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Deboever N, Eisenberg M, Hofstetter W, Mehran R, Rajaram R, Rice D, Swisher S, Walsh G, Vaporciyan A, Sepesi B, Antonoff M. 113P Clinical overstaging in pathologic stage I non-small cell lung cancer: Prognostic implications. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Cooper D, Bhuskute N, Hepworth C, Walsh G. The Economic Impact of a Pilot Digital Day-Case Pathway for Knee Arthroplasty in a U.K. Setting. JB JS Open Access 2023; 8:JBJSOA-D-22-00051. [PMID: 36844946 PMCID: PMC9949824 DOI: 10.2106/jbjs.oa.22.00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Knee replacements are an increasingly common procedure in the U.K. National Health Service (NHS). Importantly, the pathway for such procedures represents a prime opportunity to leverage digital technology, modernize and streamline the approach to care, and free up resources. Methods In this 21-patient pilot study, we assessed the impact of implementing a digital day-case pathway for knee replacement surgery at the Calderdale and Huddersfield NHS Foundation trust. Results Fourteen (67%) of the 21 eligible patients were treated as day cases, with an average length of stay of 8.8 hours. The pilot data were utilized to model the potential impact of implementing a digital day-case program more widely across the trust. This model showed increased efficiency over the entire episode of care, with reductions in physiotherapy appointments, preoperative visits, hospital days, and face-to-face consultations. Not only would these improvements free up capacity, but they would also result in an estimated saving of £240,540 to the trust while reducing the CO2 footprint of knee replacements by 119,381 kg CO2 emitted. A sensitivity analysis revealed that, even with substantial variation of several key variables within the pathway, a trust-wide digital day-case program would still be a cost-saving measure. Conclusions Overall, the present study supports the growing notion that digital technology can facilitate the transformation of care pathways, resulting in greater efficiency and financial savings for health-care providers while reducing the time patients spend in the hospital. Level of Evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- D.M. Cooper
- Centre for Health Social Care, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, England
| | - N. Bhuskute
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - C. Hepworth
- B. Braun Medical Limited, Sheffield, United Kingdom,Email for corresponding author:
| | - G. Walsh
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
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Klemanska A, Dwyer K, Walsh G. Cloning, expression, and purification of an endo‐
β
‐1,3‐glucanase from the thermophilic fungus
Thielavia terrestris. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255367] [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: 11/06/2022]
Affiliation(s)
- A. Klemanska
- University of Limerick Chemical Sciences Castletroy V94 T9PX Limerick Ireland
| | - K. Dwyer
- Monaghan Mushrooms Monaghan Biosciences Tullygony, Tyholland H18 FW95 Co. Monaghan Ireland
| | - G. Walsh
- University of Limerick Chemical Sciences Castletroy V94 T9PX Limerick Ireland
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Boyce A, Walsh G. Statistical optimisation of
β
‐glucosidase production by
Chitinophaga ginsengisegetis. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255270] [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: 11/06/2022]
Affiliation(s)
- A. Boyce
- University of Limerick Chemical Sciences Department & Bernal Institute Castletroy V94T9PX Limerick Ireland
| | - G. Walsh
- University of Limerick Chemical Sciences Department & Bernal Institute Castletroy V94T9PX Limerick Ireland
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Boyce A, Walsh G. Identification and initial characterisation of a bacterial
β
‐glucosidase of potential biotechnological interest. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255298] [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: 11/06/2022]
Affiliation(s)
- A. Boyce
- University of Limerick Chemical Sciences Department & Bernal Institute Castletroy V94T9PX Limerick Ireland
| | - G. Walsh
- University of Limerick Chemical Sciences Department & Bernal Institute Castletroy V94T9PX Limerick Ireland
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Svistunova V, Walsh G, Boyce A, Kelly R. Recombinant expression of a heparinase I enzyme derived from Bacteroides helcogenes. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255377] [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: 11/05/2022]
Affiliation(s)
- V. Svistunova
- University of Limerick Chemical Sciences V94 Limerick Ireland
| | - G. Walsh
- University of Limerick Chemical Sciences V94 Limerick Ireland
| | - A. Boyce
- University of Limerick Chemical Sciences V94 Limerick Ireland
| | - R. Kelly
- Leo Pharma Cork T45 Cork Ireland
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Cooper DM, Bhuskute N, Walsh G. Exploring the Impact and Acceptance of Wearable Sensor Technology for Pre- and Postoperative Rehabilitation in Knee Replacement Patients: A U.K.-Based Pilot Study. JB JS Open Access 2022; 7:JBJSOA-D-21-00154. [PMID: 35506018 PMCID: PMC9049033 DOI: 10.2106/jbjs.oa.21.00154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Knee replacement operations are common, highly successful procedures that are increasing in frequency. The COVID-19 pandemic has emphasized the need for innovative care pathways that reduce face-to-face appointments. We report on the impact of introducing a wearable sensor for pre- and postoperative rehabilitation of 21 knee replacement patients at 2 hospitals in the U.K.
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Affiliation(s)
- D M Cooper
- Centre for Health Social Care, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, England
| | - N Bhuskute
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
| | - G Walsh
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, England
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Federico L, McGrail DJ, Bentebibel SE, Haymaker C, Ravelli A, Forget MA, Karpinets T, Jiang P, Reuben A, Negrao MV, Li J, Khairullah R, Zhang J, Weissferdt A, Vaporciyan AA, Antonoff MB, Walsh G, Lin SY, Futreal A, Wistuba I, Roth J, Byers LA, Gaudreau PO, Uraoka N, Cruz AF, Dejima H, Lazcano RN, Solis LM, Parra ER, Lee JJ, Swisher S, Cascone T, Heymach JV, Zhang J, Sepesi B, Gibbons DL, Bernatchez C. Distinct tumor-infiltrating lymphocyte landscapes are associated with clinical outcomes in localized non-small-cell lung cancer. Ann Oncol 2022; 33:42-56. [PMID: 34653632 PMCID: PMC10019222 DOI: 10.1016/j.annonc.2021.09.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the importance of tumor-infiltrating T lymphocytes (TILs) in cancer biology, the relationship between TIL phenotypes and their prognostic relevance for localized non-small-cell lung cancer (NSCLC) has not been well established. PATIENTS AND METHODS Fresh tumor and normal adjacent tissue was prospectively collected from 150 patients with localized NSCLC. Tissue was comprehensively characterized by high-dimensional flow cytometry of TILs integrated with immunogenomic data from multiplex immunofluorescence, T-cell receptor sequencing, exome sequencing, RNA sequencing, targeted proteomics, and clinicopathologic features. RESULTS While neither the magnitude of TIL infiltration nor specific TIL subsets were significantly prognostic alone, the integration of high-dimensional flow cytometry data identified two major immunotypes (IM1 and IM2) that were predictive of recurrence-free survival independent of clinical characteristics. IM2 was associated with poor prognosis and characterized by the presence of proliferating TILs expressing cluster of differentiation 103, programmed cell death protein 1, T-cell immunoglobulin and mucin-domain containing protein 3, and inducible T-cell costimulator. Conversely, IM1 was associated with good prognosis and differentiated by an abundance of CD8+ T cells expressing cytolytic enzymes, CD4+ T cells lacking the expression of inhibitory receptors, and increased levels of B-cell infiltrates and tertiary lymphoid structures. While increased B-cell infiltration was associated with good prognosis, the best prognosis was observed in patients with tumors exhibiting high levels of both B cells and T cells. These findings were validated in patient tumors from The Cancer Genome Atlas. CONCLUSIONS Our study suggests that although the number of infiltrating T cells is not associated with patient survival, the nature of the infiltrating T cells, resolved in distinct TIL immunotypes, is prognostically relevant in NSCLC and may inform therapeutic approaches to clinical care.
