1 year with an increasing proportion developing DM at 5 years. It has been observed that some patients have transient hyperglycemia following AP episode with a subset developing persistent impaired glucose metabolism; however, the exact timeline is not well defined. The data on risk factors for developing DM after AP is limited and mixed; however, it is likely that severity of AP may impact the propensity to develop DM. Screening guidelines have not been established following AP; however, screening 1-year post-event will likely capture a sizable proportion of newly developed DM. The endocrine and exocrine pancreas are closely linked, and studies have found significant overlap in dysfunction of both after AP. Finally, there are some data to suggest that diabetes predisposes patients to structural changes in the pancreas and increased risk of developing AP.
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Affiliation(s)
- Allyson Richardson
- Department of Internal Medicine, Stanford University Medical Center, Stanford, CA,
USA
| | - Walter G. Park
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA,
USA
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Roth B, Jouve E, Daguzan A, Richardson A, Sambuc R, Bernard O, Lagouanelle-Simeoni MC. Descriptive study of young disabled children aged 2-6, enrolled in mainstream schools, and benefiting from special needs assistants in the Bouches-du-Rhône in 2014. Arch Pediatr 2020; 28:39-46. [PMID: 33309119 DOI: 10.1016/j.arcped.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 06/22/2020] [Accepted: 10/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2-6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhône (France) in 2014. METHODS A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health. RESULTS Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%). CONCLUSION This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.
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Affiliation(s)
- B Roth
- Service d'évaluation médicale, APHM, Hôpital Conception, 13005 Marseille, France.
| | - E Jouve
- Service d'évaluation médicale, APHM, Hôpital Conception, 13005 Marseille, France
| | - A Daguzan
- Service d'évaluation médicale, APHM, Hôpital Conception, 13005 Marseille, France; Aix Marseille Université, Laboratoire de Psychologie Sociale (LPS), 13100 Aix-en-Provence, France
| | - A Richardson
- MDPH (Maison Départementale des Personnes Handicapées), Conseil Général des Bouches-du-Rhône, 4, quai d'Arenc, 13304 Marseille, France
| | - R Sambuc
- Aix Marseille Université, CEReSS (Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie), 13385 Marseille, France
| | - O Bernard
- PMI (Protection Maternelle et Infantile), Conseil Départemental des Bouches-du-Rhône, 4, quai d'Arenc, 13304 Marseille, France
| | - M C Lagouanelle-Simeoni
- Service d'évaluation médicale, APHM, Hôpital Conception, 13005 Marseille, France; Aix Marseille Université, Laboratoire de Psychologie Sociale (LPS), 13100 Aix-en-Provence, France
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Wamamili B, Wallace-Bell M, Richardson A, Grace RC, Coope P. Associations of mental illness with smoking and vaping in university students in New Zealand. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People with mental illness have higher smoking prevalence, and vaping is generally higher among smokers than non-smokers. However, data on associations of mental illness with smoking and vaping in New Zealand (NZ) is lacking. This study examines associations of history of mental illness (HMI) with smoking and vaping in NZ university students.
Methods
Data came from a March 2018 national cross-sectional study. χ2 tests compared patterns of smoking and vaping in students with and without HMI. An HMI was defined as a diagnosis, or treatment for depression, anxiety or nervous disorder, or other mental health condition in the previous 12 months. Logistic regression model assessed the association of an HMI with smoking and vaping.
Results
1622 students were included: 82.7% aged <25 years, 17.3% ≥25 years; 38.6% male, 61.4% female; 7.8% Māori, 92.2% non-Māori; 18.1% reported an HMI. Of respondents, 50.5% (95% CI 48.0-53.0) reported ever, 10.0% (8.6-11.6) current and 5.0% (4.0-6.2) daily smoking. Students with HMI were significantly more likely to report ever (p<.001), current (p=.008) and daily smoking (p=.014) than those without HMI. 36.7% (34.3-39.1) of students reported ever, 6.7% (5.5-8.0) current and 2.5% (1.8-3.4) daily vaping. Students with HMI were significantly more likely to report ever (p<.001), current (p=.002) and daily vaping (p=.022) than those without HMI. The full model containing all predictors was statistically significant, χ2 (5, N = 1621) = 34.843, p < .001. Female gender: OR 0.55 (0.41-0.73); current smoking: OR 1.76 (1.19-2.60), and current vaping: OR 2.07 (1.32-3.25) were significantly associated with an HMI.
Conclusions
There were strong associations between an HMI and smoking and vaping (controlling for age, gender, ethnicity). These findings extend earlier work on the relationship between smoking and mental illness by demonstrating similar associations in university students, and generate new information on HMI and vaping.
Key messages
Significant numbers of students may have an HMI. Students with an HMI have higher prevalence of smoking and vaping than students without an HMI.
