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Pearson J, Khan A, Bhogal T, Wong H, Law A, Mills S, Santamaria N, Bishop J, Cliff J, Errington D, Hall A, Hart C, Malik Z, Sripadam R, Innes H, Flint H, Langton G, Ahmed E, Jackson R, Palmieri C. A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone. ESMO Open 2023; 8:102033. [PMID: 37866031 PMCID: PMC10774880 DOI: 10.1016/j.esmoop.2023.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. No direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs in patients commencing T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. PATIENTS AND METHODS Patients with human epidermal growth factor receptor 2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinicopathological information, prior treatment, the presence or absence of central nervous system (CNS) disease, outcomes and treatment-emergent adverse events (TEAEs) were recorded. RESULTS Twenty-nine female patients, with a median age of 52 years (interquartile range 44-62 years), were identified; the prevalence of BM was 41%. Median number of lines of prior therapy was 2 (range 2-6). At a median follow-up of 13.8 months, median progression-free survival (PFS) for the overall population was 13.9 months [95% confidence interval (CI) 12.4 months-not estimable (NE)], 16.1 months (95% CI 15.1 months-NE) for active BMs and 12.4 months (95% CI 8.3 months-NE) for progressive extracranial disease alone. The 12-month overall survival (OS) rate was 74% (95% CI 59% to 95%) in the overall population, and 83% (95% CI 58% to 100%) and 66% (95% CI 45% to 96%) for active BMs and extracranial disease only, respectively. Most common TEAEs were fatigue, alopecia, and constipation. In nine patients (31%, including two deaths), pneumonitis occurred. CONCLUSION In this real-world population, we demonstrate T-DXd to be effective in patients with active BMs and those with progressive extracranial disease alone. PFS and OS were numerically longer in those with active BMs. These data demonstrate that patients with active BM treated with T-DXd have at least comparable outcomes to those with extracranial disease alone. The high rate of pneumonitis warrants further consideration.
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Affiliation(s)
- J Pearson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - A Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - H Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Law
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - S Mills
- The Walton NHS Foundation Trust, Liverpool, UK
| | - N Santamaria
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Bishop
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Cliff
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Errington
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Hall
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - C Hart
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Sripadam
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Innes
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Flint
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - G Langton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - E Ahmed
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jackson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool.
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Hernando‐Calvo A, Malone E, Day D, Prawira A, Weinreb I, Yang SYC, Wong H, Rodriguez A, Jennings S, Eliason A, Wang L, Spreafico A, Siu LL, Hansen AR. Selinexor for the treatment of recurrent or metastatic salivary gland tumors: Results from the GEMS-001 clinical trial. Cancer Med 2023; 12:20299-20310. [PMID: 37818869 PMCID: PMC10652322 DOI: 10.1002/cam4.6589] [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: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the activity of selinexor, an oral selective inhibitor of nuclear export, in patients with recurrent or metastatic salivary gland tumors (SGT). METHODS GEMS-001 is an open-label Phase 2 study for patients with recurrent or metastatic SGT with two parts. In Part 1 of the protocol, patients had tumor samples profiled with targeted next generation sequencing as well as immunohistochemistry for androgen receptor, HER-2 and ALK. For Part 2, patients with no targeted therapies available were eligible to receive selinexor 60 mg given twice weekly every 28 days. The primary endpoint was objective response rate. Secondary endpoints included progression-free survival (PFS) and prevalence of druggable alterations across SGT. RESULTS One hundred patients were enrolled in GEMS-001 and underwent genomic and immunohistochemistry profiling. A total of 21 patients who lacked available matched therapies were treated with selinexor. SGT subtypes (WHO classification) included adenoid cystic carcinoma (n = 10), salivary duct carcinoma (n = 3), acinic cell carcinoma (n = 2), myoepithelial carcinoma (n = 2), carcinoma ex pleomorphic adenoma (n = 2) and other (n = 2). Of 18 evaluable patients, stable disease (SD) was observed in 17 patients (94%) (SD ≥6 months in 7 patients (39%)). However, no objective responses were observed. The median PFS was 4.9 months (95% confidence interval, 3.4-10). The most common treatment-related Grade 1-2 adverse events were nausea [17 patients (81%)], fatigue [16 patients (76%)], and dysgeusia [12 patients (57%)]. Most common treatment-related Grade 3-4 adverse events were hyponatremia [3 patients (14%)], neutrophil count decrease [3 patients (14%)] and cataracts [2 patients (10%)]. No treatment-related deaths were observed. CONCLUSIONS Although tumor reduction was observed across participants, single agent selinexor anti-tumor activity was limited.
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Affiliation(s)
- Alberto Hernando‐Calvo
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Eoghan Malone
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Daphne Day
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Amy Prawira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Ilan Weinreb
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | - Horace Wong
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | | | | | | | - Lisa Wang
- Princess Margaret Cancer CentreTorontoOntarioCanada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre. Department of MedicineUniversity of TorontoTorontoOntarioCanada
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Depenveiller C, Wong H, Crowet JM, Debelle L, Baud S, Dauchez M, Belloy N. Challenging level of rigid-body approach involving numerical elements (CHLORAINE) applied to repeated elastin peptides. J Struct Biol 2023; 215:107986. [PMID: 37343710 DOI: 10.1016/j.jsb.2023.107986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
Elastic proteins and derived biomaterials contain numerous tandemly repeated peptides along their sequences, ranging from a few copies to hundreds. These repetitions are responsible for their biochemical, biological and biomechanical properties. These sequences are considered to be intrinsically disordered, and the variations in their behavior are actually mainly due to their high flexibility and lack of stable secondary structures originating from their unique amino acid sequences. Consequently, the simulation of elastic proteins and large elastomeric biomaterials using classical molecular dynamics is an important challenge. Here, we propose a novel approach that allows the application of the DURABIN protocol to repeated elastin-like peptides (r-ELPs) in a simple way. Four large r-ELPs were studied to evaluate our method, which was developed for simulating extracellular matrix proteins at the mesoscopic scale. After structure clustering applied on molecular dynamic trajectories of constitutive peptides (5-mers and 6-mers), the main conformations were used as starting points to define the corresponding primitives, further used as rigid body fragments in our program. Contributions derived from electrostatic and molecular hydrophobicity potentials were tested to evaluate their influence on the interactions during simple mesoscopic simulations. The CHLORAINE approach, despite the thinner granularity due to the size of the patterns used, was included in the DURABIN protocol and emerges as a promising way to simulate elastic macromolecular systems.
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Affiliation(s)
- C Depenveiller
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Picardie Jules Verne, CNRS, GEC UMR 7025, 80039 Amiens, France
| | - H Wong
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Reims Champagne Ardenne, Plateau de Modélisation Moléculaire Multi-Echelle (P3M), Maison de la simulation de Champagne Ardenne (MaSCA), 51097 Reims, France
| | - J M Crowet
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Reims Champagne Ardenne, Plateau de Modélisation Moléculaire Multi-Echelle (P3M), Maison de la simulation de Champagne Ardenne (MaSCA), 51097 Reims, France
| | - L Debelle
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France
| | - S Baud
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Reims Champagne Ardenne, Plateau de Modélisation Moléculaire Multi-Echelle (P3M), Maison de la simulation de Champagne Ardenne (MaSCA), 51097 Reims, France
| | - M Dauchez
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Reims Champagne Ardenne, Plateau de Modélisation Moléculaire Multi-Echelle (P3M), Maison de la simulation de Champagne Ardenne (MaSCA), 51097 Reims, France
| | - N Belloy
- Université de Reims Champagne Ardenne, CNRS, MEDyC UMR 7369, 51097 Reims, France; Université de Reims Champagne Ardenne, Plateau de Modélisation Moléculaire Multi-Echelle (P3M), Maison de la simulation de Champagne Ardenne (MaSCA), 51097 Reims, France.
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Lee R, Wong H, Brown S, Roy E, Khosrotehrani K. 490 Variation in epidermal mutation burden after field treatment with topical 5-fluorouracil. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.504] [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: 11/19/2022]
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May C, Forshaw M, Wong H, Brass R, Corns A, Shenoy A, Mehta S. P11.45.B Improved overall survival following Stereotactic Radiosurgery for brain metastases - a single institution experience. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.234] [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: 11/12/2022] Open
Abstract
Abstract
Background
Brain metastases are increasingly common due to longer survival associated with advancements in treatment. Approximately 40% of cancer patients are diagnosed with brain metastases at some point during their disease. Stereotactic radiosurgery (SRS) avoids the neuro-cognitive toxicity associated with whole brain radiotherapy and has been increasingly offered as a treatment alternative for brain metastases. Combined with developments in systemic treatments, this approach has resulted in improved overall survival (OS). This study reviewed patients treated with single fraction SRS at our institution with a primary endpoint of overall survival.