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Affiliation(s)
- L Federico
- Therapeutics Discovery Division, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D J McGrail
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S-E Bentebibel
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Ravelli
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M-A Forget
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Karpinets
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P Jiang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Reuben
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Li
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Khairullah
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S-Y Lin
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Futreal
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L A Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P-O Gaudreau
- Department of Oncology, Queens' University and the Canadian Cancer Trials Group, Kingston, Canada
| | - N Uraoka
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A F Cruz
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H Dejima
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R N Lazcano
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L M Solis
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E R Parra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J J Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Zhang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - B Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - D L Gibbons
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - C Bernatchez
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Virnik K, Zhou W, Medvedev A, Walsh G, Perry-Anderson J, Majam V, Felber BK, Kumar S, Berkower I. Live attenuated rubella vectors expressing Plasmodium falciparum circumsporozoite protein (Pf-CSP) provide a novel malaria vaccine platform in the rhesus macaque. Biochem Biophys Res Commun 2021; 577:58-63. [PMID: 34507066 PMCID: PMC10167915 DOI: 10.1016/j.bbrc.2021.08.052] [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: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
There is an urgent need for a malaria vaccine that can prevent severe disease in young children and adults. Despite earlier work showing an immunological mechanism for preventing infection and reducing disease severity, there is currently no reliable vaccine that can provide durable protection. In part, this may reflect a limited number of ways that the host can respond to the NANP repeat sequences of circumsporozoite protein (CSP) in the parasite. In addition, it may reflect antigenic escape by the parasite from protective antibodies. To be successful, a vaccine must protect against repeated exposure to infected mosquitoes in endemic areas. We have created a series of live viral vectors based on the rubella vaccine strain that express multiple tandem repeats of NANP, and we demonstrate immunogenicity in a rhesus macaque model. We tested the vectors in a sequential immunization strategy. In the first step, the animals were primed with CSP-DNA vaccine and boosted with rubella/CSP vectors. In the second step, we gave rubella/CSP vectors again, followed by recombinant CSP protein. Following the second step, antibody titers were comparable to adult exposure to malaria in an endemic area. The antibodies were specific for native CSP protein on sporozoites, and they persisted for at least 1½ years in two out of three macaques. Given the safety profile of rubella vaccine in children, these vectors could be most useful in protecting young children, who are at greatest risk of severe malarial disease.
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Affiliation(s)
- Konstantin Virnik
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Wenshuo Zhou
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Alexei Medvedev
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Gabrielle Walsh
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Jasper Perry-Anderson
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Victoria Majam
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, CBER, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Barbara K Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, 21702, USA
| | - Sanjai Kumar
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, CBER, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Ira Berkower
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA.
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Walsh G, Meagher T, Malamateniou C. Evaluating the use of gradient echo imaging for the detection of cerebral microbleeds in acute stroke cases: A retrospective data analysis in a UK stroke unit. Radiography (Lond) 2020; 27:561-567. [PMID: 33281036 DOI: 10.1016/j.radi.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Imaging in stroke, allows its classification into ischaemic stroke (IS) or intracranial haemorrhagic stroke (ICH), ensuring time-sensitive treatment to be administered. Imaging can also allow detection of cerebral microbleeds (CMBs), which may further determine pharmacological intervention in acute stroke. True gradient echo (T2∗GRE) or susceptibility weighted imaging (SWI) have high sensitivity for the detection of CMBs. These two sequences are included in the national guidelines; however, the implementation of these guidelines can vary depending on local interpretation and scanner capabilities. AIM To explore the use and application of blood sensitive MRI sequences in a specialist UK stroke unit for the detection of CMBs, to improve local practice. METHODS A retrospective data analysis of the native database, spanning a 6-month period, was used. The data of 281 acute stroke patients with an MRI were reviewed and analysed. The MRI sequences applied, and the final diagnosis were noted for each case. RESULTS Of the 281 acute stroke patients with MRI, 259 (92.1%) had an IS, 16 (5.68%) an ICH and 6 (2.14%) had both. Overall, 13 (4.63%) had a CMB diagnosis. All of these 13 patients had a true T2∗GRE sequence. CMBs were not detected in the absence of a T2∗GRE sequence. CONCLUSION T2∗GRE imaging is essential for detecting CMBs. When omitted, CMB incidence can be considerably lower than that suggested in the literature. Missing CMB diagnoses in stroke patients may result in suboptimal treatment pathways, compromising the patients' standard of care. IMPLICATIONS FOR PRACTICE When SWI is not available, it is imperative to always include a true T2∗GRE sequence to detect microbleeds in suspected acute stroke cases.
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Affiliation(s)
- G Walsh
- Wycombe General Hospital, Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, Buckinghamshire, HP11 2TT, UK; School of Health Sciences, Division of Midwifery and Radiography, City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - T Meagher
- Wycombe General Hospital, Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, Buckinghamshire, HP11 2TT, UK.
| | - C Malamateniou
- School of Health Sciences, Division of Midwifery and Radiography, City, University of London, Northampton Square, London, EC1V 0HB, UK.