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Affiliation(s)
- B Wamamili
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - M Wallace-Bell
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - A Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - R C Grace
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - P Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
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Fox B, Kumar J, Stover B, Acharya V, Richardson A, Ayyagari R, Kably I, Bhatia S. 3:27 PM Abstract No. 65 Prostate artery embolization in prostate size greater than 80 g: a single-center experience with 2-year follow-up. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.090] [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] Open
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Kumar J, Richardson A, Shah V, Miller Z, Kably M, Bhatia S. 3:36 PM Abstract No. 66 Prostate artery embolization for patients with prostates size smaller than 50 g: a single-center experience with 1-year follow-up. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Richardson A. Abstract CS1-1: Origins and Clinical Implications of HER2 Heterogeneity. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-cs1-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The presentation will describe the types of HER2 heterogeneity and how it is identified pathologically including case examples and molecular studies. The implications for treatment decisions and for its possible role in patient outcomes will also be discussed.
Citation Format: A Richardson. Origins and Clinical Implications of HER2 Heterogeneity [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr CS1-1.
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Barnes DKA, Morley SA, Bell J, Brewin P, Brigden K, Collins M, Glass T, Goodall-Copestake WP, Henry L, Laptikhovsky V, Piechaud N, Richardson A, Rose P, Sands CJ, Schofield A, Shreeve R, Small A, Stamford T, Taylor B. Marine plastics threaten giant Atlantic Marine Protected Areas. Curr Biol 2019; 28:R1137-R1138. [PMID: 30300595 DOI: 10.1016/j.cub.2018.08.064] [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] [Indexed: 10/28/2022]
Abstract
There has been a recent shift in global perception of plastics in the environment, resulting in a call for greater action. Science and the popular media have highlighted plastic as an increasing stressor [1,2]. Efforts have been made to confer protected status to some remote locations, forming some of the world's largest Marine Protected Areas, including several UK overseas territories. We assessed plastic at these remote Atlantic Marine Protected Areas, surveying the shore, sea surface, water column and seabed, and found drastic changes from 2013-2018. Working from the RRS James Clark Ross at Ascension, St. Helena, Tristan da Cunha, Gough and the Falkland Islands (Figure 1A), we showed that marine debris on beaches has increased more than 10 fold in the past decade. Sea surface plastics have also increased, with in-water plastics occurring at densities of 0.1 items m-3; plastics on seabeds were observed at ≤ 0.01 items m-2. For the first time, beach densities of plastics at remote South Atlantic sites approached those at industrialised North Atlantic sites. This increase even occurs hundreds of meters down on seamounts. We also investigated plastic incidence in 2,243 animals (comprising 26 species) across remote South Atlantic oceanic food webs, ranging from plankton to seabirds. We found that plastics had been ingested by primary consumers (zooplankton) to top predators (seabirds) at high rates. These findings suggest that MPA status will not mitigate the threat of plastic proliferation to this rich, unique and threatened biodiversity.
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Affiliation(s)
| | - S A Morley
- British Antarctic Survey, NERC, Cambridge, UK
| | - J Bell
- Centre for Environment, Fisheries and Aquaculture Science, Lowestoft, UK
| | - P Brewin
- South Atlantic Environment Research Institute, Stanley, Falkland Islands
| | - K Brigden
- South Atlantic Environment Research Institute, Stanley, Falkland Islands
| | - M Collins
- Centre for Environment, Fisheries and Aquaculture Science, Lowestoft, UK
| | - T Glass
- Tristan da Cunha Conservation Department, Edinburgh, UK Overseas Territory
| | | | - L Henry
- Marine Conservation, ENRD, St. Helena Government
| | - V Laptikhovsky
- Centre for Environment, Fisheries and Aquaculture Science, Lowestoft, UK
| | | | - A Richardson
- Ascension Island Conservation and Fisheries Department
| | - P Rose
- Pristine Seas, National Geographic Society, Washington DC, USA
| | - C J Sands
- British Antarctic Survey, NERC, Cambridge, UK
| | - A Schofield
- Royal Society for the Protection of Birds, Sandy, UK
| | - R Shreeve
- Marine Conservation, ENRD, St. Helena Government
| | - A Small
- Marine Conservation, ENRD, St. Helena Government
| | - T Stamford
- Centre for Environment, Fisheries and Aquaculture Science, Lowestoft, UK
| | - B Taylor
- St. Helena National Trust, Jamestown, St. Helena
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Sodergren SC, Wheelwright SJ, Permyakova NV, Patel M, Calman L, Smith PWF, Din A, Richardson A, Fenlon D, Winter J, Corner J, Foster C. Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life-results from the ColoREctal Wellbeing (CREW) study. J Cancer Surviv 2019; 13:899-909. [PMID: 31512164 PMCID: PMC6881415 DOI: 10.1007/s11764-019-00805-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate unmet needs of patients with colorectal cancer (CRC) at the end of treatment and whether unmet needs improve over time. Identify predictors of need following treatment and whether unmet need is associated with worse health-related quality of life (HRQoL). Methods As part of the UK ColoREctal Wellbeing (CREW) cohort study, patients treated for CRC completed the Supportive Care Needs Survey Short Form-34 (SCNS SF-34) 15 and 24 months following surgery, along with questionnaires measuring HRQoL, wellbeing, life events, social support, and confidence to manage their cancer before surgery, 3, 9, 15, and 24 months post-surgery. Results The SCNS SF-34 was completed by 526 patients at 15 months and 510 patients at 24 months. About one-quarter of patients had at least one moderate or severe unmet need at both time points. Psychological and physical unmet needs were the most common and did not improve over time. Over 60% of patients who reported 5 or more moderate or severe unmet needs at 15 months experienced the same level of unmet need at 24 months. HRQoL at the beginning of treatment predicted unmet needs at the end of treatment. Unmet needs, specifically physical, psychological, and health system and information needs, were associated with poorer health and HRQoL at the end of treatment. Conclusions Unmet needs persist over time and are associated with HRQoL. Evaluation of HRQoL at the start of treatment would help inform the identification of vulnerable patients. Assessment and care planning in response to unmet needs should be integrated into person-centred care. Implications for Cancer Survivors Early identification of CRC patients at risk of unmet needs will help infrom personalised survivorship care plans. The implementation of personalised and tailored services are likely to confer HRQoL gains. Electronic supplementary material The online version of this article (10.1007/s11764-019-00805-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Sodergren
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - S J Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - N V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - M Patel
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - L Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - P W F Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - A Din
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - A Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Winter
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - C Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK.