Material and Methods
A retrospective review determined overall survival for 237 patients who received single fraction SRS for 451 brain metastases from solid tumours between 1st January 2017 and 31st December 2021. Primary tumour sites were classified as breast, kidney, colorectal, melanoma, lung or other. SPSS v.27 was used for Kaplan Meier OS determination. The median follow up was 10.3 months. Cox regression analysis assessed the association between Gross Tumour Volume (GTV) and OS.
Results
In this patient cohort, 60% (N=142) were female and 40% (N=95) were male, with a median age of 63 [32-85]. 63.7% (N = 151) had a solitary metastasis. Patients received a single fraction of 15, 17.5 or 20 Gy (prescribed to 80% isodose) dependent on the planning target volume (PTV) size and whether it was initial treatment or re-treatment. 71% of all patients were alive at 6 months with median OS of 12.0 months [10.6-13.4]. Primary tumour site significantly affected OS (Log rank, Chi squared 15.656, p0.008) with breast cancer patients (N=58) surviving longest with a median OS 16.0 months [13.6-18.4] followed by melanoma median OS 15.0 months [7.6-22.4], kidney cancer patients (N = 24) median OS 12.0 months [8.3-15.7] and lung patients (N=87) median OS 10.0 months [8.9-11.3]. The lowest median OS was for colorectal patients at 7.0 months [1.4-12.6]. However, considering the small sample size, N = 15, more data is needed to confirm the significance. The larger the GTV volume the lower the survival time (Chi squared 8.692, p 0.003).
Conclusion
71% of patients had an OS of 6.0 months or more with a median of 12.0 months. As expected, primary tumour site has a significant impact on OS, with breast cancer patients living longest. In addition, increasing GTV size is associated with significantly worse survival. Given the improved survival for these patients, the avoidance of neuro cognitive decline remains of paramount importance and outcomes for these patients need to be reported in future work.
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Affiliation(s)
- C May
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - M Forshaw
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - H Wong
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - R Brass
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - A Corns
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - A Shenoy
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
| | - S Mehta
- Clatterbridge Cancer Centre , Liverpool , United Kingdom
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McKenzie J, Kosmider S, Wong R, To Y, Shapiro J, Dunn C, Burge M, Hong W, Caird S, Lim S, Wong H, Lee B, Gibbs P, Wong V. P-187 Epidermal growth factor receptor inhibitors (EGFRi) in patients with left-side, RAS wildtype metastatic colorectal cancer: Clinician use and outcomes for patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.277] [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: 11/17/2022] Open
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Kopec J, Sayre EC, Cibere J, Li L, Wong H, Okhmatovskaia A, Esdaile J. OP0054 REDUCING THE BURDEN OF LOW BACK PAIN: RESULTS FROM A NEW MICROSIMULATION MODEL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLow back pain (LBP) has been the leading cause of disability worldwide for the past 30 years. In 2019, LBP was responsible for 64 million years lived with disability (YLDs) [1].ObjectivesThe purpose of the present study was to project and compare the impact of three strategies for reducing the population health burden of LBP: weight loss, ergonomic interventions, and an exercise program.MethodsWe have developed a microsimulation model of LBP in Canada using a novel simulation platform, SimYouLate. The initial population was derived from Cycle 1 (2001) of the Canadian Community Health Survey (CCHS). We modeled an open population 20 years of age and older. Key variables included age, sex, education, body mass index (BMI), type of work, having a back problem, pain level in persons with back problems, and exercise. The effects of interventions on the risk of LBP were obtained from the CCHS for the effect of BMI, the Global Burden of Disease Study for occupational risks, and a published meta-analysis for the effect of exercise. All interventions lasted from 2021 to 2040. Strength of the interventions varied over a wide range. YLDs were defined as LBP prevalence multiplied by disability weight. The population health impact of the interventions was calculated as a difference in YLDs between the base-case scenario and each intervention scenario and expressed as YLDs averted per intervention unit and as % of total LBP-related YLDs.ResultsIn the base-case scenario, LBP in 2020 was responsible for 424,900 YLDs in Canada and the amount increased to 460,312 YLDs in 2040. The effects of the interventions on YLDs were as follows: 27,993 (95% CI 23,373, 32,614) YLDs averted over 20 years per 0.1 unit change in log-transformed BMI (10.5% change in BMI) among overweight and obese individuals, 19,416 (16,275, 22,557) YLDs averted per 1% reduction in the proportion of workers exposed to occupational risks, and 26,058 (22,455, 29,661) YLDs averted per 1% increase in the proportion of eligible patients with back problems participating in the exercise program. Table 1 shows the intervention impact as % of total LBP-related YLDs and Figure 1 shows YLD-equivalence between the interventions. A one unit reduction in BMI per year among the overweight and obese individuals would be approximately equivalent in terms of disability reduction to an effective ergonomic intervention in 35% of at-risk workers and an exercise intervention in 27% of eligible patients with back problems over the same period (Figure 1).Table 1.YLDs averted between 2021 and 2040 as % of total LBP-related YLDs, according to intervention type and level, in persons aged 20+ in CanadaInterventionEffect (%)95% LCL95% UCLReduction in BMI per year0.11.4-1.44.10.34.82.27.30.56.33.98.81.08.56.011.03.011.99.414.45.013.510.916.0Reduction in occupational exposure20%5.21.98.540%9.56.412.760%13.810.616.980%18.114.821.4100%22.418.825.9Increase in exercise participation20%6.62.810.440%12.48.716.060%18.114.521.780%23.920.127.6100%29.625.533.7LCL: lower confidence limit. UCL: upper confidence limit.Figure 1.Equivalence between BMI, ergonomic and exercise interventions in terms of their impact on YLDs. Each point represents a specific number of YLDs averted. Values on the y-axis show reduction in % of workers at risk and increase in % exercising that are required to achieve the same reduction in YLDs as the corresponding reduction in BMI shown on the x-axis.ConclusionThis is the first population-based microsimulation study to compare currently available preventive strategies in LBP in terms of YLDs averted and to provide measures of equivalence between these strategies.References[1]Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391(10137):2356-2367.AcknowledgementsThe study was supported by a grant from the Canadian Institutes for Health Research (FRN 142440).Disclosure of InterestsNone declared.
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Lheureux S, Alqaisi H, Cohn DE, Chern JY, Duska LR, Jewell A, Corr B, Winer IS, Girda E, Crispens MA, Dhani NC, Grant RC, Uthayakumaran S, Lee C, Bowering V, Wong H, Wang L, Bedard PL, Moscow J, Oza AM. A randomized phase II study of bevacizumab and weekly anetumab ravtansine or weekly paclitaxel in platinum-resistant or refractory ovarian cancer NCI trial#10150. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5514] [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: 11/20/2022] Open
Abstract
5514 Background: Mesothelin and its binder, antigen-CA125, are highly expressed in high grade serous and endometrioid ovarian cancers (HGOC) and, can inhibit paclitaxel-induced cell death. Anetumab ravtansine (AR) is a fully-human antibody directed at the mesothelin antigen, conjugated to a tubulin polymerization inhibitor. We assessed the safety and activity of the combination AR/bevacizumab (ARB) versus weekly paclitaxel/bevacizumab (PB) in patients (pts) with platinum resistant HGOC. Methods: An initial run-in phase I assessed the safety of ARB. After determination of the recommended phase 2 dose (RP2D), a multicenter 1:1 randomized phase 2 trial was designed to evaluate the progression free survival (PFS) in pts with platinum resistant/refractory HGOC. Pts were stratified by platinum resistant or refractory and prior bevacizumab (bev). Eligibility required measurable disease and mesothelin tested positive centrally on archival tissue by IHC. No limitation on the number of prior lines of therapy. A futility analysis was planned at 35 PFS events. The control arm was weekly intravenous paclitaxel 80mg/m2 with bev 10mg/kg every 2 weeks. A CT was performed every 8 weeks for RECIST1.1 assessment. The toxicities were reported according to CTCAE version 5.1. NCT03587311. Results: 7 pts were enrolled in the run-in phase 1 and the RP2D determined as bev (10mg/kg) biweekly with AR (2.2mg/kg) weekly on a 28 day-cycle. In the phase 2, 57 pts were enrolled, 28 pts in the ARB and 29 pts in the control group. The positivity rate for mesothelin screening was 88%. Pts were heavily pre-treated, median prior lines of 3 (range (1-9) with 24 pts received prior bev (42%) and 13 pts were platinum refractory (7 in ARB and 6 in PB). At the time of 35 PFS events, one CR and 4 PR were observed (ORR = 18%) in the ARB arm, versus no CR and 16 PR in the weekly PB (ORR = 55%). The estimated median PFS was 5.3 (95% CI: 3.7-7.4) months for ARB and 9.6 (95% CI: 7.4-17.4) months for PB (HR = 1.7(95% CI: 0.9-3.4)). The median number of cycles were 4 (1, 29) and 8 (1, 19) respectively. The most common treatment-related AEs in the ARB arm were mostly grade 1/2 increase AST (71%) and ALT (64%), thrombocytopenia (61%), fatigue (57%), and peripheral neuropathy (46%). In the PB arm, the most common treatment-related AE were anemia (66%), neutropenia (59%), epistaxis (48%), fatigue (45%) and peripheral neuropathy (45%). Conclusions: At the time of futility analysis, weekly PB had better outcome than weekly ARB leading to the study termination. Molecular and blood analyses are on-going to assess potential biomarkers of response. This study highlights the importance of randomization in assessment of novel therapies and potential for re-challenge with bevacizumab. These data show that weekly PB is an effective regimen and can be considered as the control arm in platinum resistant HGOC. Clinical trial information: NCT03587311.