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Dahn H, Wilke D, Walsh G, Pignol J. PH-0597: Radiation and/or endocrine therapy? Recurrence outcomes in low-risk breast cancer patients over 70. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Virnik K, Rosati M, Medvedev A, Scanlan A, Walsh G, Dayton F, Broderick KE, Lewis M, Bryson Y, Lifson JD, Ruprecht RM, Felber BK, Berkower I. Immunotherapy with DNA vaccine and live attenuated rubella/SIV gag vectors plus early ART can prevent SIVmac251 viral rebound in acutely infected rhesus macaques. PLoS One 2020; 15:e0228163. [PMID: 32130229 PMCID: PMC7055890 DOI: 10.1371/journal.pone.0228163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/08/2020] [Indexed: 01/29/2023] Open
Abstract
Anti-retroviral therapy (ART) has been highly successful in controlling HIV replication, reducing viral burden, and preventing both progression to AIDS and viral transmission. Yet, ART alone cannot cure the infection. Even after years of successful therapy, ART withdrawal leads inevitably to viral rebound within a few weeks or months. Our hypothesis: effective therapy must control both the replicating virus pool and the reactivatable latent viral reservoir. To do this, we have combined ART and immunotherapy to attack both viral pools simultaneously. The vaccine regimen consisted of DNA vaccine expressing SIV Gag, followed by a boost with live attenuated rubella/gag vectors. The vectors grow well in rhesus macaques, and they are potent immunogens when used in a prime and boost strategy. We infected rhesus macaques by high dose mucosal challenge with virulent SIVmac251 and waited three days to allow viral dissemination and establishment of a reactivatable viral reservoir before starting ART. While on ART, the control group received control DNA and empty rubella vaccine, while the immunotherapy group received DNA/gag prime, followed by boosts with rubella vectors expressing SIV gag over 27 weeks. Both groups had a vaccine "take" to rubella, and the vaccine group developed antibodies and T cells specific for Gag. Five weeks after the last immunization, we stopped ART and monitored virus rebound. All four control animals eventually had a viral rebound, and two were euthanized for AIDS. One control macaque did not rebound until 2 years after ART release. In contrast, there was only one viral rebound in the vaccine group. Three out of four vaccinees had no viral rebound, even after CD8 depletion, and they remain in drug-free viral remission more than 2.5 years later. The strategy of early ART combined with immunotherapy can produce a sustained SIV remission in macaques and may be relevant for immunotherapy of HIV in humans.
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Affiliation(s)
- Konstantin Virnik
- Laboratory of Immunoregulation, Division of Viral Products, Office of Vaccines, Center for Biologics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Margherita Rosati
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, Maryland, United States of America
| | - Alexei Medvedev
- Laboratory of Immunoregulation, Division of Viral Products, Office of Vaccines, Center for Biologics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Aaron Scanlan
- Laboratory of Immunoregulation, Division of Viral Products, Office of Vaccines, Center for Biologics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Gabrielle Walsh
- Laboratory of Immunoregulation, Division of Viral Products, Office of Vaccines, Center for Biologics, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Frances Dayton
- Human Retrovirus Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, Maryland, United States of America
| | - Kate E. Broderick
- Inovio Pharmaceuticals, Inc., Plymouth Meeting, Pennsylvania, United States of America
| | - Mark Lewis
- BioQual, Inc., Rockville, Maryland, United States of America
| | - Yvonne Bryson
- Department of Pediatrics, Division of Infectious Disease, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Jeffrey D. Lifson
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Ruth M. Ruprecht
- University of Louisiana at Lafayette, New Iberia Research Center, New Iberia, Louisiana, United States of America
| | - Barbara K. Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, Maryland, United States of America
| | - Ira Berkower
- Laboratory of Immunoregulation, Division of Viral Products, Office of Vaccines, Center for Biologics, Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
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14
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Sepesi B, Cascone T, William W, Lin H, Leung C, Weissferdt A, Walsh G, Rice D, Roth J, Mehran R, Hofstetter W, Antonoff M, Fossella F, Mott F, Le X, Skoulidis F, Zhang J, Byers L, Lam V, Glisson B, Kurie J, Blumenschein G, Tsao A, Lu C, Altan M, Elamin Y, Gibbons D, Papadimitrakopoulou V, Lee J, Heymach J, Vaporciyan A, Swisher S. OA13.06 Surgical Outcomes Following Neoadjuvant Nivolumab or Nivolumab Plus Ipilimumab in Non-Small Cell Lung Cancer - NEOSTAR Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Miles M, Kilfoil E, Walsh G, MacIntosh D. A210 CORRELATION OF ADENOMA PER CASE WITH ADENOMA DETECTION RATE FOR CREDENTIALED SCREENING COLONOSCOPISTS IN THE NOVA SCOTIA COLON CANCER PREVENTION PROGRAM. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.209] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Miles
- Internal Medicine, Dalhousie University, Halifax, NS, Canada
| | - E Kilfoil
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - G Walsh
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - D MacIntosh
- Internal Medicine, Dalhousie University, Halifax, NS, Canada
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Miles M, Kilfoil E, Walsh G, MacIntosh D. A228 CAN SERRATED ADENOMA DETECTION RATE (SADR) BE USED TO EVALUATE THE PERFORMANCE OF CREDENTIALED SCREENING COLONOSCOPISTS IN THE NOVA SCOTIA COLON CANCER PREVENTION PROGRAM? J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Miles
- Internal Medicine, Dalhousie University, Halifax, NS, Canada
| | - E Kilfoil
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - G Walsh
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - D MacIntosh
- Queen Elizabeth II Health Science Centre, Halifax, NS, Canada
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17
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Mulholland S, Klein HA, Barwood GP, Donnellan S, Nisbet-Jones PBR, Huang G, Walsh G, Baird PEG, Gill P. Compact laser system for a laser-cooled ytterbium ion microwave frequency standard. Rev Sci Instrum 2019; 90:033105. [PMID: 30927817 DOI: 10.1063/1.5082703] [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] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
The development of a transportable microwave frequency standard based on the ground-state transition of 171Yb+ at ∼12.6 GHz requires a compact laser system for cooling the ions, clearing out of long-lived states and also for photoionisation. In this paper, we describe the development of a suitable compact laser system based on a 6U height rack-mounted arrangement with overall dimensions 260 × 194 × 335 mm. Laser outputs at 369 nm (for cooling), 399 nm (photoionisation), 935 nm (repumping), and 760 nm (state clearout) are combined in a fiber arrangement for delivery to our linear ion trap and we demonstrate this system by cooling of 171Yb+ ions. Additionally, we demonstrate that the lasers at 935 nm and 760 nm are close in frequency to water vapor and oxygen absorption lines, respectively; specifically, at 760 nm, we show that one 171Yb+ transition is within the pressure broadened profile of an oxygen line. These molecular transitions form convenient wavelength references for the stabilization of lasers for a 171Yb+ frequency standard.
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Affiliation(s)
- S Mulholland
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - H A Klein
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - G P Barwood
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - S Donnellan
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | | | - G Huang
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - G Walsh
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - P E G Baird
- Clarendon Laboratory, University of Oxford, Oxford, United Kingdom
| | - P Gill
- National Physical Laboratory, Teddington TW11 0LW, United Kingdom
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18
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Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Abstract P4-01-01: Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-01] [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. Detection of circulating tumor DNA (ctDNA) after treatment of early stage breast cancer may identify molecular residual disease. In a prior proof-of-principle study we demonstrated that detection of ctDNA predicted relapse with high accuracy (Garcia-Murillas et al Science Trans Med 2015). We conducted an independent, prospective, multi-centre validation study.