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Richardson A, Owens DJ, Ross K. MicroRNA-184 and its long noncoding RNA sponge urothelial carcinoma associated 1 are induced in wounded keratinocytes in a store-operated calcium entry-dependent manner. Br J Dermatol 2019; 180:1533-1534. [PMID: 30597516 DOI: 10.1111/bjd.17576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- A Richardson
- School of Pharmacy and Biomolecular Sciences, Liverpool, U.K
| | - D J Owens
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, U.K
| | - K Ross
- School of Pharmacy and Biomolecular Sciences, Liverpool, U.K
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Bain HDC, Davidson YS, Robinson AC, Ryan S, Rollinson S, Richardson A, Jones M, Snowden JS, Pickering‐Brown S, Mann DMA. The role of lysosomes and autophagosomes in frontotemporal lobar degeneration. Neuropathol Appl Neurobiol 2019; 45:244-261. [PMID: 29790198 PMCID: PMC6487817 DOI: 10.1111/nan.12500] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/08/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cell biological and genetic evidence implicate failures in degrading aggregating proteins, such as tau and TDP-43, through the autophagy or lysosomal pathways in the pathogenesis of frontotemporal lobar degeneration (FTLD). METHODS We investigated changes in the degradative pathways in 60 patients with different pathological or genetic forms of FTLD employing immunohistochemistry for marker proteins such as lysosomal-associated membrane proteins 1 (LAMP-1) and 2 (LAMP-2), cathepsin D (CTSD) and microtubule-associated protein 1 light chain 3 alpha (LC3A). Immunostained sections were qualitatively and semi-quantitatively assessed for the appearance, distribution and intensity of staining in neurones of the dentate gyrus (DG) and CA4 region of the hippocampus, and the temporal cortex (Tcx). RESULTS Lower levels of neuronal LAMP-1 immunostaining were present in the DG and Tcx in FTLD-tau compared to FTLD-TDP. There was less LAMP-1 immunostaining in FTLD-tau with MAPT mutations, and FTLD-tau with Pick bodies, compared to FTLD-TDP types A and B, and less LAMP-1 immunostaining in FTLD-TDP type C than in FTLD-TDP types A and B. There was greater LAMP-1 immunostaining in GRN mutation which may reflect the underlying type A histology rather than mutation. There were no differences in neuronal LAMP-2, CTSD, EEA-1 or LC3A immunostaining between any of the five FTLD histological or four genetic groups, nor between FTLD-TDP and FTLD-tau. CONCLUSIONS The underlying pathological mechanism in FTLD-tau may lie with a relative deficiency of lysosomes, or defective vesicular transport, whereas the failure to clear TDP-43 aggregates may lie with lysosomal dysfunction rather than a lack of available lysosomes or degradative enzymes.
