1,384 results on '"Royal Sussex County Hospital"'
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2. Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading (CHIP-BCIS3)
- Author
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London School of Hygiene and Tropical Medicine, The Queen Elizabeth Hospital, The Royal Bournemouth Hospital, St. George's Hospital, London, King's College Hospital, London, King's College London, Royal Victoria Hospital, Belfast, Bristol Heart Institute, Leeds General Infirmary, Freeman Hospital, Newcastle, Barts Heart Centre, London, Glenfield Hospital, Leicester, Morriston Hospital, Swansea, St Thomas' Hospital, London, Royal Sussex County Hospital, and New Cross Hospital, Wolverhampton
- Published
- 2024
3. Nodule IMmunophenotyping Biomarker for Lung Cancer Early Diagnosis Study
- Author
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Royal Brompton & Harefield NHS Foundation Trust, Royal Marsden Partners West London Cancer Alliance, Imperial College London, University College London Hospitals, Lewisham and Greenwich NHS Trust, Guy's and St Thomas' NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, King's College Hospital NHS Trust, University College London (UCL) Cancer Institute, Institute of Cancer Research, United Kingdom, Francis Crick Institute, and Royal Sussex County Hospital
- Published
- 2023
4. Coronavirus Infection in Primary or Secondary Immunosuppressed Children and Adults. (ImmunoCOVID)
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Cambridge University Hospitals NHS Foundation Trust, Alder Hey Children's Hospital, Birmingham Children's Hospital, Bradford Royal Infirmary, Bristol Royal Hospital for Children, Cardiff and Vale University Health Board, Great North Children's Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, Oxford University Hospitals NHS Trust, Leeds Teaching Hospitals NHS Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, Nottingham Children's Hospital, Royal Alexandra Children's Hospital, Royal Hospital for Sick Children, Glasgow, Royal Manchester Children's Hospital, Royal Marsden NHS Foundation Trust, Northern Care Alliance NHS Group, Royal Sussex County Hospital, Sheffield Children's NHS Foundation Trust, St George's University Hospital National Health Service Foundation Trust, Swansea Bay University Health Board, University College London Hospitals, University Hospitals Coventry and Warwickshire National Health Service Trust, East Lancashire Hospitals National Health Service Trust, Imperial College Healthcare National Health Service Trust, and National Heatlh Service Ayrshire and Arran
- Published
- 2020
5. Trial of Efficacy and Safety of Sirolimus in Tuberous Sclerosis and LAM (TESSTAL)
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University of Nottingham, St Georges Hospital Medical School, Royal Sussex County Hospital, The Tuberous Sclerosis Association, Wyeth is now a wholly owned subsidiary of Pfizer, and Julian R Sampson
- Published
- 2008
6. Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1
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Douglas Cunningham, D. Ward, Mamta K. Jain, Faiza Ajana, Magda Opsomer, Anita Rachlis, Sharon Walmsley, Frank A. Post, Anders Blaxhult, Amanda Clarke, M. J. Galindo, Marcel Stoeckle, P.-M. Girardy, Karam Mounzer, David Shamblaw, U. F. Bredeek, L. Bhatti, J. J. Eron, Andrew Ustianowski, Mar Gutierrez, John Jezorwski, Javier O Morales-Ramirez, Antonio Rivero, M.A. Johnson, Gatell Jm, Erika Van Landuyt, Stéphane De Wit, A. Wilkin, Laurent Cotte, Cheryl McDonald, D. Murphy, Cynthia Brinson, Romana Petrovic, Olayemi Osiyemi, J. de Vente, I. Poizot-Martin, Juan Berenguer, Robin Dretler, J. Bailey, B. Rashbaum, Moti Ramgopal, A. Scribner, Yazdan Yazdanpanah, Eric Florence, A. Piekarska, Brian Gazzard, Chloe Orkin, W. Halota, Gary Richmond, Jacques Reynes, C. Ricart, C. Lucasti, Ignacio Pérez-Valero, Jason Brunetta, S. Shafran, Daniel Podzamczer, Franco Antonio Felizarta, Claudia Martorell, F. Post, Peter Ruane, Edwin DeJesus, J. Portilla Sogorb, C. Orkin, K. Tashima, Federico Pulido, Bernard Vandercam, F. Pulido, José L. Casado, Christine Katlama, Kimberley Brown, J Gasiorowski, A. Witor, Joseph J. Eron, Brian Conway, Andri Rauch, Jose R. Arribas, Michel Moutschen, H. Olivet, A. Scarsella, Leo Flamholc, A. Horban, D. Cunningham, Ronald Nahass, Félix Gutiérrez, G. Huhn, W.K. Henry, A. Thalme, S De Wit, Jan Fehr, Debbie Hagins, José Antonio Iribarren, J.