Methods. In this validation study, a cohort of 170 early stage breast cancer patients were recruited from five hospitals into two prospective sample collection studies. Patients were scheduled to receive standard chemotherapy, surgery +/- radiotherapy, adjuvant endocrine therapy and HER2 antibodies as appropriate. Plasma samples were collected for ctDNA analysis at baseline, post-surgery, three monthly for the first year of follow-up, and six monthly thereafter and shipped to a central lab for processing. Using previously established criteria, tumor was sequenced to identify somatic mutations that were tracked by digital PCR in DNA extracted from 4mls of plasma at all available time points. Buffy coat DNA was analysed at all time-points to control for clonal haematopoesis of indeterminate potential (CHIP) detection. The primary endpoint was to compare invasive disease free survival between patients with and without detection of ctDNA after treatment. A combined analysis of this validation study, and the prior proof-of-principle study, was also conducted to analyse secondary endpoints.
Results. After tumor sequencing, 101 patients from the validation study had at least one mutation to track. At median 35.5 months follow-up, ctDNA was detected in plasma of 15.8% (16/101) patients. Detection of ctDNA strongly predicted relapse, hazard ratio 24.5 (95% CI 6.5 to 93.2, P<0.001 time-dependent Cox model), and was predictive of relapse in all tumor subtypes.
In the combined analysis (N=144), lead-time between ctDNA detection and relapse was 10.7 months (95% CI 7.7-17.0). Six patients had a clinical relapse that was not detected by ctDNA prior to relapse. These patients had a distinct pattern of oligo-metastatic relapse, 3 patients with brain-only metastases (P=0.0068), 1 ovarian oligo-metastasis and 2 local disease recurrence. The level of ctDNA in baseline plasma, prior to treatment, was associated with tumor subtype, highest in triple negative breast cancer (P=0.0036).
Conclusion. Detection of ctDNA after treatment is associated with a high risk of future relapse in early-stage breast cancer. Prospective studies are required to assess the potential of molecular residual disease detection to guide adjuvant therapy.
Citation Format: Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer [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 P4-01-01.
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Affiliation(s)
- N Turner
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Garcia-Murillas
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - N Chopra
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Comino-Mendez
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Beaney
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - R Cutts
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - C Swift
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Kriplani
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Afentakis
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Hrebien
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - G Walsh
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Johnston
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Ring
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Russell
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Evans
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Skene
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Wheatley
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Dowsett
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Smith
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
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Rafter N, Finn R, Burns K, Condell S, Conroy RM, Hickey A, O'Connor P, Vaughan D, Walsh G, Williams DJ. Identifying hospital-acquired infections using retrospective record review from the Irish National Adverse Events Study (INAES) and European point prevalence survey case definitions. J Hosp Infect 2018; 101:313-319. [PMID: 30590090 DOI: 10.1016/j.jhin.2018.12.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Point prevalence surveys (PPSs) collect data on hospital-acquired infections (HAIs) at one point in time but do not provide information on incidence over the entire admission or impact on patients or healthcare resources. Retrospective record review examines the entire admission to determine adverse event prevalence, incidence, preventability, physical impairment and additional length of stay. AIM To establish whether European HAI surveillance definitions can be applied to the Irish National Adverse Events Study (INAES) retrospective record review data to determine HAI burden. METHODS In the INAES, 1574 admissions were reviewed using a two-stage methodology and 247 adverse events were found. These were examined against European HAI case definitions to determine whether the event was an HAI. Results were compared with the 2011/12 European PPS data for Ireland. FINDINGS The prevalence of HAI adverse events in INAES was 4.4% (95% confidence interval (CI) 3.1-6.1%) with an incidence of 3.8 (95% CI 2.5-5.2) HAI adverse events per 100 admissions. The PPS HAI prevalence for Ireland was 5.2%. HAI types and micro-organisms were similar in INAES and the PPS. Approximately three-quarters of INAES HAI adverse events were preventable, 7% caused permanent impairment and 7% contributed to death. A mean of 10 additional bed days were attributed to HAI adverse events, equivalent to €9400 per event. CONCLUSION Retrospective record review is an accurate source of information on HAI incidence, preventability and impact that complements PPS prevalence rates. HAI adverse events result in higher costs to the healthcare system than other adverse events.
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Affiliation(s)
- N Rafter
- Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - R Finn
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - K Burns
- Department of Clinical Microbiology, RCSI and Beaumont Hospital, Health Protection Surveillance Centre, Dublin, Ireland
| | - S Condell
- Clinical Effectiveness Unit, National Patient Safety Office, Department of Health, Dublin, Ireland
| | - R M Conroy
- Division of Population Health Sciences, RCSI, Ireland
| | - A Hickey
- Department of Psychology, Division of Population Health Sciences, RCSI, Ireland
| | - P O'Connor
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - D Vaughan
- Department of Quality and Safety, Children's Hospital Group, Dublin, Ireland
| | - G Walsh
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - D J Williams
- Department of Geriatric & Stroke Medicine, RCSI and Beaumont Hospital, Dublin, Ireland
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Weissferdt A, Cascone T, Pataer A, Kalhor N, Moran C, Antonoff M, Walsh G, Bernatchez C, Gibbons D, Wistuba I, Roth J, Zhang J, Roarty E, Landry L, Vaporciyan A, Heymach J, Swisher S, Sepesi B. P3.09-27 Histopathologic Parameters Define Features of Treatment Response to Neoadjuvant Chemotherapy in Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1796] [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: 10/28/2022]
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21
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Lam V, Tran H, Vasquez M, Li K, Yuen K, Vang F, Jaimovich A, Kennedy D, Odegaard J, Mortimer S, Olsen S, Raymond V, Vaporciyan A, Antonoff M, Walsh G, Roarty E, Lacerda L, Roth J, Swisher S, Bernatchez C, Sepesi B, Gibbons D, Zhang J, Heymach J. MA23.02 Circulating Tumor DNA Analysis with a Novel Variant Classifier for Recurrence Detection in Resected, Early-Stage Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.512] [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: 11/26/2022]
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22
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Lorimer C, Walsh G, MacKinnon M, Greenwood K, Corbett A, Bedborough K, Saran F, Chalmers A, Brock J. P01.017 Geriatric Assessments in Neuro Oncology - a viable prospect. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.059] [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)
- C Lorimer
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - G Walsh
- Sussex Cancer Centre, Brighton, United Kingdom
| | - M MacKinnon
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - K Greenwood
- The Royal Marsden NHS Trust, Sutton, United Kingdom
| | - A Corbett
- The Royal Marsden NHS Trust, Sutton, United Kingdom
| | - K Bedborough
- The Royal Marsden NHS Trust, Sutton, United Kingdom
| | - F Saran
- The Royal Marsden NHS Trust, Sutton, United Kingdom
| | - A Chalmers
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - J Brock
- Sussex Cancer Centre, Brighton, United Kingdom
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23
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Walsh G, Curley S, Costello A, Elliott L, Ryan E, Blanco A, Kolch W, Eissner G. PO-311 Characterisation of colorectal tumour endothelial cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Background Cancer-patient navigators who are oncology nurses support and connect patients to resources throughout the cancer care trajectory, including end of life. Although qualitative and cohort studies of navigated patients have been reported, no population-based studies were found. The present population-based study compared demographic, disease, and outcome characteristics for decedents who had been diagnosed with cancer by whether they did or did not see a navigator. Methods This retrospective study used patient-based administrative data in Nova Scotia (cancer registry, death certificates, navigation visits) to generate descriptive statistics. The study population included all adults diagnosed with cancer who died during 2011-2014 of a cancer or non-cancer cause of death. Results Of the 7694 study decedents, 74.9% had died of cancer. Of those individuals, 40% had seen a navigator at some point in their disease trajectory. The comparable percentage for those who did not die of cancer was 11.9%. Decedents at the oldest ages had the lowest navigation rates. Navigation rates, time from diagnosis to death, and time from last navigation visit to death varied by disease site. Conclusions This population-based study of cancer-patient navigation enrolees compared with non-enrolees is the first of its kind. Most findings were consistent with expectations. However, we do not know whether the rates of navigation are consistent with the navigation needs of the population diagnosed with cancer. Because more people are living longer with cancer and because the population is aging, ongoing surveillance of who requires and who is using navigation services is warranted.