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Affiliation(s)
- H. D. C. Bain
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterSalford Royal HospitalSalfordUK
| | - Y. S. Davidson
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterSalford Royal HospitalSalfordUK
| | - A. C. Robinson
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterSalford Royal HospitalSalfordUK
| | - S. Ryan
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - S. Rollinson
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - A. Richardson
- Cerebral Function UnitGreater Manchester Neurosciences CentreSalford Royal HospitalSalfordUK
| | - M. Jones
- Cerebral Function UnitGreater Manchester Neurosciences CentreSalford Royal HospitalSalfordUK
| | - J. S. Snowden
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterSalford Royal HospitalSalfordUK
- Cerebral Function UnitGreater Manchester Neurosciences CentreSalford Royal HospitalSalfordUK
| | - S. Pickering‐Brown
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - D. M. A. Mann
- Division of Neuroscience and Experimental PsychologySchool of Biological SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterSalford Royal HospitalSalfordUK
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Kably M, Richardson A, Chang Y, Amin A, Bhatia S. 03:27 PM Abstract No. 6 Role of adjunctive embolization of collateral arteries communicating with penile plexus during prostatic artery embolization (PAE). J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sandhu J, Amin A, Kably I, Shah K, Richardson A, Garcia J, Bhatia S. Abstract No. 458 Safety and feasibility of prostate artery embolization via transradial access: single-center experience. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.539] [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] Open
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Kably M, Menon B, Richardson A, Bhatia S. 03:45 PM Abstract No. 127 Bladder artery embolization (BAE) in refractory vesical hematuria of malignant origin. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sandoval Leon AC, Ghanta S, Richardson A, Kesmodel S, Hurley J. Abstract P5-13-03: The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-13-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are disparities in breast cancer (BC) diagnosis. Black and Hispanic women have a lower rate of screening mammography while the uninsured are less likely to seek medical care even if a palpable mass is found in the breast.
Jackson Memorial Hospital is the Safety-Net Hospital that serves the 2.5 million residents of Miami-Dade County which is the most populous county in the State of Florida. The Affordable Care Act (ACA) was signed into law on March 3, 2010 and the goal was to increase the number of insured individuals. In January 2011, it was mandated that health insurance providers cover the cost of screening mammograms. The decision to expand Medicaid was left to the individual states. Florida did not expand Medicaid coverage. Prior to the implementation of the ACA it was estimated that 25-35% of the residents of Miami-Dade County were uninsured or underinsured. By January 2017, more than 1.3 million Floridians had signed up for health insurance through the ACA. Currently almost one in five Americans receiving health coverage via Healthcare.gov or the Spanish language version, CuidadodeSalud.gov, resides in Florida. South Florida is home to the eight congressional districts with the highest concentrations of ACA enrollees in the US. The top 38 zip codes for ACA sign-ups in Florida are in South Florida.
We postulated that evaluating the number of patients diagnosed, the stage at which they are diagnosed and the type of insurance used for the period of time 6 years before (2007-2012) and 4 years after the implementation of the ACA (2014-2017) should give a picture of the effect of the ACA on breast cancer diagnosis in an underserved population.
Methods: A retrospective review of patients diagnosed with invasive and in situ breast cancer at the Breast Diagnostic Center at Jackson Memorial Hospital between 1/1/2007 – 12/31/2017 was approved by the University of Miami IRB. We collected data including: age, stage at diagnosis and type of insurance. In keeping with other similar studies, the year 2013 was excluded since it was a transition period. The trends were compared using ANOVA and chi-squared tests.
Results: A total of 2155 patients were analyzed. The absolute number of patients with stage 0 seen every year remained stable (30 per year) throughout the time period. The percentage of patients with Stage 0 increased from 12.5% to 16.02% (p=0.049).Both the absolute number and percentage of patients with stage IV decreased, from 15 to 8 patients per year (6.42% to 4.12% (p=0.016)). The total number of patients diagnosed yearly with breast cancer decreased from 233 to 186 (p= 0.005). The absolute number and percentage of insured patients increased from 75 to 126 patients per year (23.5% to 38.3% (p= 0.02)).
Conclusions: Fewer patients were diagnosed with breast cancer at the safety net hospital in Miami-Dade County after the initiation of the ACA. More patients had insurance and there was a stage shift towards lower stage at presentation. Availability of insurance to residents of Miami-Dade County decreased the burden on the safety net hospital and resulted in the diagnosis of lower stage breast cancer.
Citation Format: Sandoval Leon AC, Ghanta S, Richardson A, Kesmodel S, Hurley J. The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-03.
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Richardson A, Haridass SA, Ward E, Ayres J, Baskind NE. Investigation and treatment of premature ovarian insufficiency: A multi-disciplinary review of practice. Post Reprod Health 2018; 24:155-162. [PMID: 30392440 DOI: 10.1177/2053369118811233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess compliance with the European Society for Human Reproduction and Embryology (ESHRE) guidelines on the investigation and management of women with premature ovarian insufficiency at the Leeds Teaching Hospitals NHS Trust (LTHT) and to determine whether this varies depending on the clinical setting in which the women present. STUDY DESIGN A retrospective review of all females diagnosed with premature ovarian insufficiency between 1 July 2016 and 30 June 2017, presenting to one of the following clinics: reproductive medicine, specialist menopause, general gynaecology, oncology long-term follow-up, general endocrinology or paediatric endocrinology. MAIN OUTCOME MEASURES Proportion of patients who had the necessary investigations performed and relevant treatment options discussed. RESULTS 103 women were included in the study. Overall, 40.6% had a karyotype. Screening for the Fragile-X pre-mutation, thyroid peroxidase and 21-hydroxylase antibodies occurred in 7.4%, 11.1% and 13.6% of women, respectively. Only 35.9% had their bone mineral density measured. There was significant variation in the performance of a karyotype (p < 0.001) and thyroid peroxidase antibodies (p < 0.01) between the different clinical settings. Overall, lifestyle advice was offered to 30.1%. Estrogen replacement, contraception, fertility options and bone protection were discussed with 76.0%, 38.4%, 59.0% and 75.0%, respectively. Psychological support was offered to 25.2%. There was significant variation for all apart from contraception. CONCLUSION The investigation and treatment of women with premature ovarian insufficiency at the LTHT is not consistent with the ESHRE guidelines and requires improvement. Furthermore, there is significant variation in management depending on the department to which the patient initially presents.