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Affiliation(s)
- Stephanie Lheureux
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David E. Cohn
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | | | | | - Andrea Jewell
- University of Kansas Medical Hospital/The Women’s Cancer Center, Overland Park, KS
| | | | | | - Eugenia Girda
- Rutgers Cancer Inst of New Jersey, New Brunswick, NJ
| | | | - Neesha C. Dhani
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert C. Grant
- Department of Medical Oncology and Hematology, Toronto, ON, Canada
| | | | - Crystal Lee
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Valerie Bowering
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Horace Wong
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Amit M. Oza
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Alexander M, Harris S, Underhill C, Torres J, Sharma S, Lee N, Wong H, Eek R, Michael M, Tie J, Rogers J, Heriot A, Ball D, MacManus M, Wolfe R, Solomon B, Burbury K. PO-44: Risk assessment model potency to detect patients most likely to benefit from thromboprophylaxis: an application of the TARGET- TP score. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00234-1] [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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Alexander M, Harris S, Underhill C, Torres J, Sharma S, Lee N, Wong H, Eek R, Michael M, Tie J, Rogers J, Heriot A, Ball D, MacManus M, Wolfe R, Solomon B, Burbury K. OC-15: Targeted thromboprophylaxis in ambulatory patients receiving anticancer therapies for lung or gastrointestinal cancers (TARGET-TP); a randomized trial. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dight J, Sormani L, Hashemi G, Wong H, Patel J, Roy E, Khosrotehrani K. 258 Interleukin 6 signalling in endovascular progenitors is a driver of melanoma vascularisation and metastasis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhao J, Patel J, Kaur S, Sim S, Styke C, Wong H, Yoder M, Roy E, Francois M, Khosrotehrani K. 345 Abrogation of Sox9 expression in the endothelium blocks aberrant vascular EndMT and fibrosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wong H, Lim F, Cheng A. PO-1174 3-weekly paclitaxel-carboplatin with radiation for stage III NSCLC – option during COVID-19 pandemic. Radiother Oncol 2021. [PMCID: PMC8629141 DOI: 10.1016/s0167-8140(21)07625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abraham C, Nicholas O, Lewis R, Selby A, Wong H, Hugtenburg R. PO-1899 Hippocampal Dose Sparing in Nasopharyngeal Carcinoma Patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Dight J, Hashemi G, Wong H, Sim S, Sormani Le Bourhis L, Patel J, Khosrotehrani K. 696 Interleukin 6 signalling in endovascular progenitors is a driver of melanoma vascularisation and metastasis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Zhao J, Patel J, Kaur S, Sim S, Wong H, Styke C, Francois M, Yoder M, Khosrotehrani K. 637 Abrogation of Sox9 expression in the endothelium blocks aberrant vascular EndMT and fibrosis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Woo J, Leung D, Yu R, Lee R, Wong H. Factors Affecting Trends in Societal Indicators of Ageing Well in Hong Kong: Policies, Politics and Pandemics. J Nutr Health Aging 2021; 25:325-329. [PMID: 33575723 PMCID: PMC7552947 DOI: 10.1007/s12603-020-1488-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To document the trend in a quality of life indicator for the older Hong Kong population as an assessment of the impact of age friendly city policies, political conflicts and the covid-19 pandemic. DESIGN Random telephone survey and collection of government data over four years (2017-2020). SETTING Community living older people. PARTICIPANTS People aged 50 years and over. MEASUREMENTS The Hong Kong Quality of Life Index covering four domains of in income security, health status, capability and enabling environment. RESULTS From 2017-9, improvements were seen in various domains in parallel with the adoption of the World Health Organization's Age Friendly City concept by government policy together with a territory wide initiative supported by a major philanthropic organization. However scores of all domains dropped markedly as a result of political conflicts as well as the onset of the pandemic. CONCLUSION The documentation of the trend in HKEQOL shows that while it may be used as a macro indicator that is able to reflect policies affecting the well-being of older people, it is also able to reflect the impact of societal unrest and pandemics, and that the latter may override the effect of existing ageing policies. It also follows that during social unrest and pandemics, specific policies targeting older people may be needed to maintain well-being.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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18
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Brooker RC, Hobkirk A, Cashman H, Sato T, Broderick D, Wong H, Kyzas P, Haridass A, Sacco JJ, Schache AG. Adjuvant management of locally advanced oral squamous cell carcinoma - real-world challenges and opportunities. Br J Oral Maxillofac Surg 2020; 59:952-958. [PMID: 33131802 DOI: 10.1016/j.bjoms.2020.08.034] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022]
Abstract
Patients with locally advanced oral squamous cell cancer (LAOSCC) are treated with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) following surgical ablation. This depends on the pathological risk factors and aims to reduce the risk of local recurrence and improve survival. Delivery of these aggressive treatments is, however, challenging particularly following major surgery. To inform the adaptations necessary to deliver gold-standard therapy, we aimed to describe real-world delivery of multimodality treatment in LAOSCC, in a UK population with high levels of disease incidence and low socioeconomic status. Patients with LAOSCC (T1-4 N1-3/T3-4 N0) who were treated between October 2014 and October 2016 and had a minimum follow up of 24 months were included. They were identified using the Somerset Cancer Register and data were collected through retrospective case note review. Approval was obtained from the audit departments at the relevant NHS institutions, and data were analysed using IBM SPSS Statistics for Windows version 24 (IBM Corp). The analysis included 129 patients with 82% having an initial performance status (PS) of 0-1. The most frequent change in PS was a one point drop (46%). Twenty of the 93 eligible patients (22%) underwent adjuvant CRT. A total of 37 (40%) began adjuvant CRT/RT within 42 days, and 79 (85%) within 56 days. A delay in initiating adjuvant therapy was associated with higher rates of complications and a longer postoperative hospital stay. Concordance between imaging and pathological nodal staging was poor (cK 0.223). PS frequently declines after complex surgical procedures and long postoperative recovery periods, leading to difficulties providing adjuvant treatments within the national guidance of 42 days. Frequent deviation from planned adjuvant therapies highlights the need for improved treatment strategies.
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Affiliation(s)
- R C Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, CH63 4JY, United Kingdom; Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, University of Liverpool, Liverpool, L69 3BX, United Kingdom.
| | - A Hobkirk
- Head and Neck Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Fazakerly, Liverpool, L9 7AL, United Kingdom
| | - H Cashman
- Head and Neck Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Fazakerly, Liverpool, L9 7AL, United Kingdom
| | - T Sato
- Head and Neck Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Fazakerly, Liverpool, L9 7AL, United Kingdom
| | - D Broderick
- Head and Neck Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Fazakerly, Liverpool, L9 7AL, United Kingdom
| | - H Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, CH63 4JY, United Kingdom
| | - P Kyzas
- North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 5RB, United Kingdom
| | - A Haridass
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, CH63 4JY, United Kingdom
| | - J J Sacco
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral, CH63 4JY, United Kingdom; Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, University of Liverpool, Liverpool, L69 3BX, United Kingdom
| | - A G Schache
- Head and Neck Unit, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Fazakerly, Liverpool, L9 7AL, United Kingdom; Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, University of Liverpool, Liverpool, L69 3BX, United Kingdom
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Goemans N, McDonald C, Signorovitch J, Sajeev G, Fillbrunn M, Wong H, Mercuri E, Vandenborne K, Muntoni F, Ward S, ImagingDMD study T, iMDEX, cTAP. DMD & BMD – CLINICAL. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Adderley H, Chan J, Alameddine M, Kelly C, Salih Z, Lim K, Fox R, Tetlow C, Arundell D, Wong H, Harries M, Armstrong A, Thorp N. Permanent Hair Loss Associated with Taxane Chemotherapy Use in Breast Cancer: a Retrospective Review at Two Tertiary UK Cancer Centres. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.008] [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: 10/23/2022]
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21
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Wong H, Poh Y, Mok Y. 0574 Prevalence and Characteristics of Rapid Eye Movement Obstructive Sleep Apnoea (REM OSA) in a Multi-Ethnic OSA Cohort. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent studies have shown that REM OSA is associated with increased incidence of hypertension and insulin resistance. However, there is a lack of Asian data on REM OSA. Our study aimed to examine the prevalence and characteristics of REM OSA in a multi-ethnic OSA cohort.