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Affiliation(s)
| | - G.M. Johnston
- School of Health Administration, Dalhousie University; and
- Cancer Care Program, Nova Scotia Health Authority, Halifax, NS
| | | | - G. Walsh
- Cancer Care Program, Nova Scotia Health Authority, Halifax, NS
| | - M. McCallum
- Cancer Care Program, Nova Scotia Health Authority, Halifax, NS
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25
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Nelson D, Rice D, Niu J, Vaporciyan A, Antonoff M, Hofstetter W, Walsh G, Swisher S, Roth J, Giordano S, Mehran R, Sepesi B. F-028PREDICTORS OF TRIMODALITY THERAPY AND TRENDS IN THERAPY FOR MALIGNANT PLEURAL MESOTHELIOMA. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Sepesi B, Cuentes EP, Canales J, Behrens C, Correa A, Antonoff M, Gibbons D, Heymach J, Hofstetter W, Mehran R, Rice D, Roth J, Vaporciyan A, Walsh G, Weissferdt A, Kalhor N, Moran C, Swisher S, Wistuba I. Tumor-Infiltrating Lymphocytes and Overall Survival in Surgically Resected Stage II and III Non–Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Turner SW, Miller D, Walsh G, Power U, Shields M, Devereux G. S70 Neonatal airway epithelial cell IL-8 responses to infection are reduced in those who go on to wheeze. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Levin S, Semler D, Gad S, Burton E, Walsh G, Costello A, Chengelis CP. Preliminary Studies on Bemitradine-Induced Cardiotoxicity in Female Rats. ACTA ACUST UNITED AC 2016. [DOI: 10.3109/10915819109078648] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The mechanism of bemitradine (SC-33643) cardiotoxicity in female rats was investigated in the set of preliminary experiments reported here. Specifically, the involvement of bemitradine metabolites and the potential role of adrenal epinephrine release were examined. Desethylbemi-tradine (the primary metabolite of bemitradine) was shown to be cardiotoxic at oral dosages greater than 300 mg/kg for 7 days. In a separate experiment, a major metabolite (bemitradine glycol) unique to the rat was not cardiotoxic at dosages up to 600 mg/kg for 7 days. Treatment of rats with SKF 525-A enhanced the lethality and the cardiotoxicity of bemitradine. In contrast, prior treatments of rats with phenobarbital resulted in decreased cardiotoxicity of both bemitradine and desethylbemitradine (a bemitradine metabolite presumably further metabolized by the microsomal mixed function oxidases). In other independent experiments, bemitradine-induced cardiotoxicity was shown to be accompanied by adrenal damage and decreases in adrenal epinephrine. Propranolol (a β-antagonist) treatment protected rats against cardiotoxicity. Bemitradine also had a direct effect on the heart, as evidenced in an experiment in which bemitradine caused dose-related increases in the T-wave of the rat ECG complex. These data suggest that (1) both bemitradine and desethylbemitradine may be responsible for the cardiotoxicity, and the other downstream metabolites are not and (2) cardiotoxicity may be due to the combination of direct effects of bemitradine on the rat heart and the bemitradine-mediated release of adrenal epinephrine (a known cardiotoxin at high circulating levels).
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Affiliation(s)
- S. Levin
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | - D. Semler
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | - S. Gad
- Becton Dickinson, Research Triangle Park, NC
| | - E. Burton
- Department of Product Safety Assessment, Searle Research & Development, Skokie, Illinois
| | | | | | - C. P. Chengelis
- WIL Research Laboratories 1407 George Road Ashland, OH 44805-9281
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Georges H, Critchley G, Lynch M, Walsh G, Creak A, Brock J. PO65TAILORING HIGH GRADE GLIOMA MANAGEMENT IN THE ELDERLY. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.58] [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: 11/12/2022] Open
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Yeo B, Kotsori K, Mohammed K, Walsh G, Smith IE. Long-term outcome of HER2 positive metastatic breast cancer patients treated with first-line trastuzumab. Breast 2015; 24:751-7. [PMID: 26456898 DOI: 10.1016/j.breast.2015.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Trastuzumab has changed the natural history of metastatic HER2 positive breast cancer. Some patients remain well and in remission for many years. There is currently no established duration after which trastuzumab in the advanced setting can be safely discontinued. This study aims to evaluate long-term efficacy and cardiac safety of trastuzumab when used as first-line treatment for patients with metastatic HER2 positive breast cancer. PATIENT AND METHODS We retrospectively identified 215 patients with HER2 positive, locally advanced or metastatic breast cancer who commenced first line trastuzumab-containing therapy for metastatic disease between 2001 and 2010 at The Royal Marsden Hospital. RESULTS The median progression free survival for all patients was 12 months (95%CI: 10.3-14.6 months); 103 (48%) patients remained in remission beyond one year, 59 (27%) beyond two years and 25 (12%) beyond five years. The median overall survival was 2.6 years (95% confidence interval (CI): 2.2-3.3). The objective response rate (ORR) was 65% with 17 (8%) complete responses and 120 (57%) partial responses. Trastuzumab was well tolerated. Twenty eight (13%) patients recorded any grade of left ventricular dysfunction. There was no significant difference in cardiac toxicity between those patients on less than or more than one year of trastuzumab. CONCLUSION Trastuzumab is associated with long-term remissions in a significant proportion of patients with metastatic HER2 positive disease when used in the first-line advanced setting.
