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One-year follow-up of conservative management of appendicitis: results from a single centre during extended lockdown in the COVID-19 pandemic. Ann R Coll Surg Engl 2023; 105:S54-S59. [PMID: 35639081 PMCID: PMC10390236 DOI: 10.1308/rcsann.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Conservative management with antibiotics was recommended by the UK Surgical Royal Colleges early in the COVID-19 pandemic as the first-line treatment for acute uncomplicated appendicitis. METHODS This is a prospective single-centre cohort study of patients aged 16 years or over, diagnosed clinically and confirmed radiologically with acute appendicitis in a secondary care setting who were initially treated conservatively with antibiotics. The primary outcome was the response to conservative management with antibiotics. Secondary outcomes were: antibiotic duration; operative rates; surgical approach (open, laparoscopic or conversion to open); complication rates; COVID-19 positive rate; rates of readmission within 12 months; and length of hospital stay. RESULTS A total of 109 patients were included in the study, 67 of whom were male. Median age was 37 (range 17-93) years. A further 28 patients were excluded because of a decision to manage operatively on the index admission or because of other diagnoses. Thirty-three patients (30.3%) had surgery on the index admission after failed conservative management and 15 (13.8%) had surgery on readmission. On histology, 32/48 patients (66.7%) had a diagnosis of complicated appendicitis and 18/48 (37.5%) had a confirmed appendicolith. CONCLUSIONS There was a high readmission rate (47/109; 43.1%) for surgery, a radiological drain or conservative management within the first year following initial conservative management. There is a significant risk of recurrence of symptoms, particularly in the presence of an appendicolith. Laparoscopic appendicectomy should be the first-line treatment, with conservative management reserved for patients with acute uncomplicated appendicitis who are COVID-19 positive or have comorbidities.
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Constructing custom-made radiotranscriptomic signatures from CT angiograms: an application in COVID-19 vascular inflammation. Eur Heart J 2022. [PMCID: PMC9619526 DOI: 10.1093/eurheartj/ehac544.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Advances in computational methodologies have enabled processing of large datasets originating from imaging studies. However, most imaging biomarkers suffer from a lack of direct links with underlying biology, as they are only observationally correlated with pathophysiology. Purpose To develop and validate a novel AI-assisted image analysis platform, by applying quantitative radiotranscriptomics that quantifies cytokine-driven vascular inflammation from routine CT angiograms (CTA) performed as part of clinical care in COVID-19. Methods We used this platform to train the radiotranscriptomic signature C19-RS, derived from the perivascular space around the aorta and the internal mammary artery in routine chest CTAs, to best describe cytokine-driven vascular inflammation, defined using transcriptomic profiles from RNA sequencing data from human arterial biopsies (A). This signature was validated externally in 358 clinically indicated CT pulmonary angiograms from patients with or without COVID-19 from 3 different geographical regions. Results First, 22 patients who had a CTA before the pandemic underwent repeat CTA <6 months post COVID-19 infection (B). Compared with 22 controls (matched for age, gender, and BMI) C19-RS was increased only in the COVID-19 group (C). Next, C19-RS was calculated in a cohort of 331 patients hospitalised during the pandemic, and was higher in COVID-19 positives (adjusted OR=2.97 [95% CI: 1.43–6.27], p=0.004, D). C19-RS had prognostic value for in-hospital mortality in COVID-19, with HR=3.31 ([95% CI: 1.49–7.33], p=0.003) and 2.58 ([95% CI: 1.10–6.05], p=0.028) in two testing cohorts respectively (E, F), adjusted for clinical