-M. Molina, S. Henn, F Raffi, Juan A. Pineda, Marina B. Klein, Eugenia Negredo, Hernando Knobel, J. Slim, P. Benson, L. Waters, E. Teicher, Linos Vandekerckhove, Craig A. Dietz, Magnus Gisslén, Joel E. Gallant, J. Gathe, P. Shalit, D. Prelutsky, G. Voskuhl, D. Rey, E. Van Wijngaerden, Anthony Mills, Erkki Lathouwers, Carl J. Fichtenbaum, I. Brar, Gordon Crofoot, Veerle Hufkens, I. Santos Gil, University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Queen Mary University of London (QMUL), Pueblo Family Physicians, Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), King's College Hospital (KCH), Université libre de Bruxelles (ULB), Janssen Pharmaceutica [Beerse], Janssen Research & Development, Institute of Tropical Medicine [Antwerp] (ITM), Department of Infectious and Parasitic Diseases (University Liege), Université de Liège, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Living Hope Foundation, Ghent University Hospital, Cliniques Universitaires Saint-Luc [Bruxelles], Maple Leaf Clinic, Vancouver Infectious Diseases Centre, McGill University = Université McGill [Montréal, Canada], University of Toronto, Sunnybrook Health Sciences Centre, University of Alberta, University Health Network, Services des maladies infectieuses [Tourcoing], Centre Hospitalier de Tourcoing, Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de maladies infectieuses et tropicales [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Strasbourg, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service de Maladies Infectieuses et Tropicales [CHU Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Wrocław [Poland] (UWr), Faculty of Medicine [Bydgoszcz, Poland], Nicolaus Copernicus University [Toruń], Medical University of Warsaw - Poland, Medical University of Łódź (MUL), Regional Hospital [Chorzow, Poland], La Paz Hospital, IdiPAZ, Hospital General Universitario 'Gregorio Marañón' [Madrid], Hospital Universitario Ramón y Cajal [Madrid], Universidad de Alcalá - University of Alcalá (UAH), Infectious Diseases Service, AIDS Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain., Hospital Universitario de Elche, Hospital Universitario de Valencia, Hospital de la Santa Creu i Sant Pau, Donostia Hospital Universitario San Sebastian, IMIM-Hospital del Mar, Generalitat de Catalunya, LLuita contra la Sida Fdn-HIV Unit, Germans Trias i Pujol University Hospital- Universitat Autònoma de Barcelona, Hospital Universitario de Valme, Hospital Universitari de Bellvitge, Universitat de València (UV), Hospital Universitario Reina Sofía, Hospital La Princesa, Madrid, Karolinska Institutet, Södersjukhuset, Skane University Hospital [Malmo], Lund University [Lund], University of Gothenburg (GU), Karolinska University Hospital [Stockholm], University hospital of Zurich [Zurich], Bern University Hospital [Berne] (Inselspital), University Hospital Basel [Basel], Royal Sussex County Hospital, Chelsea and Westminster Hospital, North Manchester General Hospital, University College of London [London] (UCL), Johns Hopkins University School of Medicine [Baltimore], Be Well, AIDS healthcare foundation [California], Henry Ford Hospital, Metropolis Medical, Central Texas Clinical Research, The Crofoot Research Center, Orlando Immunology Center, Kansas City Free Health Clinic, University of Cincinnati (UC), University of Minnesota System, University of Texas Southwestern Medical Center, South Jersey Infectious Disease, Infectious Disease, Tarrant County Infectious Disease Associates, Southern California Men’s Medical Group, Clinical Research Puerto Rico Inc, Philadelphia FIGHT, ID care, Community Research Initiative of New England, Triple O Research Institute PA, Washington University School of Medicine in St. Louis, Washington University in Saint Louis (WUSTL), Midway Immunology Center, Capital Medical Associates, Broward General Medical Center, Ruane Clinical Research Group, Pacific Oaks Medical Group, DCOL Center for Clinical Research, Peter Shalit MD and Associates, La Playa Medical Group, Seton Hall University, Warren Alpert Medical School of Brown University, AIDS Arms, Inc, Dupont Circle Physicians Group, Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Hospital Universitario Donostia [San Sebastian, Spain] (HUD), Universitat Autònoma de Barcelona (UAB), Hospital Universitario de La Princesa, HAL AMU, Administrateur, UCL - SSS/IREC/SLUC - Pôle St.-Luc, and UCL - (SLuc) Service de médecine interne générale