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Affiliation(s)
- B Yeo
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
| | - K Kotsori
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - K Mohammed
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - G Walsh
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - I E Smith
- Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
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31
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Hussain S, Adams C, Cleland A, Jones PM, Walsh G, Kiaii B. Lessons from aviation - the role of checklists in minimally invasive cardiac surgery. Perfusion 2015; 31:68-71. [DOI: 10.1177/0267659115584785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe an adverse event during minimally invasive cardiac surgery that resulted in a multi-disciplinary review of intra-operative errors and the creation of a procedural checklist. This checklist aims to prevent errors of omission and communication failures that result in increased morbidity and mortality. We discuss the application of the aviation - led “threats and errors model” to medical practice and the role of checklists and other strategies aimed at reducing medical errors.
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Affiliation(s)
- S Hussain
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - C Adams
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - A Cleland
- Division of Clinical Perfusion Services, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - PM Jones
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - G Walsh
- Division of Clinical Perfusion Services, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - B Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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Abstract
OBJECTIVE To examine factors associated with the number of psychiatric admissions per in-patient suicide and the suicide rate per 100,000 in-patient years in psychiatric hospitals. METHOD Random-effects meta-analysis was used to calculate pooled estimates, and meta-regression was used to examine between-sample heterogeneity. RESULTS Forty-four studies published between 1945 and 2013 reported a total of 7552 in-patient suicides. The pooled estimate of the number of admissions per suicide calculated using 39 studies reporting 150 independent samples was 676 (95% CI: 604-755). Recent studies tended to report higher numbers of admissions per suicide than earlier studies. The pooled estimate of suicide rates per 100,000 in-patient years calculated using 27 studies reporting 95 independent samples was 147 (95% CI: 138-156). Rates of suicide per 100,000 in-patient years tended to be higher in more recent samples, in samples from regions with a higher whole of population suicide rate, in samples from settings with a shorter average length of hospital stay and in studies using coronial records to define suicide. CONCLUSION Rates of in-patient suicide in psychiatric hospitals vary remarkably and are disturbingly high. Further research might clarify the extent to which patient factors and the characteristics of in-patient facilities contribute to the unacceptable mortality in psychiatric hospitals.
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Affiliation(s)
- G Walsh
- Mental Health Services, The Prince of Wales Hospital, Sydney, NSW, Australia
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33
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McCarthy SE, O'Boyle CA, O'Shaughnessy A, Walsh G. Online patient safety education programme for junior doctors: is it worthwhile? Ir J Med Sci 2014; 185:51-8. [PMID: 25366816 DOI: 10.1007/s11845-014-1218-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 05/29/2014] [Accepted: 10/25/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Increasing demand exists for blended approaches to the development of professionalism. Trainees of the Royal College of Physicians of Ireland participated in an online patient safety programme. AIMS Study aims were: (1) to determine whether the programme improved junior doctors' knowledge, attitudes and skills relating to error reporting, open communication and care for the second victim and (2) to establish whether the methodology facilitated participants' learning. METHODS 208 junior doctors who completed the programme completed a pre-online questionnaire. Measures were "patient safety knowledge and attitudes", "medical safety climate" and "experience of learning". Sixty-two completed the post-questionnaire, representing a 30 % matched response rate. RESULTS Participating in the programme resulted in immediate (p < 0.01) improvement in skills such as knowing when and how to complete incident forms and disclosing errors to patients, in self-rated knowledge (p < 0.01) and attitudes towards error reporting (p < 0.01). Sixty-three per cent disagreed that doctors routinely report medical errors and 42 % disagreed that doctors routinely share information about medical errors and what caused them. Participants rated interactive features as the most positive elements of the programme. CONCLUSIONS An online training programme on medical error improved self-rated knowledge, attitudes and skills in junior doctors and was deemed an effective learning tool. Perceptions of work issues such as a poor culture of error reporting among doctors may prevent improved attitudes being realised in practice. Online patient safety education has a role in practice-based initiatives aimed at developing professionalism and improving safety.
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Affiliation(s)
- S E McCarthy
- Institute of Leadership, Royal College of Surgeons in Ireland, Reservoir House, Ballymoss Road, Sandyford, Dublin 18, Ireland.
| | - C A O'Boyle
- Institute of Leadership, Royal College of Surgeons in Ireland, Reservoir House, Ballymoss Road, Sandyford, Dublin 18, Ireland
| | - A O'Shaughnessy
- Education and Professional Development Department, Royal College of Physicians of Ireland, Frederick House, 19 South Frederick Street, Dublin 2, Ireland
| | - G Walsh
- Education and Professional Development Department, Royal College of Physicians of Ireland, Frederick House, 19 South Frederick Street, Dublin 2, Ireland
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Mcgarry T, Gao W, Connolly M, Walsh G, McCormick J, Veale D, Fearon U. AB0051 Toll-Like Receptor 2 Activation Induces Pro-Inflammatory, Inflammasome and Notch Signalling Pathways in Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Stephens N, Rice D, Correa A, Hoffstetter W, Mehran R, Roth J, Walsh G, Vaporciyan A, Swisher S. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg 2014; 46:607-13. [DOI: 10.1093/ejcts/ezu036] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martin N, Molodowitch C, Vivenzio T, Czerminska M, Walsh G, Mamon H, Killoran J. Development and Implementation of Customized Software for Physician Peer Review and Clinical Care. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1558] [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]
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Ajani JA, Xiao L, Roth JA, Hofstetter WL, Walsh G, Komaki R, Liao Z, Rice DC, Vaporciyan AA, Maru DM, Lee JH, Bhutani MS, Eid A, Yao JC, Phan AP, Halpin A, Suzuki A, Taketa T, Thall PF, Swisher SG. A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer. Ann Oncol 2013; 24:2844-9. [PMID: 23975663 DOI: 10.1093/annonc/mdt339] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The contribution of induction chemotherapy (IC) before preoperative chemoradiation for esophageal cancer (EC) is not known. We hypothesized that IC would increase the rate of pathologic complete response (pathCR). METHODS Trimodality-eligibile patients were randomized to receive no IC (Arm A) or IC (oxaliplatin/FU; Arm B) before oxaliplatin/FU/radiation. Surgery was attempted ∼5-6 weeks after chemoradiation. The pathCR rate, post-surgery 30-day mortality, overall survival (OS), and toxic effects were assessed. Bayesian methods and Fisher's exact test were used. RESULTS One hundred twenty-six patients were randomized dynamically to balance the two arms for histology, baseline stage, gender, race, and age. Fifty-five patients in Arm A and 54 in Arm B underwent surgery. The median actuarial OS for all patients (54 deaths) was 45.62 months [95% confidence interval (CI), 27.63-NA], with median OS 45.62 months (95% CI 25.56-NA) in Arm A and 43.68 months (95% CI 27.63-NA) in Arm B (P = 0.69). The pathCR rate in Arm A was 13% (7 of 55) and 26% (14 of 54) in Arm B (two-sided Fisher's exact test, P = 0.094). Safety was similar in both arms. CONCLUSIONS These data suggest that IC produces non-significant increase in the pathCR rate and does not prolong OS. Further development of IC before chemoradiation may not be beneficial. Clinical trial no.: NCT 00525915 (www.clinicaltrials.gov).