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Affiliation(s)
- A Richardson
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S A Haridass
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Ward
- Department of Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Ayres
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N E Baskind
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Richardson A, Downs M, Blenkinsopp A, Lord K. UK NURSES’ VIEWS ON THEIR ROLE IN HOSPITAL TO CARE HOME TRANSITIONS FOR PEOPLE LIVING WITH DEMENTIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Richardson
- University of Bradford, Bradford, England, United Kingdom
| | - M Downs
- University of Bradford, Bradford, UK
| | | | - K Lord
- University of Bradford, Bradford
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Howard-Jones G, Richardson A, Vassilev I, Fenlon D, Ewings S. The influence of social networks on cancer survivors’ self-management support: A survey analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy341.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Troxel WM, Richardson A, DeSantis A, Ghosh-Dastidar B, Beckman R, Buman M, Hale L, Buysse D, Dubowitz T. 0147 Neighborhood Safety and Crime are Linked with Poorer Sleep Efficiency in Urban, African American Residents. Sleep 2018. [DOI: 10.1093/sleep/zsy061.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - M Buman
- Arizona State University, Phoenix, AZ
| | - L Hale
- Stony Brook University, Stony Brook, NY
| | - D Buysse
- University of Pittsburgh, Pittsburgh, PA
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Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Abstract P1-07-09: Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Everolimus (EVE) plus exemestane (EXE) doubled progression-free survival (PFS) while maintaining quality of life versus EXE alone in postmenopausal women with hormone receptor positive (HR+), HER2-negative metastatic breast cancer (mBC) (BOLERO-2 phase 3; NCT00863655). Pretreatment serum activin A was previously reported as a prognostic factor in first-line hormone therapy (letrozole vs tamoxifen) (Novartis P025) and anti-HER2 mBC (lapatinib vs trastzmab) (CCTG MA.31) trials. Here we investigate the prognostic and predictive ability of activin A in BOLERO-2.
Methods: Activin A levels were determined on pretreatment serum samples using ELISA. Cox-proportional hazards model was used to assess the efficacy of EVE in the activin A low and high subgroups (median cut-point), and the prognostic effect of activin A on PFS and overall survival (OS).
Results: Baseline activin A levels were determined in 513 patients (71% of 725 BOLERO-2 patients randomized 2:1 to EVE+EXE or EXE). Predictive and prognostic signals are shown in the table below
Predictive and prognostic signalsPredictive/PrognosticEnd-pointAct-ivin ATreatmentNEventsMedian PFSHR (95% CI); p valuepredictivePFSHEXE93832.5 (1.5-2.8)-predictivePFSHEVE+EXE1631325.4 (4.1-6.8)0.46 (0.34 - 0.60); <0.0001predictivePFSLEXE89774.2 (2.0 -5.4)-predictivePFSLEVE+EXE1681059.9 (8.1-12.5)0.38 (0.28 - 0.51); <0.0001predictiveOSHEXE936820.1 (13.8-22.6)-predictiveOSHEVE+EXE16312917.7 (15.7-22.3)1.04 (0.78 - 1.40); 0.78predictiveOSLEXE8939NA (34.7-NA)-predictiveOSLEVE+EXE1687241.4 (36.4-NA)1.02 (0.69 - 1.50); 0.93prognosticPFSH 2562154.1 (2.9-4.2)-prognosticPFSL 2571826.9 (6.7-8.5)0.54 (0.45 - 0.66); <0.0001prognosticOSH 25619718.0 (16.5-21.1)-prognosticOSL 25711142.3 (38.5-NA)0.34 (0.27 - 0.42); <0.0001
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In multivariate analysis (including sensitivity to prior hormone therapy and visceral disease), activin A remained a significant independent prognostic factor for PFS and OS [HR 0.57 (0.46-0.69) and 0.34 (0.27-0.43), respectively].
Conclusions: Higher serum activin A was strongly associated with shorter PFS and OS in HR+/HER2- mBC patients. Everolimus was efficacious regardless of serum activin A level. These results are similar to our previous studies in phase 3 trials of letrozole-tamoxifen (Novartis P025), and HER2-targeted therapy, lapatinib vs trastuzmab (CCTG MA.31): pretreatment serum activin A was prognostic for outcome, but was not a predictive factor for treatment arm selection.