factors and biochemical biomarkers of inflammation and myocardial injury. The corrected HR for in-hospital mortality was 8.24 [95% CI: 2.16–31.36], p=0.002 for those who received no treatment with dexamethasone, but only 2.27 [95% CI: 0.69–7.55], p=0.18 in those who received dexamethasone subsequently to the C19-RS based image analysis, suggesting that vascular inflammation may have been a therapeutic target of dexamethasone in COVID-19. Finally, C19-RS was strongly associated (r=0.61, p=0.0003) with a whole blood transcriptional module representing dysregulation of coagulation and platelet aggregation pathways. Conclusion We present the first proof of concept study that combines transcriptomics with radiomics to provide a platform for the development of machine learning derived radiotranscriptomics analysis of routine clinical CT scans for the development of non-invasive imaging biomarkers. Application in COVID-19 produced C19-RS, a marker of cytokine-driven inflammation driving systemic activation of coagulation, that predicts in-hospital mortality and identifies people who will have better response to anti-inflammatory treatments, allowing targeted therapy. This AI-assisted image analysis platform may have applications across a wide range of vascular diseases, from infections to autoimmune diseases. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): EPSRC, British Heart Foundation, NIHR
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Automated deep learning quantification of epicardial adiposity on cardiac CT predicts atrial fibrillation risk immediately following cardiac surgery and long-term. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Epicardial adipose tissue (EAT) is a visceral fat deposit within the pericardial sac which surrounds the heart myocardium and coronary arteries. The automated quantification of EAT volume is possible from routine CCTA scans via a deep-learning approach. The use of automated EAT quantification for the assessment of atrial fibrillation (AF) risk in the post-operative period, and longer-term, has not been previously investigated.
Purpose
To apply a deep-learning approach for automated segmentation of EAT from routine CCTA scans to assess the immediate post-operative and long-term risk of AF conveyed by EAT.
Methods
A deep-learning automated EAT segmentation tool using a 3D Residual-U-Net neural network architecture for 3D volumetric segmentation of CCTA data was created and trained on over 2800 consecutive CCTA performed as part of clinical care in patients with stable chest pain from 2015 onwards within the European arm of the Oxford Risk Factors And Non Invasive Imaging (ORFAN) Study. External validation in 817patients demonstrated excellent correlation between machine and human expert (CCC = 0.972). The prognostic value of deep-learning derived EAT volume was assessed in the AdipoRedOx Study (n=253; UK patients undergoing cardiac surgery) against both immediate in-hospital outcomes and longer-term outcomes from UK-wide NHS data, with adjustment for AF risk factors.
Results
There were 97 cases of new-onset AF in the immediate post-operative period (38.3%). EAT volume was found to be an independent predictor of post-operative AF regardless of body mass index. Utilising the median EAT volume as the cut point, the adjusted hazard ratio (HR [95% CI]) for risk of new-onset post-operative AF in-hospital was 1.56 [1.09–3.85], p<0.01 (Figure 1A). In receiver-operator characteristic analysis EAT volume added significant incremental prognostic power for the discrimination of in-hospital post-operative AF over a traditional risk factor model ΔAUC=0.101, p<0.01 (Figure 1B).
Over a median follow-up period of 89 months there were 48 unique cases (19%) of confirmed AF found in nation-wide NHS hospital episode statistics data for the AdipoRedOx cohort. EAT volume was found to be a significant independent predictor of long-term AF. Utilising the median EAT volume as the cut point, the adjusted HR for risk of new-onset long-term AF following cardiac surgery was 1.25 [1.08–3.17], p<0.01 (Figure 1C).