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Affiliation(s)
- J A Ajani
- Departments of Gastrointestinal Medical Oncology
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Stephens A, Rice D, Swisher S, Vaporcyian A, Hofstetter W, Walsh G, Mehran R, Roth J. F-104VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY IS ASSOCIATED WITH IMPROVED SHORT-TERM AND LONG-TERM OUTCOMES COMPARED TO OPEN LOBECTOMY FOR C-STAGE I NON-SMALL CELL LUNG CANCER: A PROPENSITY-MATCHED ANALYSIS OF 963 CASES. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wong M, O'Neill S, Walsh G, Smith I. Goserelin with chemotherapy to preserve ovarian function in pre-menopausal women with early breast cancer: menstruation and pregnancy outcomes. Ann Oncol 2013; 24:133-8. [DOI: 10.1093/annonc/mds250] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harden PN, Walsh G, Bandler N, Bradley S, Lonsdale D, Taylor J, Marks SD. Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure. BMJ 2012; 344:e3718. [PMID: 22661725 DOI: 10.1136/bmj.e3718] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PROBLEM Transition from paediatric to adult care of young adults with chronic diseases is poorly coordinated, often delayed, and usually managed through a single referral letter. About 35% of young adults lose a successfully functioning kidney transplant within 36 months of transfer from paediatric to adult services. DESIGN Before and after study of the impact of a new integrated paediatric-adult clinical service for patients with kidney failure. SETTING Adult renal centre in Oxford and two paediatric renal centres in London. STRATEGIES FOR CHANGE An integrated paediatric-young adult joint transition clinic and care pathway was established in 2006, in conjunction with a young adult clinical service with regular community based clinics. Previously, young adult transplant recipients were transferred by a single referral letter to an adult renal consultant and managed in a conventional adult clinic. KEY MEASURES FOR IMPROVEMENT Rates of acute rejection and loss of kidney transplants five years before and five years after the introduction of the integrated young adult care pathway. EFFECTS OF THE CHANGE: Nine young adult kidney transplant recipients were transferred directly to adult care between 2000 and 2006 (group 1). From 2006 to 2010, 12 young adult transplant recipients underwent integrated transition into the new young adult service (group 2). Six transplants were lost in group 1 (67%) compared with no transplant losses in group 2. LESSONS LEARNT Implementing an integrated transition clinic, coupled with improving young adults' healthcare experience through a young adult clinic, improved patient adherence to regular medication and engagement with healthcare providers, as judged by reduced transplant failure rates. This model may be applicable to other young adult populations with chronic disease transferring to adult healthcare.
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Affiliation(s)
- P N Harden
- Oxford Kidney Unit and Transplant Centre, Churchill Hospital, Oxford OX3 7LJ, UK.
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Livingstone E, Noble G, Walsh G, Turner S. P82 Episodic viral wheeze and multitrigger wheeze: are they really different phenotypes? Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mehran R, Rice D, El-Zein R, Huang JL, Vaporciyan A, Goodyear A, Mehta A, Correa A, Walsh G, Roth J, Swisher S, Hofstetter W. Minimally invasive esophagectomy versus open esophagectomy, a symptom assessment study. Dis Esophagus 2011; 24:147-52. [PMID: 21040152 DOI: 10.1111/j.1442-2050.2010.01113.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Minimally invasive esophagectomy (MIE) is used with hope to decrease the morbidity associated with an open esophagectomy. Reflux and dumping syndromes are the most important functional complaints in patients after esophagectomy. This study compares the functional benefits of MIE with open esophagectomy. The study enrolled patients who underwent either minimally invasive or open esophagectomy for cancer between 2004 and 2009. No patients in the MIE group had a pyloroplasty or myotomy. Each patient in the MIE group was paired to a patient in the open esophagectomy group via propensity matching. Matching variables included age, race, gender, preoperative treatment, history of prior cancer, American Society of Anesthesiologists Risk Scale, performance status, clinical stage, body mass index, histology, level of anastomosis, and time elapsed since surgery. The patients were asked to answer 26 questions about their reflux and dumping using validated questionnaires. A total of 181 patients were included in the study. From this group, 44 pairs of patients were created and used for the analysis. The median follow-up was 12.1 months for the MIE group and 18.3 months for the open group. The reflux score was slightly worse in the MIE group (5.5 versus 3.5, P= 0.021). There was no difference in the dumping symptoms between the two groups. The most common complaints seen in the dumping questionnaire in almost one-third of all patients were early satiety, abdominal discomfort, nausea, and diarrhea. Of the patients, 77% were satisfied or very satisfied with their condition in the MIE group compared with 93% in the open group (P= 0.287). Reflux, dumping, and overall satisfaction after MIE without pyloroplasty are comparable with those obtained after open esophagectomy with a pyloric drainage procedure.
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Affiliation(s)
- R Mehran
- Department of Thoracic Surgery, MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Rodgers M, Walsh G, Healy MG. Different depth intermittent sand filters for laboratory treatment of synthetic wastewater with concentrations close to measured septic tank effluent. J Environ Sci Health A Tox Hazard Subst Environ Eng 2011; 46:80-85. [PMID: 21104498 DOI: 10.1080/10934529.2011.526907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The objective of this study was to apply hydraulic and chemical oxygen demand (COD) loading rates at the upper limits of the design criteria for buried sand filters to test the sand filter depth design criteria. Over a 274-day study duration, synthetic effluent with a strength of domestic wastewater was intermittently dosed onto two sand filters of 0.2 m diameter, with depths of 0.3 and 0.4 m. Hydraulic and organic carbon loading rates of 105 L m(-2) d(-1) and 40 g COD m(-2) d(-1), respectively, were applied to the filters. The filters did not clog and had good effluent removal capabilities for 274 and 190 days, respectively. However, the 0.3 m-deep filter did experience a reduced performance towards the end of the study period. In the 0.3 and 0.4 m-deep filters, the effluent COD and SS concentrations were less than 86 and 31 mg L(-1), respectively, and nitrification was nearly complete in both these columns. Ortho-phosphorus (PO(4)-P) removal in fine sand and laterite 'upflow' filters, receiving effluent from the 0.3 m-deep filter, was 10% and 44%, respectively.