Citation Format: Ali SM, Chen D, Ali A, Krecko L, Leitzel K, Vasekar M, Nagabhairu V, Marks E, Polimera H, Richardson A, May M, He W, Patel P, Lavin M, Hofsess S, Sweetman R, Hortobagyi G, Baselga J, Lipton A. Serum activin A and outcomes in HR+ /HER2- metastatic breast cancer patients treated with everolimus: Results from BOLERO-2 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-09.
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Affiliation(s)
- SM Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Chen
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ali
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Krecko
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Leitzel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Vasekar
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - V Nagabhairu
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Marks
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - H Polimera
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Richardson
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M May
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - W He
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - P Patel
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Lavin
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Hofsess
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Sweetman
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Hortobagyi
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Baselga
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Lipton
- Penn State Hershey Medical Center, Hershey, PA; Lebanon VA Medical Center, Lebanon, PA; Novartis Pharmaceutical Corp, East Hanover, NJ; Pinnacle Health System, Harrisburg, PA; R & D Systems, Minneapolis, MN; MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY
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Prior M, Richardson A, Asif S, Polanski L, Parris-Larkin M, Chandler J, Fogg L, Jassal P, Thornton JG, Raine-Fenning NJ. Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study. Ultrasound Obstet Gynecol 2018; 51:110-117. [PMID: 29055072 DOI: 10.1002/uog.18935] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the prevalence of congenital uterine anomalies, including arcuate uterus, and their effect on reproductive outcome in subfertile women undergoing assisted reproduction. METHODS Consecutive women referred for subfertility between May 2009 and November 2015 who underwent assisted reproduction were included in the study. As part of the initial assessment, each woman underwent three-dimensional transvaginal sonography. Uterine morphology was classified using the modified American Fertility Society (AFS) classification of congenital uterine anomalies proposed by Salim et al. If the external contour of the uterus was uniformly convex or had an indentation of < 10 mm, but there was a cavity indentation, it was defined as arcuate or septate. Arcuate uterus was further defined as the presence of a concave fundal indentation with a central point of indentation at an obtuse angle. Subseptate uterus was defined as the presence of a septum, not extending to the cervix, with the central point of the septum at an acute angle; if the septum extended to the internal cervical os, the uterus was defined as septate. Reproductive outcomes, including live birth, clinical pregnancy and preterm birth, were compared between women with a normal uterus and those with a congenital uterine anomaly. Subgroup analysis by type of uterine morphology and logistic regression analysis adjusted for age, body mass index, levels of anti-Müllerian hormone, antral follicle count and number and day of embryo transfer were performed. RESULTS A total of 2375 women were included in the study, of whom 1943 (81.8%) had a normal uterus and 432 (18.2%) had a congenital uterine anomaly. The most common anomalies were arcuate (n = 387 (16.3%)) and subseptate (n = 16 (0.7%)) uterus. The rate of live birth was similar between women with a uterine anomaly and those with a normal uterus (35% vs 37%; P = 0.47). The rates of clinical pregnancy, mode of delivery and sex of the newborn were also similar between the two groups. Preterm birth before 37 weeks' gestation was more common in women with uterine anomalies than in controls (22% vs 14%, respectively; P = 0.03). Subgroup analysis by type of anomaly showed no difference in the incidence of live birth and clinical pregnancy for women with an arcuate uterus, but indicated worse pregnancy outcome in women with other major anomalies (P = 0.042 and 0.048, respectively). CONCLUSIONS Congenital uterine anomalies as a whole, when defined using the modified AFS classification, do not affect clinical pregnancy or live-birth rates in women following assisted reproduction, but do increase the incidence of preterm birth. The presence of uterine abnormalities more severe than arcuate uterus significantly worsens all pregnancy outcomes. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Prior
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
- Department of Child Health, Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - A Richardson
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - S Asif
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - L Polanski
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - M Parris-Larkin
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - J Chandler
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - L Fogg
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - P Jassal
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - J G Thornton
- Department of Child Health, Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - N J Raine-Fenning
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
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Nolan ET, Downes KJ, Richardson A, Arkhipkin A, Brickle P, Brown J, Mrowicki RJ, Shcherbich Z, Weber N, Weber SB. Life-history strategies of the rock hind grouper Epinephelus adscensionis at Ascension Island. J Fish Biol 2017; 91:1549-1568. [PMID: 29068043 DOI: 10.1111/jfb.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
Epinephelus adscensionis sampled from Ascension Island, South Atlantic Ocean, exhibits distinct life-history traits, including larger maximum size and size at sexual maturity than previous studies have demonstrated for this species in other locations. Otolith analysis yielded a maximum estimated age of 25 years, with calculated von Bertalanffy growth parameters of: L∞ = 55·14, K = 0·19, t0 = -0·88. Monthly gonad staging and analysis of gonad-somatic index (IG ) provide evidence for spawning from July to November with an IG peak in August (austral winter), during which time somatic growth is also suppressed. Observed patterns of sexual development were supportive of protogyny, although further work is needed to confirm this. Mean size at sexual maturity for females was 28·9 cm total length (LT ; 95% C.I. 27·1-30·7 cm) and no females were found >12 years and 48·0 cm LT , whereas all confirmed males sampled were mature, >35·1 cm LT with an age range from 3 to 18 years. The modelled size at which 50% of individuals were male was 41·8 cm (95% C.I. 40·4-43·2 cm). As far as is known, this study represents the first comprehensive investigation into the growth and reproduction of E. adscensionis at its type locality of Ascension Island and suggests that the population may be affected less by fisheries than elsewhere in its range. Nevertheless, improved regulation of the recreational fishery and sustained monitoring of abundance, length frequencies and life-history parameters are needed to inform long-term management measures, which could include the creation of marine reserves, size or temporal catch limits and stricter export controls.