Conclusions
Automatically segmented EAT volume measured using a deep learning network predicts risk of both short-term new onset AF following cardiac surgery, and long-term risk of AF in the 7 years following the surgery independently of BMI and AF risk factors. This suggests that EAT is a potent mediator of AF risk in the post cardiac surgery setting.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation - TG/19/2/34831EU Commission - 965286
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410 Automated Deep Learning Quantification Of Epicardial Adiposity On Cardiac CT Predicts Atrial Fibrillation Risk Immediately Following Cardiac Surgery And Long-term. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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90P Disease-free survival (DFS) as a predictor of overall survival (OS) in completely resected early stage non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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89P Treatment patterns, overall survival (OS), and disease-free survival (DFS) in early stage non-small cell lung cancer (NSCLC) following complete resection. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Proteome and secretome profiling of zinc availability in Cryptococcus neoformans identifies Wos2 as a subtle influencer of fungal virulence determinants. BMC Microbiol 2021; 21:341. [PMID: 34903172 PMCID: PMC8667453 DOI: 10.1186/s12866-021-02410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fungal infections impact over 25% of the global population. For the opportunistic fungal pathogen, Cryptococcus neoformans, infection leads to cryptococcosis. In the presence of the host, disease is enabled by elaboration of sophisticated virulence determinants, including polysaccharide capsule, melanin, thermotolerance, and extracellular enzymes. Conversely, the host protects itself from fungal invasion by regulating and sequestering transition metals (e.g., iron, zinc, copper) important for microbial growth and survival. RESULTS Here, we explore the intricate relationship between zinc availability and fungal virulence via mass spectrometry-based quantitative proteomics. We observe a core proteome along with a distinct zinc-regulated protein-level signature demonstrating a shift away from transport and ion binding under zinc-replete conditions towards transcription and metal acquisition under zinc-limited conditions. In addition, we revealed a novel connection among zinc availability, thermotolerance, as well as capsule and melanin production through the detection of a Wos2 ortholog in the secretome under replete conditions. CONCLUSIONS Overall, we provide new biological insight into cellular remodeling at the protein level of C. neoformans under regulated zinc conditions and uncover a novel connection between zinc homeostasis and fungal virulence determinants.
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P53.06 A Multi-Phase Quality Initiative to Improve Processes of Care for Non-small Cell Lung Cancer (NSCLC) in US Community Cancer Centers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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MA12.01 A Novel Program Offering Remote, Asynchronous Subspecialist Input in Thoracic Oncology: Early Experience During a Pandemic. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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FP02.01 Utilization and Refusal of Adjuvant Chemotherapy for Non-Small Cell Lung Cancer: A National Cancer Database Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Real world cost and health outcomes of patients presented with chest pain in England: which is the most cost-effective first-line test? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The National Institute for Health and Care Excellence (NICE) updated their guidance for the management of patients with stable chest pain and recommended that all patients undergo computed tomography coronary angiography (CTCA). This update has sparked a great deal of debate, and was followed by upgrade of CTCA into a Class I indication in the recent ESC guidelines. The cost-effectiveness of using CTCA as first line investigation is still unclear.
Purpose
To describe the current clinical pathway of patients with stable chest pain presented to outpatient clinics, assess the compliance with the updated NICE guideline, and explore the costs and health outcomes of different non-invasive diagnostic tests in real-world clinical setting.
Methods
We used data of 4,297 patients who attended chest pain clinics in Oxford between 1 January 2014 and 31 July 2018. Data included clinical presentation (e.g. age and previous cardiovascular conditions), diagnostic tests, outpatient visits, hospitalization, and hospital mortality and was compared between 6 alternative first-line diagnostic tests. Multinomial regressions were performed to estimate the probability of receiving each alternative and the associated cost after adjusting for clinical presentation. A decision tree was developed to describe the clinical pathway for each alternative first-line diagnostic in terms of subsequent diagnostic tests and treatments and to estimate the associated costs and life days.
Results
The proportion of patients who received CTCA as first line diagnostic test increased from 1% in 2014 to 17% in 2018, while the publication of the updated NICE guidelines in 2016 led to a threefold increase in this proportion. CTCA is less likely to be provided as a first-line diagnostic to patients who are younger age, males, smokers, and have angina, PVD, or diabetes. The standardised rate of hospital admission was the lowest in the exercise ECG cohort (0.35 admissions per 1,000 life-days) followed by the CTCA cohort (0.40 admissions per 1,000 life-days) while the latter cohort had the lowest standardised rate of cardiovascular treatment (2.74% per 1,000 life days). Stress echocardiography and MPS were associated with higher costs compared with CTCA, other ECG, and exercise ECG after adjusting for clinical presentation and days of follow-up. CTCA is the pathway most likely to be cost-effective, even compared to exercise ECG, while the other diagnostic alternatives are dominated (i.e. they cost more for less life-days).