Methods
This was a retrospective observational study of all patients who underwent an overnight diagnostic polysomnography at a Singapore tertiary hospital from 1st August 2017 to 31st August 2018. All patients with a diagnosis of OSA (Apnoea Hypopnea Index (AHI) ≥5) were included in the study. REM OSA is defined as an overall AHI≥5, REM AHI/Non REM (NREM) AHI>2, NREM AHI<15 and at least 15 minutes of REM sleep.
Results
457 OSA subjects were included in the analysis. 19% (87/457) had REM OSA. Univariate analysis showed that REM OSA was more prevalent among female OSA than male OSA [34/115 (29.6%) versus 53/342 (15.5%) respectively, p<0.001]. Compared to non REM OSA, REM OSA had milder OSA severity [mean AHI 12.74±4.71 versus 45.34±28.38, p<0.001] and lower prevalence of hypertension [21/87 (24.1%) versus 138/370(37.3%), p=0.02]. No differences were found between both groups for age (p=0.273), ethnicity (p=0.615), Body Mass Index (p=0.336), diabetes mellitus (p=0.245) and Epworth Sleepiness Scale (0.06). Gender and OSA severity differences between both groups remained statistically significant in multivariate analysis (higher prevalence of REM OSA in female, p=0.043 and milder disease severity in REM OSA, p=0.006).
Conclusion
REM OSA was common in our OSA cohort and had higher prevalence in female and milder disease severity compared to non REM OSA. However, we did not find an increased prevalence of hypertension or diabetes mellitus in REM OSA. Further population-based study on REM OSA is needed to understand this phenotype better.
Support
NIL
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Affiliation(s)
- H Wong
- Changi General Hospital, Singapore, SINGAPORE
| | - Y Poh
- Changi General Hospital, Singapore, SINGAPORE
| | - Y Mok
- Changi General Hospital, Singapore, SINGAPORE
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22
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Torres IJ, Qian H, Basivireddy J, Chakrabarty T, Wong H, Lam RW, Yatham LN. Three-year longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Acta Psychiatr Scand 2020; 141:98-109. [PMID: 31840225 DOI: 10.1111/acps.13141] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The longitudinal course of neuropsychological functioning after the first manic episode in bipolar disorder is unknown. The present study evaluated cognitive change in bipolar disorder in the first 3 years after the initial manic episode. METHODS Ninety-one newly diagnosed patients with bipolar disorder and 61 demographically similar healthy participants received a neuropsychological evaluation assessing multiple cognitive domains at baseline, 1-year, and 3-year time points. Patients also received clinical assessments including mood ratings at all time points. RESULTS Patients showed deficits in all domains at baseline, but similar longitudinal trajectories across time relative to healthy participants in most cognitive domains. For processing speed, patients showed more gains than controls from baseline to 1 year, but these gains stabilized thereafter. Patients with alcohol/substance abuse showed an initial delay but subsequent recovery in executive functioning. Patients who discontinued antipsychotic treatment showed better cognitive outcomes in verbal memory. CONCLUSION Appropriately treated patients with bipolar disorder showed favorable cognitive outcome in the first 3 years after experiencing an initial manic episode, arguing against cognitive neuroprogression at this stage of the illness. Discontinuation of antipsychotic treatment may be associated with better cognitive outcomes, but clarification of the role of antipsychotics on cognitive functioning requires further investigation.
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Affiliation(s)
- I J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - H Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - J Basivireddy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - T Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - H Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - R W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - L N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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23
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Wei CX, Wong H, Xu F, Liu Z, Ran L, Jiang RD. IRF4-induced upregulation of lncRNA SOX2-OT promotes cell proliferation and metastasis in cholangiocarcinoma by regulating SOX2 and PI3K/AKT signaling. Eur Rev Med Pharmacol Sci 2019; 22:8169-8178. [PMID: 30556855 DOI: 10.26355/eurrev_201812_16509] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the role of lncRNA SOX2-OT in the proliferation and metastasis of cholangiocarcinoma (CCA) and its underlying mechanisms. PATIENTS AND METHODS A total of 82 patients with CCA underwent surgery in our hospital were enrolled in this study. Five CCA cell lines (HuH-28, QBC939, HuCCT1, CCLP1, RBE) were used. The ability of proliferation and metastasis of CCA cells were detected by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay, colony formation assay, and transwell assay, respectively. Additionally, in vivo tumor metastasis assay was done. Furthermore, the Kaplan Meier method was used to validate the prognostic importance of SOX2-OT for patients with cholangiocarcinoma. Besides, the protein and mRNA expression of CCA cells were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot, respectively. RESULTS The expression level of lncRNA SOX2-OT was significantly upregulated in cholangiocarcinoma tissues. Functional assays were further conducted to prove the oncogenic role of SOX2-OT on the proliferation and metastasis of cholangiocarcinoma cells. Furthermore, mechanism investigations manifested that transcription factor IRF4 upregulates SOX2-OT by promoting the transcriptional activity of SOX2-OT. SOX2-OT could positively regulate the nearby gene SOX2. SOX2-OT suppressed the nuclear transcription of PTEN, thereby activating PI3K/AKT signaling. CONCLUSIONS lncRNA SOX2-OT upregulated by IRF4 promotes cell proliferation and metastasis in cholangiocarcinoma via upregulating SOX2 and activating PI3K/AKT signaling pathway.
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Affiliation(s)
- C-X Wei
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
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24
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d'Arienzo P, Olsson-Brown A, Sallam M, Ortega-Franco A, Wong H, Escriu C. Immune-related toxicities in NSCLC: Real-world experience from a tertiary cancer center. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.029] [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: 11/14/2022] Open
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25
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Curry N, Foley C, Wong H, Mora A, Curnow E, Zarankaite A, Hodge R, Hopkins V, Deary A, Ray J, Moss P, Reed MJ, Kellett S, Davenport R, Stanworth S. The application of a haemorrhage assessment tool in evaluating control of bleeding in a pilot trauma haemorrhage trial. Transfus Med 2019; 29:454-459. [PMID: 31680331 DOI: 10.1111/tme.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/22/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether it was feasible to use a haemorrhage assessment tool (HAT) within a trauma trial and whether the data obtained could differentiate patients who had achieved haemostasis. BACKGROUND Major haemorrhage is one of the leading causes of death worldwide, affecting 40% of trauma patients. Clinical trials evaluating haemostatic interventions often use transfusion outcomes as a primary endpoint. Transfusion is highly dependent on local practice, limiting its reliability as a robust, transferable endpoint. METHODS A five-point HAT questionnaire was applied to participants enrolled into the EFIT-1 trial. This RCT evaluated the feasibility of administering a 6 g fibrinogen concentrate to patients with severe trauma haemorrhage. RESULTS Of participants, 98% completed a HAT; 75% participants had 'achieved haemostasis' at the time of tool completion, as determined by clinical acumen alone. HAT scores were able to differentiate which participants required transfusion after 3 h. Of participants, 56% were transfused red blood cells when they scored 0-2, compared to 17% with HAT scores between 3 and 5. CONCLUSION This study has confirmed the feasibility of using a HAT during the emergency care of patients suffering trauma haemorrhage, and future studies should be conducted to determine its value as an endpoint in haemostasis studies.