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Affiliation(s)
- E T Nolan
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - K J Downes
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - A Richardson
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - A Arkhipkin
- Falkland Islands Government Fisheries Department, PO Box 598, Stanley, Falkland Islands
| | - P Brickle
- South Atlantic Environmental Research Institute, Stanley, Falkland Islands
- School of Biological Sciences (Zoology), University of Aberdeen, Tillydrone Avenue, Aberdeen, AB24 2TZ, U.K
- Shallow Marine Surveys Group, PO Box 609, Stanley, Falkland Islands
| | - J Brown
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - R J Mrowicki
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - Z Shcherbich
- Falkland Islands Government Fisheries Department, PO Box 598, Stanley, Falkland Islands
| | - N Weber
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
| | - S B Weber
- Ascension Island Government Conservation & Fisheries Department, Georgetown, ASCN 1ZZ, Ascension Island
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Campling N, Richardson A, Mulvey M, Bennett M, Johnston B, Latter S. Self-management support at the end of life: Patients’, carers’ and professionals’ perspectives on managing medicines. Int J Nurs Stud 2017; 76:45-54. [DOI: 10.1016/j.ijnurstu.2017.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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47
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Pearson JF, Alla S, Clarke G, Mason DF, Anderson T, Richardson A, Miller DH, Sabel CE, Abernethy DA, Willoughby EW, Taylor BV. Multiple Sclerosis impact on employment and income in New Zealand. Acta Neurol Scand 2017; 136:223-232. [PMID: 27891575 DOI: 10.1111/ane.12714] [Citation(s) in RCA: 23] [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] [Accepted: 11/09/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES We investigated the demographic, social and clinical characteristics associated with employment status and income for people with multiple sclerosis (MS) in New Zealand (NZ). METHODS The NZ National MS Prevalence study included all persons resident in NZ on census day 2006 diagnosed with MS (96.7% coverage). Factors associated with employment and income status among the working age population (25-64 years) were identified by linear regression. RESULTS Over 90% of working age people with MS (n=1727) had a work history, but 54% were not working. Work loss occurred early in the disease course, and at low disability (P<.001). Advancing age, progressive disease, longer disease duration, higher disability levels, partner loss and lower education were associated with work loss (P<.001). Working age people with MS had lower income than the NZ population (P<.0001). Higher qualifications yielded no additional income for MS females and about half the additional income for MS males (P<.0001). CONCLUSIONS MS profoundly reduces employment and income early in the disease course, and at low levels of disability, however, unemployment is not entirely accounted for by clinical, social and demographic factors. These findings suggest social supports should be explored early in the disease course to reduce loss of income and unemployment for people with MS.
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Affiliation(s)
| | - S. Alla
- University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
| | - G. Clarke
- New Zealand Brain Research Institute; Christchurch New Zealand
| | - D. F. Mason
- University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
- Neurology Department; Christchurch Public Hospital; Christchurch New Zealand
| | - T. Anderson
- University of Otago; Christchurch New Zealand
- New Zealand Brain Research Institute; Christchurch New Zealand
- Neurology Department; Christchurch Public Hospital; Christchurch New Zealand
| | - A. Richardson
- School of Health Sciences; University of Canterbury; Christchurch New Zealand
| | - D. H. Miller
- New Zealand Brain Research Institute; Christchurch New Zealand
- Queen Square Multiple Sclerosis Centre; UCL Institute of Neurology; London UK
| | - C. E. Sabel
- New Zealand Brain Research Institute; Christchurch New Zealand
- School of Geographical Sciences; University of Bristol; Bristol UK
| | | | - E. W. Willoughby
- Neurology Department; Auckland City Hospital; Auckland New Zealand
| | - B. V. Taylor
- Menzies Institute for Medical Research; University of Tasmania; Hobart Australia
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48
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Richardson A, Raine-Fenning N, Deb S, Campbell B, Vedhara K. Anxiety associated with diagnostic uncertainty in early pregnancy. Ultrasound Obstet Gynecol 2017; 50:247-254. [PMID: 27484256 DOI: 10.1002/uog.17214] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis. METHODS We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test. RESULTS A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005). CONCLUSIONS The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an ultrasound examination, the certainty of the diagnosis affects anxiety levels more than does the positive or negative connotations associated with the diagnosis per se. Healthcare providers should be aware of this when communicating uncertain diagnoses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Richardson
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- Nurture Fertility, The East Midlands Fertility Centre, Nottingham, UK
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
- Nurture Fertility, The East Midlands Fertility Centre, Nottingham, UK
| | - S Deb
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - B Campbell