Conclusions
Currently, the updated NICE guidelines for stable chest pain are implemented only to a fifth of the cases in England. Our findings support existing evidence that CTCA is the most-cost effective first-line diagnostic test for this population. Hopefully, this will inform the debate around the implementation of the guidelines and help commissioning and clinical decision processes worldwide.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research Oxford Biomedical Research Centre
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ARE Wives of Migrants in Rural Bangladesh Really “Left behind”? A Nuanced Analysis of How Spousal Migration Affects Women’s Healthcare Utilization. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self‐help materials to prevent post‐traumatic stress disorder following childbirth. BJOG 2020; 127:886-896. [DOI: 10.1111/1471-0528.16163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
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Position of an international panel of lung cancer experts on the decision for expansion of approval for pembrolizumab in advanced non-small-cell lung cancer with a PD-L1 expression level of ≥1% by the USA Food and Drug Administration. Ann Oncol 2019; 30:1686-1688. [PMID: 31504132 DOI: 10.1093/annonc/mdz295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P1.01-127 Antitumor Activity of the Oral EGFR/HER2 Inhibitor TAK-788 in NSCLC with EGFR Exon 20 Insertions. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Computerized Cognitive Rehabilitation verses Clinician Directed Therapy in mTBI. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz035.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cognitive problems following mTBI are common and typically managed with one-on-one clinician directed treatment (CDT); however, this is time and labor intensive. Computerized cognitive rehabilitation (CCR) programs overcome these limitation but the comparable efficacy is not well understood in mTBI.
Method
A randomized controlled trial included 13 active duty service members with a history of mTBI and persistent cognitive complaints. Participants received either CCR (N = 6) or CDT (N = 7) during the initial phase of this study. Treatments were one hour, 3 times a week for 4 weeks. Average age was 32.77 (SD = 7.96). Average intelligence estimated by word reading was average (WTAR M = 107.46, SD = 9.32). Specific measures for attention included Symbol Digit Modality Test (SDMT), Paced Auditory Serial Addition Test (PASAT), Conners Continuous Performance Test (CPT-3), as well as Digit Forward (DF), Digit Backward, and Driving from the Neuropsychological Assessment Battery (NAB). Standard scores corrected for age were analyzed. Change scores were computed between pre and post intervention.
Results
There was a significant difference for SDMT (p = 0.034, d = 1.342) and DF (p = 0.0015, d = 2.33), where those who received CDT showed greater improvement. The groups did not differ on Driving, PASAT, CPT-3, and DB (p’s > 0.62).
Conclusions
Preliminary analysis of data suggests that clinician directed treatment was superior to a computerized intervention matched for time and intensity in treating patients with persistent cognitive complaints following mTBI. Large effects were observed on measures of processing speed and focused attention. This may suggest computerized treatment alone is less effective though further data is needed.
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Brigatinib in crizotinib-refractory ALK+ non-small cell lung cancer (NSCLC): efficacy updates and exploratory analysis of target lesion response by baseline brain lesion status in the ALTA Trial. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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IMpower130: Progression-free survival (PFS) and safety analysis from a randomised phase III study of carboplatin + nab-paclitaxel (CnP) with or without atezolizumab (atezo) as first-line (1L) therapy in advanced non-squamous NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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P3.01-32 An Open-Label, Non-Randomized, Biomarker Study of Concordance in Non-Invasive and Tissue Tests for T790M Detection in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Quantitative Synthetic MRI in Children: Normative Intracranial Tissue Segmentation Values during Development. AJNR Am J Neuroradiol 2017; 38:2364-2372. [PMID: 28982788 DOI: 10.3174/ajnr.a5398] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/03/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Synthetic MR imaging is a new technique to create absolute R1 relaxivity (1/T1), R2 relaxivity (1/T2), and proton-density maps using a single multiple-spin-echo saturation recovery sequence. These relaxivity maps allow rapid automated intracranial segmentation of tissue types. To assess its utility in children, we created a normative data base of intracranial volume and brain parenchymal, GM, WM, CSF, and myelin volumes in a pediatric population with normal brain MRI findings using synthetic MR imaging. MATERIALS AND METHODS All multiple-spin-echo saturation recovery sequences containing brain MR imaging examinations performed during 34 months were retrospectively reviewed. Abnormal examination findings were excluded following a detailed radiographic and clinical chart review. The remaining normal examination findings were then quantitatively analyzed with synthetic MR imaging. Intracranial, brain parenchymal, GM, WM, CSF, and myelin volumes were plotted versus age. Qualitative assessment of segmentation accuracy was performed. Selected abnormal examination findings were compared with these normative curves. RESULTS One hundred twenty-two MRI examinations with normal findings were included of individuals ranging from 0.1 to 21.5 years of age (median, 11.8 years). Resulting normative data plots compared favorably with previously published data obtained using more onerous techniques. Differentiation from pathologic states was possible using quantitative values in select cases. CONCLUSIONS A pediatric data base of normal intracranial tissue volumes using a single sequence and rapid software analysis has been compiled and correlates with previously published data. This provides a framework for clinical interpretation of quantitative synthetic MR images during development. Improved age-based segmentation algorithms in young children are needed.