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Affiliation(s)
- N Curry
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK
| | - C Foley
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - H Wong
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - A Mora
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - E Curnow
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Zarankaite
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - R Hodge
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - V Hopkins
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - A Deary
- NHS Blood and Transplant Clinical Trials Unit, NHS Blood and Transplant, Cambridge and Bristol, UK
| | - J Ray
- Department of Emergency Medicine, John Radcliffe Hospital, Oxford, UK
| | - P Moss
- Department of Emergency Medicine, St. George's Hospital, London, UK
| | - M J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Kellett
- Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - S Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.,NIHR BRC Blood Theme, Oxford University, Oxford, UK.,NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
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26
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Taddio A, Shah V, Bucci L, MacDonald NE, Wong H, Stephens D. Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial. CMAJ 2019; 190:E1245-E1252. [PMID: 30348739 DOI: 10.1503/cmaj.180175] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Parents have reported that they want to learn how to reduce pain in infants during vaccinations. Our objective was to compare different levels of intensity of postnatal education about pain mitigation on parental self-reported use of interventions at future infant vaccinations. METHODS We conducted a longitudinal, 3-group parallel, add-on, randomized controlled trial on the postnatal ward of a hospital. New mothers, unaware of the hypothesis, were randomly assigned to 1 of 3 intervention groups and 3 follow-up groups (i.e., 9 groups, 3 × 3). The 3 intervention groups were control (general immunization information), pain pamphlet (pain mitigation information), and pain pamphlet and pain video (pain mitigation information). Both pain mitigation education groups also received general immunization information. The 3 follow-up groups were 2-, 4- and 6-month infant vaccinations. Mothers reported use of breastfeeding, sucrose and topical anesthetics during infant vaccinations in a telephone survey. RESULTS Of 3420 participants, follow-up was available for 2549 (75%): 36.1%, 34.2% and 29.7% reported on pain mitigation practices at 2-, 4- and 6-month vaccinations, respectively (p = 0.9). Maternal characteristics did not differ (p > 0.05): mean age, 33.6 years; 58% were primipara. Utilization of any intervention (breastfeeding, sucrose or topical anesthetics) was 53.2%, 61.4% and 63.0% for control, pain pamphlet, and pain pamphlet and pain video groups, respectively (p < 0.001); both pain education groups had higher utilization than the control group, but did not differ from one another. Uptake differed among intervention groups at 2 and 4 months but not at 6 months. INTERPRETATION Hospital-based postnatal education increased parental use of pain interventions at infant vaccinations and can be added to existing education. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01937143.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont.
| | - Vibhuti Shah
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont
| | - Lucie Bucci
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont
| | - Noni E MacDonald
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont
| | - Derek Stephens
- Leslie Dan Faculty of Pharmacy (Taddio, Wong), University of Toronto; Department of Pediatrics (Shah), Mt. Sinai Hospital, Toronto, Ont.; Immunize Canada (Bucci), Canadian Public Health Association, Ottawa, Ont.; Department of Paediatrics, Faculty of Medicine (MacDonald), Dalhousie University, Halifax, NS; Biostatistics and Data Analysis Unit (Stephens), The Hospital for Sick Children, Toronto, Ont
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Crampton KM, Wood J, Wong H, McKay M, Madi A. Evaluation of the introduction of primary G-CSF prophylaxis to the FLOT chemotherapy regimen. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.103] [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: 11/14/2022] Open
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Goemans N, Signorovitch J, Sajeev G, Fillbrunn M, Wong H, Ward S, McDonald C, Mercuri E. P.202A composite prognostic score for time to loss of walking ability in Duchenne muscular dystrophy (DMD). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wong H, Sanghera K, Neufeld A, Maxner C, Shankar JJS. Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension. Neuroradiology 2019; 62:49-53. [PMID: 31506733 DOI: 10.1007/s00234-019-02288-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/09/2019] [Accepted: 08/28/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Although several studies have reported imaging findings associated with idiopathic intracranial hypertension (IIH), less is known about the correlation between imaging findings and IIH-related symptoms or signs. Our study aimed to determine if clinical features of IIH are correlated with magnetic resonance imaging (MRI) features. METHODS A retrospective chart review was conducted on consecutive patients presenting at the neuro-ophthalmology department over the last 15 years. All patients diagnosed with IIH were identified and those with available MRI were included in the final analysis. All MRI images were reviewed by a neuroradiologist blinded to the presenting symptoms and signs. Statistical analysis was performed to determine the correlation between the MRI findings with each clinical symptom or sign. RESULTS Thirty-one out of 88 patients with the initial diagnosis of IIH had MRI available and were included in the study. Significant correlations were observed between colour vision and amount of perineural fluid around the optic nerve on MRI (r = - 0.382; p = 0.004), disc assessment and intraocular optic nerve protrusion (r = 0.364; p = 0.004), disc assessment and perineural fluid around the optic nerve (r = 0.276; p = 0.033) and disc assessment and venous sinus stenosis (r = 0.351; p = 0.009). CONCLUSION Our study highlights correlations between imaging and clinical findings of IIH. MRI findings in IIH may be useful in ruling out ominous causes of intracranial pressure and risk stratifying ophthalmologic intervention and management of patients with headaches possibly due to IIH.
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Affiliation(s)
- H Wong
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - K Sanghera
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - A Neufeld
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - C Maxner
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Jai Jai Shiva Shankar
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada.
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Room 807K-JBRC/715 Mc Dermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
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30
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Dight J, Patel J, Wong H, Hashemi G, Khosrotehrani K. 453 Endovascular progenitors initiate and drive de novo vascularisation in melanoma. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.503] [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: 10/26/2022]
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Patel J, Hamilton H, Kahler S, Sim S, Wong H, Khosrotehrani K. 623 Changing endothelial cell fate in wound healing through modulation of Sox9 to reduce scarring. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.628] [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: 11/29/2022]
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Smith FM, Pritchard DM, Wong H, Whitmarsh K, Hershman MJ, Sun Myint A. A cohort study of local excision followed by adjuvant therapy incorporating a contact X-ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer. Colorectal Dis 2019; 21:663-670. [PMID: 30742736 DOI: 10.1111/codi.14584] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
AIM Recent data have suggested near-equivalent oncological results when treating early rectal cancer by local excision followed by radio- ± chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact X-ray brachytherapy within this paradigm. METHOD All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact X-ray brachytherapy. Postoperative (chemo)radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, postoperative therapy received, follow-up duration, disease-free survival, salvage surgery and stoma-free survival. RESULTS In total, 180 patients with a median age of 70 (range 36-99) years were assessed. Following local excision, pT stages were pT1 = 131 (72%), pT2 = 44 (26%), pT3 = 5 (2%). All patients received contact X-ray brachytherapy boosting at our centre and, in addition, 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow-up of 36 months (range 6-48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (three isolated nodal), five underwent salvage abdominoperineal excision. Eight patients developed distant disease, of whom five underwent metastasis surgery. At last included follow-up 173 (96%) patients were free of all disease and 170 (94%) were stoma free. CONCLUSIONS Contact therapy can be offered in addition to external beam radio (±chemo) therapy instead of radical surgery as follow-on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial.
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Affiliation(s)
- F M Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - D M Pritchard
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - H Wong
- Clatterbridge Cancer Centre, Bebington, UK
| | | | | | - A Sun Myint
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Clatterbridge Cancer Centre, Bebington, UK