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - K Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Batehup L, Porter K, Gage H, Williams P, Simmonds P, Lowson E, Dodson L, Davies NJ, Wagland R, Winter JD, Richardson A, Turner A, Corner JL. Follow-up after curative treatment for colorectal cancer: longitudinal evaluation of patient initiated follow-up in the first 12 months. Support Care Cancer 2017; 25:2063-2073. [PMID: 28197848 PMCID: PMC5445145 DOI: 10.1007/s00520-017-3595-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare patient-triggered follow-up (PTFU) for curatively treated colorectal cancer against traditional outpatient follow-up (OPFU). METHODS Questionnaires were mailed at four time points over one-year post-treatment to two prospectively-recruited cohorts: A, patients entering follow-up and receiving OPFU pre-implementation of PTFU; B, patients entering follow-up (FU) and receiving either OPFU (B1) or PTFU (B2) post-implementation of PTFU. Bi-variate tests were used to compare patient characteristics and outcomes eight months after entering follow-up (generic and cancer-specific quality of life (QoL), satisfaction). Regression analysis explored associations between follow-up model and outcomes. Resource implications and costs of models were compared. RESULTS Patients in Cohort B1 were significantly more likely to have received chemotherapy (p < 0.001), radiotherapy (p < 0.05), and reported poorer QoL (p = 0.001). Having a longstanding co-morbid condition was the most important determinant of QoL (p < 0.001); model of care was not significant. Patients were satisfied with their follow-up care regardless of model. Health service costs were higher in PTFU over the first year CONCLUSIONS: PTFU is acceptable to patients with colorectal cancer and can be considered to be a realistic alternative to OPFU for clinically suitable patients. The initial costs are higher due to provision of a self-management (SM) programme and remote surveillance. Further research is needed to establish long-term outcomes and costs.
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Affiliation(s)
- L Batehup
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK.
| | - K Porter
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - H Gage
- School of Economics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - P Williams
- Department of Mathematics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - P Simmonds
- Cancer Research UK, Clinical Research Unit, University of Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - E Lowson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - L Dodson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - N J Davies
- Health Psychology Consultancy Ltd., Staffordshire, UK
| | - R Wagland
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
| | - J D Winter
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - A Richardson
- Health Sciences, Nightingale Building, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - A Turner
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK
| | - J L Corner
- The University of Nottingham, Executive Office, Trent Building, University Park, Nottingham, NG7 2RD, UK
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Richardson A, Hopkisson J, Campbell B, Raine-Fenning N. Use of double decidual sac sign to confirm intrauterine pregnancy location prior to sonographic visualization of embryonic contents. Ultrasound Obstet Gynecol 2017; 49:643-648. [PMID: 27194568 DOI: 10.1002/uog.15966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine the diagnostic accuracy of the double decidual sac sign (DDSS) for predicting an intrauterine pregnancy (IUP) prior to visualization of embryonic contents, using modern high-resolution transvaginal sonography (TVS). METHODS The study was conducted following STARD guidelines and participants were recruited prospectively from Nurture Fertility, Nottingham, UK, following in-vitro fertilization/intracytoplasmic sperm injection treatment between 1 January 2015 and 31 October 2015. Women were excluded if there was no evidence of intrauterine fluid collection during the index test, a yolk sac or fetal pole was visible during the index test, no outcome data were available or pregnancy location could not be determined by the reference standard. The index test consisted of TVS at 32-34 days' gestation using a high-frequency transvaginal probe. Reference standard was TVS at 7 weeks' gestation. The outcome of interest was an IUP. RESULTS A total of 67 intrauterine fluid collections were observed and included in the analysis, of which 61 exhibited the DDSS and 65 were proven to be IUPs. Two ectopic pregnancies were included, neither of which demonstrated the DDSS. The DDSS therefore had a sensitivity of 93.9% (95% CI, 85.0-98.3%), specificity of 100% (95% CI, 15.8-100%) and overall diagnostic accuracy of 94.0% (95% CI, 88.3-99.7%) for predicting an IUP. The negative likelihood ratio and positive and negative predictive values were 0.06 (95% CI, 0.02-0.16), 100% (95% CI, 94.1-100%) and 33.3% (95% CI, 4.3-77.7%), respectively. CONCLUSION With modern high-resolution TVS, presence of the DDSS can be used to confirm accurately IUP location prior to sonographic visualization of embryonic contents, and therefore to exclude effectively ectopic pregnancy. Absence of the DDSS, however, does not preclude an IUP. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Richardson
- Nurture Fertility, The East Midlands Fertility Clinic, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - J Hopkisson
- Nurture Fertility, The East Midlands Fertility Clinic, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - B Campbell
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - N Raine-Fenning
- Nurture Fertility, The East Midlands Fertility Clinic, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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