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Left Atrial and Left Ventricular Strain in the Prediction of Atrial Fibrillation in a Community Cohort with Risk Factors. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Serial plasma genotyping of patients with EGFR-mutant lung cancer treated with ASP8273 demonstrates acquired resistance mediated by EGFR C797S. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Renal transplantation using donor grafts with complete ureteral duplication. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Phase 1b study of crizotinib in combination with pembrolizumab in patients (pts) with untreated ALK-positive (+) advanced non-small cell lung cancer (NSCLC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Exposure to cardiovascular disease risk factors in childhood is associated with increased carotid extra medial thickness in adulthood: The childhood determinants of adult health study. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brigatinib (BRG) in Crizotinib (CRZ)-Refractory ALK+ Non–Small Cell Lung Cancer (NSCLC): efficacy and safety results from ALTA, a pivotal randomized phase 2 Trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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The failure of figitumumab: the danger of taking shortcuts in drug development. Ann Oncol 2015; 26:447-8. [DOI: 10.1093/annonc/mdu570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Exposure to parental smoking in childhood is associated with increased risk of carotid atherosclerotic plaque in adulthood: The Cardiovascular Risk in Young Finns Study. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abound.Sqm: a Phase 3 Randomized Study of Maintenance Nab-Paclitaxel (Nab-P) After Induction Therapy with Nab-P Plus Carboplatin (C) in Patients (Pts) with Squamous Cell (Scc) Non-Small Cell Lung Cancer (Nsclc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu348.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Exposure to parental smoking in childhood is associated with increased risk of carotid atherosclerotic plaque in adults. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey. Hernia 2013; 17:657-64. [PMID: 23543332 PMCID: PMC3788180 DOI: 10.1007/s10029-013-1061-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
Purpose Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent. Methods Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined. Results The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons’ personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these. Conclusion In the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.