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Freedman T, Taddio A, Alderman L, McDowall T, deVlaming-Kot C, McMurtry CM, MacDonald N, Alfieri-Maiolo A, Stephens D, Wong H, Boon H. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on student symptoms. Paediatr Child Health 2019; 24:S42-S53. [PMID: 30948922 PMCID: PMC6438866 DOI: 10.1093/pch/pxz020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many students are afraid of receiving vaccinations at school. We implemented a novel, multifaceted knowledge translation intervention incorporating evidence-based vaccination coping strategies-The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-and evaluated impact on student attitudes, knowledge, coping strategies used, and symptoms during school-based vaccinations. METHODS Mixed methods. Ten schools participated in a controlled clinical trial: five experimental and five control. Experimental School (ES) students completed a knowledge and attitudes survey during an in-class CARD™ educational session prior to school vaccinations and selected coping strategies for upcoming vaccinations. Control School (CS) students received the usual vaccine education lesson, which did not include information about or selection of coping strategies. At all schools and during both vaccination clinic visits (fall and spring), injecting nurses recorded specific coping strategies used, and students independently rated their fear, pain, and dizziness during vaccinations. Focus groups were conducted at five schools after all clinics were completed (three ES, two CS). RESULTS ES students had higher knowledge (P<0.001), less fear (P=0.03), and greater willingness to be vaccinated (P=0.001) after the in-class education session. Students rated the education as understandable, sufficient, useful, and that it prepared them for vaccinations. During school vaccination clinics, ES students selected more coping interventions than CS students. There were fewer students with high levels of fear (P=0.008) and dizziness (P=0.04) in the ES group. In round 2, fewer students (P=0.02) in the ES group returned to the clinic postvaccination because they were feeling unwell. ES students participating in focus groups scored higher on their knowledge test (P<0.001) compared with CS students and reported learning and benefitting from CARD™. DISCUSSION This small-scale implementation study provides preliminary evidence of the effectiveness of CARD™ in improving vaccination experiences for students at school. Future research is recommended that examines CARD™ in different settings to confirm these results.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | | | | | | | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Taddio A, Freedman T, Wong H, McMurtry CM, MacDonald N, Ilersich ANT, Ilersich ALT, McDowall T. Stakeholder feedback on The CARD™ System to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S29-S34. [PMID: 30948920 PMCID: PMC6438868 DOI: 10.1093/pch/pxz018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE School-based vaccination programs can be a source of distress for many students due to the pain from the needle injection and related fears. We created a multifaceted Knowledge Translation (KT) intervention to address vaccination and pain, fear, and fainting called The CARD™ System. The objectives were to document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear. METHODS Quantitative and qualitative methods were used. Students, school staff, public health nurses, and parents participated in separate focus groups whereby they independently completed a knowledge and attitudes survey and provided structured and qualitative feedback on key KT tools of the multifaceted KT intervention. They then repeated the knowledge and attitudes survey. RESULTS Altogether, 22 students (grade 6 and 7), 16 school staff (principals, grade 7 and 8 teachers, resource teachers, secretaries), 10 nurses (injecting, charge, and school nurses), and 3 parents participated. Knowledge test scores increased post-KT tool review: 8.5 (2.1) versus 7.3 (1.9); P<0.001. Attitudes were more positive about the individual nature of pain and fear experience during vaccination. Student fear scores were lower post-tool review: 5.1 (2.9) versus 4.6 (3.0); P<0.001. The majority of the participants reported they understood all the information, the amount was just right and that the information was useful. DISCUSSION The KT tools were demonstrated to be acceptable and to improve knowledge. Future research is warranted to determine their impact on student experience during school vaccinations.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | | | | | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Freedman T, Taddio A, McMurtry CM, Wong H, MacDonald N, McDowall T, deVlaming-Kot C, Alderman L. Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S19-S28. [PMID: 30948919 PMCID: PMC6438867 DOI: 10.1093/pch/pxz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Pain, fear, and fainting management during school-based vaccinations is suboptimal. The objective was to examine stakeholder perceptions of barriers and facilitators to better practices. Method: Six semi-structured focus groups were conducted in Niagara Region, Ontario: two parent groups (n=7); one grade 7 to 8 student group (n=9); two nurse groups (n=12); and one school staff group (n=6). Participants shared perceptions about school vaccination clinics and the implementation of specific strategies and tools. Focus groups were audio recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis. RESULTS Feedback from stakeholders was categorized into four domains of CFIR: intervention characteristics, inner setting, outer setting, and characteristics of individuals. Intervention characteristics included: vaccine educational materials, vaccination accommodations, distraction techniques, topical anaesthetics, and food. Inner setting factors included: school vaccination procedures, relationships between school staff and nurses, assessment and documentation of student fear, and factors that contribute to a chaotic vaccination clinic. Outer setting factors were: the social environment and addressing parent and student needs. Stakeholder roles were discussed in characteristics of individuals. CONCLUSION This study identified elements that can facilitate and challenge pain and fear mitigation tools and strategies; these elements should be considered in the development of a Knowledge Translation (KT) intervention to improve the school vaccination experience.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Hutton N, Callender J, Hutton D, Williams L, Wong S, Wong H, Syndikus I. EP-2180 The effect of Rectal size and shape on Bladder deformation in Urinary Bladder Radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32600-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taddio A, Ilersich ANT, Ilersich ALT, Schmidt C, Chalmers G, Wilson E, McMurtry CM, MacDonald N, Bucci LM, Freedman T, Wong H. Piloting The CARD™ System for education of students about vaccination: Does it improve the vaccination experience at school? Paediatr Child Health 2019; 24:S35-S41. [PMID: 30948921 PMCID: PMC6438862 DOI: 10.1093/pch/pxz019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Many students are fearful of vaccine injection-associated pain. In prior research, we created Knowledge Translation (KT) tools to address school vaccinations and associated pain, fear, and fainting. The objectives of this pilot implementation project were to determine the acceptability and impact of these KT tools on student knowledge, attitudes, and perceptions of their vaccination experience. METHODS Pre-post mixed methods design. Students in an independent school in the Greater Toronto Area, Ontario, participated in two separate focus groups before and after school vaccinations. In both sessions, they independently completed a knowledge and attitudes survey, reviewed three KT tools (two videos and one pamphlet) and then repeated the knowledge and attitudes survey. They provided structured and qualitative feedback about the KT tools and described the impact of the education on the vaccination experience. RESULTS Altogether, 11 grade 7 students participated. Knowledge scores were higher post-tool review compared to baseline in the first focus group. There was no significant difference in fear scores and attitudes about getting vaccinated. Qualitative feedback was categorized into two themes: intervention characteristics and characteristics of the school environment. Students reported the KT tools helped them to prepare for vaccination. They used the information on vaccination day to reduce their own fear and pain and to assist peers. They believed all students should view the KT tools. Students reported that teachers and nurses did not do enough to make vaccinations a positive experience. For example, they did not provide a private setting as an option for vaccination and prevented them from using some coping strategies recommended in the KT tools. DISCUSSION This study provides preliminary evidence of the acceptability and positive impact of the KT tools on students' vaccination experiences. Future research is recommended that involves inclusion of all students and adults in the KT intervention.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | | | | | | | | | - Evelyn Wilson
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| | | | | | | | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Wong RMY, Wong H, Zhang N, Chow SKH, Chau WW, Wang J, Chim YN, Leung KS, Cheung WH. The relationship between sarcopenia and fragility fracture-a systematic review. Osteoporos Int 2019; 30:541-553. [PMID: 30610245 DOI: 10.1007/s00198-018-04828-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
Sarcopenia is a common geriatric syndrome characterized by progressive decrease of muscle mass and function leading to an increased risk of physical disability, poor quality of life, and mortality. Increasing evidence shows that sarcopenia is related with fragility fractures. This systematic review aimed to summarize the following: (1) the prevalence of sarcopenia in patients with fragility fracture and (2) the associated risk factors for fragility fracture in patients with sarcopenia. Literature search was conducted in PubMed and Cochrane databases. Studies with the prevalence of sarcopenia in elderly patients with fragility fracture and associated risk factors in patients with sarcopenia were included. A total of 15 papers were included, with 10 reporting sarcopenia prevalence, and 5 on fracture risk in patients with sarcopenia. The prevalence of sarcopenia after fracture ranged from 12.4 to 95% in males and 18.3 to 64% in females. The prevalence of sarcopenia in elderly patients with fragility fracture was high, especially in men. Two studies showed that sarcopenia was a risk factor for fragility fracture when associated with low bone mineral density (BMD) but only in men. Caution should be taken for male patients with sarcopenia and low BMD, which is related to significantly increased risk of fractures. There is a pressing need for further research on sarcopenia and its risk on fragility fracture to better understand the relationship, pathophysiology, and mechanisms, which may shed light on potential interventions to improve clinical outcomes.
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Affiliation(s)
- R M Y Wong
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - H Wong
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - N Zhang
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - S K H Chow
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
- The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, People's Republic of China
| | - W W Chau
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - J Wang
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - Y N Chim
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - K S Leung
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - W H Cheung
- Department of Orthopaedics and Traumatology, 5/F, Clinical Sciences Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China.
- The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, People's Republic of China.