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Affiliation(s)
- M Rodgers
- Civil Engineering, National University of Ireland, Galway, Rep. of Ireland
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Abstract
The purpose of this study is to determine the appropriate arterial pump flow /cardiac index (CI) utilizing a mini-bypass system. The unique feature of most mini-bypass systems is that the centrifugal pump combines the function of kinetic venous drainage with arterial pump flow. Therefore, if drainage is reduced, arterial pump flow is also reduced. Managing this system can present challenges to the clinical perfusionist. We reviewed fifteen cases, using the Medtronic Resting Heart System (RHS). This retrospective study examined the arterial pump flow, measured as cardiac index (CI), mean arterial pressure, inlet venous saturation, urine output, vasopressor use, and lactate production during routine cardiac surgery. The mean cardiac index for all patients was 1.90 +/- 0.14, range 1.63-2.08 L/min/m(2). The mean hemoglobin on cardiopulmonary bypass (CPB) was 10.6 +/- 1.2, with a range of 9.2-13.3 g/dL. The lactate produced on CPB was 2.03 +/-0.67 with a range of 1.5-3.5 mmol/L. The mean change in lactate measured from pre CPB to post CPB was 0.85 +/- 0.71 with a median lactate of 0.6 mmol/L. The venous saturation was 65.53 +/- 6.03% with a median of 65% and a range of 57-82%. The mean arterial pressure was 67.04 +/- 10.45 mmHg with a median of 62.5 mmHg. The median urine output was 125 mls. The vasopressor median was 2200 microg. All patients were maintained on CPB with a mean nasopharyngeal temperature of 35.43 degrees Celsius. Despite using lower than predicted flows, it would appear that adequate perfusion is provided. The higher hemoglobin content achieved through reduced hemodilution and reduced inflammation appears to enable this system to deliver adequate flow and perfusion at reduced cardiac indices. This research provides evidence which challenges longstanding beliefs that a cardiac index of 2.4 L/min/m(2) is required for all cases.
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Affiliation(s)
- P Fernandes
- London Health Sciences Centre, Clinical Perfusion Services, London, Ontario, Canada.
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Kotsori A, Dolly S, Sheri A, Parton M, Shaunak N, Ashley S, Walsh G, Johnston S, Smith I. Is Capecitabine Efficacious in Triple Negative Metastatic Breast Cancer? Oncology 2010; 79:331-6. [DOI: 10.1159/000323175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
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Jones RL, Walsh G, Ashley S, Chua S, Agarwal R, O'Brien M, Johnston S, Smith IE. A randomised pilot Phase II study of doxorubicin and cyclophosphamide (AC) or epirubicin and cyclophosphamide (EC) given 2 weekly with pegfilgrastim (accelerated) vs 3 weekly (standard) for women with early breast cancer. Br J Cancer 2009; 100:305-10. [PMID: 19165198 PMCID: PMC2634727 DOI: 10.1038/sj.bjc.6604862] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Accelerated (dose-dense) chemotherapy, in which the frequency of administration is increased without changing total dose or duration, may increase the efficacy of cancer chemotherapy. We performed a randomised Phase II study to assess the safety and relative toxicity of AC (doxorubicin; cyclophosphamide) vs E(epirubicin)C given by conventional or accelerated schedules as neoadjuvant or adjuvant chemotherapy for early breast cancer. Furthermore, the relative toxicity of doxorubicin and epirubicin remains uncertain. Patients were randomised to one of four arms; four courses of standard 3 weekly cyclophosphamide 600 mg m−2 in combination with doxorubicin 60 mg m−2 (AC) vs epirubicin 90 mg m−2 (EC) 3 weekly vs the same regimens administered every 2 weeks with pegfilgrastim (G-CSF). A total of 126 patients were treated, 42 with standard AC, 42 with accelerated AC, 19 with standard EC and 23 with accelerated EC. Significantly more grade 3/4 day one neutropenia was seen with standard (6/61, 10%) compared to accelerated (0/65,) regimens (P=0.01). A trend towards more neutropenic sepsis was seen in the combined standard and accelerated AC arms (12/84, 14%) compared to the combined EC arms (1/42, 2%), P=0.06. Falls in left ventricular ejection fraction were not increased with accelerated treatment. Accelerated AC and EC with pegfilgrastim are safe and feasible regimens in the treatment of early breast cancer with less neutropenia than conventional 3 weekly schedules.
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Affiliation(s)
- R L Jones
- Breast Unit, Royal Marsden NHS Trust, London, UK
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Walsh G, Pearce EI. The difference between belief and reality for Viktorin’s method of inter-pupillary distance measurement. Ophthalmic Physiol Opt 2009; 29:150-4. [DOI: 10.1111/j.1475-1313.2008.00619.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Abstract
Nurses commonly face challenges placing peripheral intravenous (IV) lines in adults and children, a situation described as difficult venous access (DVA). Multiple venipuncture attempts can heighten patient anxiety and suffering, delay vital treatment, and increase costs. Numerous factors such as small, fragile or hidden veins can predispose patients to DVA, and collapsed veins due to dehydration are especially problematic. Several techniques can improve venous prominence, but when IV access cannot be achieved promptly, other routes of administration can be valuable. For rehydration fluids and certain drugs, subcutaneous administration may be a safe and effective alternative, providing cost and ease-of-use advantages.
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Sirohi B, Arnedos M, Popat S, Ashley S, Nerurkar A, Walsh G, Johnston S, Smith IE. Platinum-based chemotherapy in triple-negative breast cancer. Ann Oncol 2008; 19:1847-52. [PMID: 18567607 DOI: 10.1093/annonc/mdn395] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Experimental data suggest that triple-negative (TN) breast cancer may have increased sensitivity to platinum-based chemotherapy but clinical data are limited. We present our long-term results with platinum-based chemotherapy for TN breast cancer. PATIENTS AND METHODS In all, 94 (17 TN), 79 (11 TN) and 155 (34 TN) patients receiving platinum-based chemotherapy in neo-adjuvant/adjuvant and advanced setting were included. Response rates and outcome were compared for TN tumours versus others. RESULTS Neo-adjuvant complete response rates were significantly higher for TN tumours (88%) than others (51%; P = 0.005). The 5-year overall survival (OS) for TN tumours following adjuvant/neo-adjuvant chemotherapy was 64% [95% confidence interval (CI) 44% to 79%] compared with 85% (95% CI 79% to 90%) for others. Five-year disease-free survival for TN tumours was 57% (95% CI 37% to 73%) compared with 72% (95% CI 64% to 78%) for others. For patients with advanced breast cancer, overall response rates were 41% for TN tumours and 31% for others (P = 0.3). Patients with TN tumours had a significantly prolonged progression-free survival of 6 months compared with 4 months for others (P = 0.05), though the OS was not significantly different between the two groups (11 versus 7 months). CONCLUSION Platinum-based chemotherapy achieves increased response rates for TN tumours, with a trend towards worse survival in early breast cancer through an improved survival in advanced disease. Prospective randomised trials are warranted.
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Affiliation(s)
- B Sirohi
- Breast Unit, Royal Marsden NHS Foundation Trust, London, UK
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Sirohi B, Arnedos M, Popat S, Ashley S, Nerurkar A, Walsh G, Johnston S, Smith IE. Platinum-based chemotherapy in triple-negative (TN) breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1051] [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: 11/20/2022] Open
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