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Final Results of a Phase 2, Open-Label Study of Ramucirumab (IMC-1121B; RAM), an IGG1 MAB Targeting Vegfr-2, with Paclitaxel and Carboplatin as First-Line Therapy in Patients (PTS) with Stage IIIB/IV Non-Small Cell Lung Cancer (NSCLC) (NCT00735696). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cardiovascular safety assessments in the conscious telemetered dog: Utilisation of super-intervals to enhance statistical power. J Pharmacol Toxicol Methods 2010; 62:12-9. [DOI: 10.1016/j.vascn.2010.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
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QA interval as an indirect measure of cardiac contractility in the conscious telemeterised rat: Model optimisation and evaluation. J Pharmacol Toxicol Methods 2009; 60:159-66. [DOI: 10.1016/j.vascn.2009.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/10/2009] [Indexed: 11/28/2022]
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Phase I/II study of MKC-1 and pemetrexed (PEM) as second-line therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19005 Background: MKC-1 is a novel oral cell cycle inhibitor with preclinical activity against NSCLC cell lines including multi-drug resistant lines, and single agent activity in NSCLC pts. Binding targets of MKC-1 include microtubules, members of the importin-β family and AKT-mTOR. This phase 1/2 study evaluated MKC-1 in combination with PEM as second-line therapy in pts with advanced NSCLC. Methods: Eligible pts had NSCLC previously treated with one regimen for metastatic disease or disease progression within one year following adjuvant and neoadjuvant therapy. Phase 1 dose escalation used 3+3 design. Phase 2 pts were treated with MKC-1 at 75 mg/m2 given p.o. BID for 14 days along with PEM at 500 mg/m2 given i.v. on day 1 of each 21 day cycle. Following 4 cycles of combined treatment, single agent MKC-1 was continued as maintenance therapy. An interim analysis after 17 pts in phase 2 would allow accrual to continue provided one response was confirmed. Results: 27 pts were enrolled (8 in phase 1 and 19 in phase 2). Median age/PS for phase 2 is 64/1 and 89% had adenocarcinoma. Total # of treatment cycles to date for phase 2 pts is 95, with a median of 4 cycles. Of the 19 phase 2 pts, 18 were evaluable for tumor response. The best response was confirmed PR, noted in 3 pts. 5 additional pts (4 confirmed) had minor responses (>10% but <30% shrinkage). One additional pt continues on study with stable disease for >18 months. In phase 2 (n=19), all grade toxicities were anorexia (59%), fatigue (63%), nausea (58%), and dyspnea (48%). Grade 3/4 toxicities included fatigue (26%); neutropenia (22%); dyspnea, anorexia, AST and ALT elevation (11% each); nausea and constipation (5% each). 7 pts had at least one dose reduction of both PEM and MKC-1 and 3 additional pts had only MKC-1 reduced. Median PFS was 86 days with two pts continuing on study (treated for 530+ days and 140+ days, respectively). Conclusions: The phase 2 dose of MKC-1 (75 mg/m2 BID) and PEM (500 mg/m2) has been defined. The combination is well tolerated with 17% of patients achieving a confirmed PR thus far. A decision to proceed with additional accrual in this single arm study versus initiating a randomized phase 2 study of this combination is pending. [Table: see text]
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Application of modified ECG lead placement technique in rat telemetry safety studies; outcome and potential use. J Pharmacol Toxicol Methods 2008. [DOI: 10.1016/j.vascn.2008.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Long-term survival with gefitinib (ZD 1839) therapy for advanced bronchioloalveolar lung cancer (BAC): Southwest Oncology Group (SWOG) study S0126. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Phase II trial of 21-day regimen of irinotecan and carboplatin for chemonaive or relapsed small-cell lung cancer: Long-term survival. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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39
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Phase 1/2 trial of MKC-1 and pemetrexed in patients (pts) with advanced NSCLC. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mitochondrial genomes of the sheep blowfly, Lucilia sericata, and the secondary blowfly, Chrysomya megacephala. MEDICAL AND VETERINARY ENTOMOLOGY 2008; 22:89-91. [PMID: 18380659 DOI: 10.1111/j.1365-2915.2008.00710.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This paper presents complete mitochondrial genomes for the sheep blowfly, Lucilia sericata (Meigen), and the secondary blowfly, Chrysomya megacephala (Fabricius). Both L. sericata and C. megacephala had standard dipteran-type mitochondrial genome architectures and lengths of 15 945 bp and 15 831 bp, respectively. Additionally, C. megacephala possessed a tRNA duplication either side of the D-loop, as previously reported in another Chrysomya species, C. putoria; this duplication appears to be synapomorphic for the genus Chrysomya. As in other insect mitochondrial genomes, base compositions had a high AT content, with both genomes more than 76% AT-rich.