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Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Abstract P6-18-32: Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-32] [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: Palbociclib plus endocrine therapy (ET) significantly increases progression free survival compared to ET alone. Within PALOMA2 neutropenia was the most common AE and reason for dose reductions. No real data exists regarding dose reductions (DRs), dose interruptions (DIs), toxicities and benefits of palbociclib. Objective: To describe the early haematological dynamics, DRs/DIs with 1st line palbociclib in the context of a routine UK clinical practice. Methods: A prospective record was maintained of all patients with ER-positive, HER2-negative metastatic BC registered on the Pfizer patient programme at the Clatterbridge Cancer Centre NHS Foundation Trust. The clinical records of all patients commenced on treatment between April and December 2017 were reviewed, and clinico-pathological information, haematological data & toxicity data recorded. Data lock was 31st March 2018. Results: 48 patients received at least one cycle of treatment. The median age was 58, 29% (14/48) premenopausal & 71% (34/48) postmenopausal. 43% (21/48) had bone only disease with 42% (20/48) having visceral disease. The median number of cycles delivered 8 (range 2-11). DRs: 18/48 (38%) patients had a total of 21 DRs; 14/18 (78%) had 1 DR to 100mg; 1/18 (5%) 1 DR to 75mg; & 3/18 (17%) 2 DRs to 75mg. Reasons for DRs: 13 neutropenia, 2 leukopenia, 1 thrombocytopenia, 2 fatigue, 1 poor appetite, 1 sore mouth & 1 non-specially unwell. DIs: occurred in 24/48 patients (50%). Details of DRs/DIs by cycle will be presented. 85% (41 of 48) patients remain on treatment with 59% (24/41) on 125mg; 34% (14/41) on 100mg & 7% (3/41) on 75mg. FBC were available for 41/48 (85%) cases & dynamics considered over the first 6 cycles using FBC at the time of planned treatment delivery. Hb Baseline all patients (AP):129 (121 – 138), patients; patients with no dose reductions (NDR) 127 (123 – 139) & patient dose reduction (DR): 130 (118 – 136). Hb changes to cycles 2, 4 and 6 AP: 122 (115 – 131), 121 (116 – 127) and 125 (116 – 134); NDR:122 (110 - 135), 125 (117 - 127) and 131 (116 – 135); DR: 115 (112 - 120), 120 (115 - 124) and 122 (115 – 129). WCC Baseline AP: 6.8 (5.6 – 7.7); NDR: 7.2 (6.3 – 7.7); DR: 6.7 (5.2 – 7.7). WCC changes to cycles 2, 4 and 6 AP: 3.7 (2.9 – 4.4), 3.7 (3.1 – 4.4) and 3.3 (3 – 3.9); NDR: 3.5 (2.9 – 4.1), 3.6 (3.2 – 4.3) and 3.6 (3.1 – 4.1); DR: 2.1 (1.7 – 2.5), 4.3 (3 – 4.6) and 3.3 (2.8 – 3.5). ANC Baseline AP: 4.0 (3.2 – 5.1); NDR: 4.4 (3.4 – 5.0); DR: 3.6 (2.9 – 5.2). ANC changes to cycles 2, 4 and 6 AP: 1.5 (1.2 – 2.1), 1.7 (1.3 – 2.0) and 1.4 (1.2 – 1.9) NDR: 1.5 (1.1 – 2.1), 1.7 (1.4 – 2.0) and 1.3 (1.2 – 2.0); DR: 0.8 (0.6 – 0.8), 1.7 (1.2 – 2.3) and 1.4 (1.3 – 1.6). Plts Baseline AP: 298 (226 – 339), NDR: 252 (211 – 336); DR: 299 (253 – 339). Plt changes to cycles 2, 4 and 6 AP: 252 (198 – 310), 221 (186 – 259) and 200 (169 – 243). NDR: 249 (185 – 334), 229 (171 – 267) and 205 (177 – 263);DR: 208 (199 – 210), 216 (199 – 243) and 194 (162 -210). Conclusion: These initial real world data are consistent with the PALOMA2 data. Baseline WCC & ANC show no significant difference between NDR and DR cases. Updated data will be presented as well as outcome data for first time.
Citation Format: Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic 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 P6-18-32.
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Affiliation(s)
- A Bhojwani
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Flint
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - B Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Innes
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J Cliff
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - E Ahmed
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Z Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J O'Hagan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Tolan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - K Hyatt
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - D Errington
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - F Alam
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - P Robson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - N Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S O'Reilly
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Law
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Cicconi
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - R Jackson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - C Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
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Ragaz J, Qian H, Wong H, Wilson KS, Shakeraneh S, Spinelli JJ. Abstract P6-13-04: Estrogen-alone based hormone replacement therapy (HRT) reduces breast cancer (BrCa) incidence and mortality whereas estrogen plus progestin Provera based HRT increases both BrCa incidence and BrCa mortality: A comparative analysis of Women's Health Initiative trials. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-13-04] [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
OBJECTIVE: To quantitate breast cancer incidence (BrCa-I) and mortality (BrCa-M) outcome differences between the two Women's Health Initiative (WHI) HRT trials,1,2 the ratio of hazards was calculated for estrogen-alone based hormone replacement therapy (E-HRT) vs. placebo (P), and E + progestin Provera (ProgProv) combination HRT vs. P trials.
METHODS: Hazard ratios (HR) of BrCa-I and BrCa-M and 95% confidence intervals (CI) were obtained from both WHI HRT trials. Subsequently, to compare BrCa outcomes between E-HRT vs. E + ProgProv, the ratios of HRs between the trials (HR1/HR2) were estimated separately for i. BrCa-I all women, ii. BrCa-I low Gail score (Gail score <1.75*), and iii. BrCa-M. The 95% CI was derived through logarithmic transformation of the 95% CI originally reported.
RESULTS:
Outcome Comparison, the two WHI HRT randomized trials. Ratio of Hazards, BrCa Incidence and BrCa mortality E-HRT vs. P, HR1 (95% CI)E-HRT + ProgProv vs. P, HR2 (95% CI)HR1/HR2 (95% CI)pBrCa-I All Woman10.77 (0.62-0.95)1.25 (1.07-1.46)0.62 (0.47-0.80)0.0004BrCa-I Low Gail Score* (Gail score <1.75)10.65 (0.50-0.86)1.24 (1.01-1.51)0.53 (0.38-0.74)0.0002BrCa-M20.55 (0.33-0.92)1.44 (0.97-2.15)0.38 (0.20-0.75)0.004*Gail score <1.75; HRs calculated from Reference 1, Figure 3
CONCLUSIONS: Our calculations show that the different outcomes between the two WHI HRT trials, estimated as ratio of hazards, are highly significant on statistical basis, both for BrCa incidence and for BrCa mortality. These findings highlight the potential carcinogenic impact of ProgProv and the major public health benefits of HRT based on E alone.
REFERENCES:
1. Anderson GL, Chlebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial. The Lancet Oncology 2012;13:476-86.
2. Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA 2017;318:927-38.
Citation Format: Ragaz J, Qian H, Wong H, Wilson KS, Shakeraneh S, Spinelli JJ. Estrogen-alone based hormone replacement therapy (HRT) reduces breast cancer (BrCa) incidence and mortality whereas estrogen plus progestin Provera based HRT increases both BrCa incidence and BrCa mortality: A comparative analysis of Women's Health Initiative trials [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 P6-13-04.
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Affiliation(s)
- J Ragaz
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - H Qian
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - H Wong
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - KS Wilson
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - S Shakeraneh
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - JJ Spinelli
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
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Ragaz J, Shakeraneh S, Qian H, Wilson KS, Wong H, Spinelli JJ. Abstract P6-13-06: Estrogen-based hormone replacement [HRT] therapy is substantially more effective than tamoxifen in reducing breast cancer mortality and breast cancer case fatality ratio: Emergence of a new paradigm. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-13-06] [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
OBJECTIVE: To compare, in the setting of breast cancer (BrCa) prevention, the impact of estrogen-based hormone replacement therapy (E-HRT) vs. tamoxifen (TAM) on breast cancer mortality (BrCa-M) and breast cancer case fatality ratio (BrCa-CFR), by analyzing data from the Women's Health Initiative Trial 2 (WHI HRT Trial 2, E-HRT vs. placebo [P])1 and the International Breast Cancer Intervention Study 1 (IBIS-1), TAM vs. P.2
METHODS: Hazard ratios (HR) and confidence intervals (CI) for BrCa incidence and mortality were extracted from the original WHI HRT Trial 2 and IBIS-1 trials.1,2 BrCa-CFRs were estimated by dividing the mortality HR by the incidence HR. Subsequently, to compare E-HRT vs. TAM outcomes, the ratios of HRs (HR1/HR2) between the two trials were estimated separately for BrCa-M and BrCa-CFR. The 95% CI was derived through logarithmic transformation of the 95% CI originally reported.
RESULTS:
Mortality and Case Fatality Outcomes: Impact of E-HRT versus TAM, expressed as ratio of HRs E-HRT vs. Placebo, HR1TAM vs. Placebo, HR2HR1/HR2pMortality0.55 (0.33-0.92)1.19 (0.68-2.10)0.46 (0.22-0.99)0.046Case Fatality0.70 (0.40-1.20)1.68 (0.93-3.01)0.42 (0.18-0.94)0.040
CONCLUSIONS: While acknowledging between-trial comparisons including eligibility differences, E-HRT yields significant reductions in BrCa mortality and case fatality as compared with TAM (54% and 58% respectively). These unexpected breast cancer mortality reductions represent major public health gains, additional to the already known superiority of E-HRT over TAM in terms of skeletal fracture rates and Alzheimer's dementia mortality reduction, and, in women entering menopause, also of cardiac and all-cause mortality reductions.
REFERENCES:
1. Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA 2017;318:927-38.
2. Cuzick J, Sestak I, Cawthorn S, et al. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. The Lancet Oncology 2015;16:67-75.
Citation Format: Ragaz J, Shakeraneh S, Qian H, Wilson KS, Wong H, Spinelli JJ. Estrogen-based hormone replacement [HRT] therapy is substantially more effective than tamoxifen in reducing breast cancer mortality and breast cancer case fatality ratio: Emergence of a new paradigm [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 P6-13-06.
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Affiliation(s)
- J Ragaz
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - S Shakeraneh
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - H Qian
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - KS Wilson
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - H Wong
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
| | - JJ Spinelli
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada; Institute on Aging & Lifelong Health, University of Victoria, Delta, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada; BC Cancer Agency, Victoria, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada
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Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Abstract P6-17-27: Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-27] [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: Studies of neoadjuvant (NA) dual HER2 blockade with trastuzumab (T) and pertuzumab (P) in combination with chemotherapy (CT) for early breast cancer (BC) have reported pathological complete response (pCR) rates of 39 to 62%. These studies also report manageable toxicity with diarrhoea reported in up to 73% of cases. To date no real-world studies have explored the efficacy and toxicity of this treatment. The objective of this study was to describe the medical and surgical management of women treated with neoadjuvant T-P in combination with CT (NAT-P-CT). As well as to determine the efficacy toxicity of NAT-P-CT in the context of a routine UK NHS clinical practice.
Methods: Patients with HER2+ BC treated neoadjuvantly with T-P accessed via the NHS England Cancer Drug Fund (CDF) at the Clatterbridge Cancer Centre NHS Foundation Trust between October 2016 and January 2018 were retrospectively identified. Clinico-pathological information, treatment data, nurse led toxicity review and echocardiographic were reviewed. Data lock was 19th June 2018.
Results: 78 female patients were identified with a median age of 50 years (IQR: 44.4-60.2). At diagnosis: median tumour size 30mm (23.0-47.5mm), 62% (48/78) were LN positive & 56% (44/78) ER+. CT regimens: 81% (63/78) FEC-DHP of these 30% (19/63) switched to weekly paclitaxel (wP). or nab-paclitaxel; 5% (4/78); AC/EC-DHP; 9% (8/78) TCHP with 13% (1/8) switched to wP. At time of analysis, 88% (69/78) had undergone definitive surgery. Surgical details: Breast: 52% (36/69) mastectomy & 48% (33/69) WLE, Axillary management: 51% (35/69) axillary dissection (Ax Dx) & 49% (34/69) sentinel node biopsy (4 performed prior to NA treatment). 91% (32/35) of those undergoing Ax Dx were LN+ at presentation, of these 59% (19/32) had no evidence of axillary involvement at surgery. pCR rate (ypT0/is, N0) was 46% (32/69) [pCR by HR: ER+ 43% (21/49) & ER- 55% (11/20]. pCR for 20 patients switched to wP was 60% (12/20). 7% (5/69) achieved pCR in the breast alone (in these LN status ITCx1, micrometsx3 & macrometsx1). Of the 54% (37/69) with residual breast tumour median size was 13mm (1-22mm). Toxicity Data: Ejection fraction (EF) did not decline beyond 10% of baseline in any patients. Diarrhoea (any grade) occurred in 74% of cases, and CTCAE grade 3-4 toxicity occurring in >2% of patients: diarrhoea, fatigue, and infection. Updated analysis regarding pCR rate and toxicity, as well as initial outcome data will be presented.
Conclusion: These results (1) confirm the efficacy of NA T-P in a real world population; (2) support the use of NA wP; (3) indicate significant proportion of patients axilla are downstaged & (4) reveal diarrhoea rates in keeping with the literature. Currently, NHS England rules do not allow wP to be used routinely in NA setting with T-P this should be reviewed in light of these data and those of the BERENICE study. Measures to identify patients who can avoid axillary dissection as well as to mitigate diarrhoea should be considered.
Citation Format: Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund [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 P6-17-27.
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Affiliation(s)
- B Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Bhojwani
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Innes
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - E Ahmed
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J Cliff
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Z Malik
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J O'Hagan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Tolan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - K Hayat
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - D Errington
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - F Alam
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - N Thorp
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Flint
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Law
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Wong
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S O'Reilly
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Jackson
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Cicconi
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C Palmieri
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
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Wong H, Moss C, Moss SM, Shah V, Halperin SA, Ito S, Mithal P, Qu A, Taddio A. Effect of alcohol skin cleansing on vaccination-associated infections and local skin reactions: a randomized controlled trial. Hum Vaccin Immunother 2019; 15:995-1002. [PMID: 30513266 DOI: 10.1080/21645515.2018.1553474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Recommendations regarding the need to use alcohol prior to vaccine injections are inconsistent and based on low-level evidence. The objective was to assess the effectiveness of alcohol in reducing local skin reactions and infection post-vaccination. METHODS Randomized controlled trial in a pediatric clinic. A research assistant cleansed the skin with alcohol at (swab group) or adjacent to (control group) the pre-defined injection site(s). Clinicians, parents and children were blinded to group allocation. Parents reported local skin reactions using paper diaries for 15 days post-vaccination (Day 0-14). Telephone interviews were conducted Day 1, 5, and 14. The Brighton Collaboration criteria were used to diagnose cellulitis and infectious abscess Day 5 and afterward. RESULTS 170 children participated (May-November 2017). Baseline characteristics did not differ (p > 0.05) between groups. Children received 1-4 separate injections. There were no differences between swab and control groups in the incidence of any local skin reactions (58% vs. 54%), and specifically, pain (45% vs. 40%), redness (26% vs. 21%), swelling (20% vs. 13%), warmth (19% vs. 27%), and spontaneous drainage of pus (0% in both groups) over the post-vaccination follow-up period. Day 5 data was available for 99% of participants from diaries and telephone surveys; there were no cases of cellulitis or infectious abscess. CONCLUSION These findings are the first direct evidence for vaccine injections demonstrating that cleansing the skin with alcohol may not be needed. Our study is underpowered; however, to detect a difference in incidence of skin infection, future research is recommended.
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Affiliation(s)
- Horace Wong
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Corinne Moss
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Steven M Moss
- b Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Vibhuti Shah
- c Department of Pediatrics , Mount Sinai Hospital , Toronto , Ontario , Canada
| | - Scott A Halperin
- d Canadian Center for Vaccinology , IWK Health Centre and Dalhousie University , Halifax , Nova Scotia , Canada
| | - Shinya Ito
- e Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Priyanjali Mithal
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Angie Qu
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada
| | - Anna Taddio
- a Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Ontario , Canada.,e Child Health Evaluative Sciences , The Hospital for Sick Children , Toronto , Ontario , Canada
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McCaffrey C, Liu B, Liu G, Kung R, Wong H, Kives S, Satkunaratnam A, Solnik J, Simpson A, Secter M, Kroft J. Development of an Educational Tool Using Qualitative Analysis to Teach Components of Total Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Secter M, Kroft J, Liu G, Wong H. The Relationship between Endometrioma Size and Treatment with Dienogest: a Retrospective Cohort Study. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.070] [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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Sallam M, Wong H, Escriu C. Treatment beyond four cycles of first line platinum and etoposide chemotherapy in real-life patients with stage IV small cell lung cancer: A retrospective study of the Merseyside and Cheshire cancer network. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.005] [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: 11/14/2022] Open
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Moerman-Herzog A, Rahmatallah Y, Glazko G, Brooks A, Blair S, Wong H. 222 DNA methylomic profiles of TWIST1, PLS3 and GATA6 genes in Sezary Syndrome. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.227] [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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Roy E, Legrand J, Baz B, Wong H, Morahan G, Walker G, Khosrotehrani K. 985 Genome wide mapping identifies regulation of MAPKinase pathway as key genetic determinant of allergic contact dermatitis. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Suspension of living hepatocytes were microencapsulated inside 300 micron mean diameter alginate artificial cells. The galactosamine fulminant hepatic failure rat model was used. 48 hours after the injection of galactosamine, grade II coma hepatic failure rats were divided into pairs. One of the pair was randomly chosen for the control group, and the other for the treated group. Each rat in the control group received one peritoneal injection of microcapsules containing no hepatocytes. Each rat in the treated group received one peritoneal injection of microcapsules containing hepatocytes. The survival of the treated group is significantly higher than the control group.
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Affiliation(s)
- H. Wong
- Artificial Cells and Organs Research Centre Faculty of Medicine, McGill University Montreal, PQ, Canada
| | - T.M.S. Chang
- Artificial Cells and Organs Research Centre Faculty of Medicine, McGill University Montreal, PQ, Canada
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Capurro M, Greenfield L, Wong H, Robinson L, Jones N. A271 THE HELICOBACTER PYLORI VACA TOXIN IMPAIRS LYSOSOMAL CALCIUM CHANNEL TRPML1 ACTIVITY TO PROMOTE COLONIZATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- M Capurro
- The Hospital for Sick Children. Cell Biology Program and Departments of Paediatrics and Physiology, University of Toronto, Toronto, ON, Canada
| | - L Greenfield
- The Hospital for Sick Children. Cell Biology Program and Departments of Paediatrics and Physiology, University of Toronto, Toronto, ON, Canada
| | - H Wong
- The Hospital for Sick Children. Cell Biology Program and Departments of Paediatrics and Physiology, University of Toronto, Toronto, ON, Canada
| | - L Robinson
- The Hospital for Sick Children. Cell Biology Program and Departments of Paediatrics and Physiology, University of Toronto, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children. Cell Biology Program and Departments of Paediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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