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Potentialities and Limitations of Medical Data on Official Birth Certificates. Am J Public Health Nations Health 2008; 50:338-45. [PMID: 18017804 DOI: 10.2105/ajph.50.3_pt_1.338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P1388 Aminoglycosides, mortality and increase of serum-creatinine in patients with bacteraemia given appropriate empirical therapy. A Danish hospital-based cohort study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Combination of EGFR gene copy number and protein expression predicts outcome for advanced non-small-cell lung cancer patients treated with gefitinib. Ann Oncol 2007; 18:752-60. [PMID: 17317677 DOI: 10.1093/annonc/mdm003] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Biological markers for optimal selection of patient to epidermal growth factor receptor (EGFR)-targeted therapies are not established in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS EGFR/HER2 gene copy number by FISH, EGFR protein and pAKT expression by immunohistochemistry (IHC) and EGFR and KRAS mutations were tested in 204 gefitinib-treated NSCLC patients. RESULTS Increased EGFR and HER2 gene copy number (FISH+), EGFR protein overexpression (IHC+), EGFR mutations and pAKT overexpression were all associated with significantly higher response rates (33%, 29%, 22%, 39% and 20% respectively). EGFR FISH+ (32%) and IHC+ (61%) correlated with improved survival, while EGFR mutations (27%), KRAS mutations (26%) and pAKT expression (69%) did not. In multivariate survival analysis EGFR FISH and IHC were independent predictive markers. EGFR FISH+/IHC+ patients (23%) had a median survival of 21 months versus 6 months for double-negative patients (30%). CONCLUSION Combination of EGFR FISH and IHC is effective predictor for benefit from gefitinib. Patients with double-negative results are unlikely to benefit in western NSCLC populations.
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Abstract
7072 Background: EGFR mutations are associated with better response and in some studies (mainly Asian) also with prolonged survival after gefitinib therapy in patients with advanced NSCLC. Although a number of mutations have been reported, most frequent are exon 19 or exon 21 mutations of the EGFR tyrosine kinase domain.Whether clinical outcomes differ by subtype of EGFR mutation has not been previously reported. Methods: Mutation analysis (as previously described) was performed in 157 of 204 patients with advanced NSCLC treated with gefitinib (250 mg or 500 mg) in 2 study cohorts (Italian study of Iressa Expanded Access Program and SWOG 0126). Fifty nanograms of genomic DNA was isolated from pretreatment tumors, amplified for EGFR exons 19 and 21 by touchdown hemi-nested polymerase chain reaction and sequenced in both sense and antisense directions. Results: EGFR mutations were found in 43 pts (27%). Overall, patients with EGFR mutations had a response rate of 39% versus 7% for those without (p ≤ 0.001), disease control rate of 52% versus 37% (p = 0.14), time to progression of 3 months in both groups and median survival of 13 months versus 11 months (p = 0.14). Patients with exon 19 mutations exclusively (N = 11) had better outcome than those with exon 21 mutations exclusively (N = 31), with response rates of 67% versus 20% (p = 0.02), median time to progression of 15 months versus 2 months, and median survival of 26 months versus 10 months. There was a difference in time to progression (11 months versus 3 months) and overall survival (median 26 months versus 11 months) between patients with and without exon 19 mutations, while no difference was apparent in these outcome measures in patients with and without exon 21 mutations. Sample size provided insufficient power for significance tests of differences in survival outcomes. Conclusions: Not all EGFR mutations are created equal. Mutations in exon 19 are more predictive of response and survival after gefitinib than exon 21 mutations. [Table: see text]
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P-497 ZD6474 in combination with carboplatin and paclitaxel as first-line treatment in patients with NSCLC: Results of the run-in phase of a two-part randomized Phase II study. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80990-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pemetrexed (P) plus gemcitabine (G) as front-line chemotherapy for patients (Pts) with locally advanced or metastatic non-small cell lung cancer (NSCLC): A phase II clinical trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Preliminary phase II safety evaluation of ZD6474, in combination with carboplatin and paclitaxel, as 1st-line treatment in patients with NSCLC. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7102] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Phase I trial of irinotecan and epirubicin in patients with advanced solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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A multi-institution phase II trial of irinotecan and carboplatin for extensive or relapsed small-cell lung cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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