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Male ,DOLUTEGRAVIR ,Sustained Virologic Response ,HIV Infections ,Gastroenterology ,chemistry.chemical_compound ,0302 clinical medicine ,Medicine and Health Sciences ,Emtricitabine ,030212 general & internal medicine ,Pharmacology & Pharmacy ,Darunavir ,0303 health sciences ,Alanine ,Drug Substitution ,Cobicistat ,Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination ,Lamivudine ,Antiretrovirals ,Middle Aged ,Viral Load ,OPEN-LABEL ,3. Good health ,WEIGHT-GAIN ,Drug Combinations ,Treatment Outcome ,Dolutegravir ,NON-INFERIORITY ,Female ,Safety ,Viral load ,Life Sciences & Biomedicine ,medicine.drug ,Tablets ,Adult ,medicine.medical_specialty ,Efficacy ,Anti-HIV Agents ,RITONAVIR ,TENOFOVIR ALAFENAMIDE ,LAMIVUDINE ,Tenofovir alafenamide ,Single-tablet regimen ,03 medical and health sciences ,Internal medicine ,Virology ,medicine ,VIH (Virus) ,Humans ,Switch study ,Protease Inhibitors ,Tenofovir ,Aged ,Pharmacology ,Science & Technology ,030306 microbiology ,business.industry ,HIV (Viruses) ,Adenine ,Darunavir/cobicistat/emtricitabine/TAF ,Antiretroviral agents ,COBICISTAT ,MAINTENANCE ,chemistry ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,HIV-1 ,Ritonavir ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,RESISTANCE - Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg was investigated through 96 weeks in EMERALD (NCT02269917). Virologically-suppressed, HIV-1-positive treatment-experienced adults (previous non-darunavir virologic failure [VF] allowed) were randomized (2:1) to D/C/F/TAF or boosted protease inhibitor (PI) plus emtricitabine/tenofovir-disoproxil-fumarate (F/TDF) over 48 weeks. At week 52 participants in the boosted PI arm were offered switch to D/C/F/TAF (late-switch, 44 weeks D/C/F/TAF exposure). All participants were followed on D/C/F/TAF until week 96. Efficacy endpoints were percentage cumulative protocol-defined virologic rebound (PDVR; confirmed viral load [VL] ≥50 copies/mL) and VL
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- 2019
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7. Imaging features of paratesticular masses
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Secil, M. and Bertolotto, M. and Rocher, L. and Pekindil, G. and Stocca, T. and Richenberg, J. and Ramchandani, P. and Derchi, L.E., Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey, Department of Radiology, University of Trieste, Trieste, Italy, Department of Radiology, Bicêtre Hospital, Paris, France, Department of Radiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey, Department of Radiology, San Giovanni di Dio Hospital, Gorizia, Italy, Royal Sussex County Hospital Brighton and Brighton, Sussex Medical School, Brighton, Sussex, United Kingdom, Department of Genitourinary Radiology, University of Pennsylvania Medical Center, Philadelphia, PA, United States, and Department of Radiology, Dipartimento di Scienze della Salute, University of Genoa, Genoa, Italy
- Abstract
In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non-neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented. © 2017 by the American Institute of Ultrasound in Medicine.
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- 2017
8. EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy
- Author
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Erkka Valovirta, Hans Jørgen Malling, Oliver Pfaar, Jean Bousquet, Montserrat Fernandez-Rivas, Ludger Klimek, Marek Jutel, Pascal Demoly, Gianenrico Senna, Gabriela Senti, Carmen Vidal, Giovanni Battista Pajno, Victoria Cardona, Ralph Mösges, Jocelyne Just, Antonio Nieto, Cezmi A. Akdis, Aziz Sheikh, Claus Bachert, Sabina Rak, Lars Jacobsen, Anthony J. Frew, Antonella Muraro, Albrecht Bufe, Peter Eng, Rudolph Valenta, Nikolaos G. Papadopoulos, Stephen R. Durham, Moises A. Calderon, Marianne van Hage, Roy Gerth van Wijk, Eva M. Varga, Ulrich Wahn, Jan Lötvall, B. M. Bilo, Johannes C Virchow, Alain Didier, Barbara Bohle, Ronald Dahl, Giovanni Passalacqua, Walter Canonica, Jörg Kleine-Tebbe, Glenis Scadding, Carmen Moreno, Emilio Alvarez-Cuesta, Bodo Niggemann, Internal Medicine, Section of Allergy and Clinical Immunology, Imperial College London-National Heart and Lung Institute [UK], Pneumologie et allergologie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Pharmacoepidemiologie et évaluation de l'impact des produits de santé sur les populations, Université Bordeaux Segalen - Bordeaux 2-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Allergology, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Centre for Population Health Sciences, University of Edinburgh, Department of Respiratory Medicine, Royal Sussex County Hospital, The Royal National Throat, Nose and Ear Hospital, Upper Airway Research Laboratory (URL), Ghent University Hospital, Allergy Clinic, National University Hospital, Division of Immunopathology, Department of Pathophysiology and Allergy Research, Medizinische Universität Wien = Medical University of Vienna, Department of Internal Medicine, Immunology, Allergy & Respiratory Diseases, University Hospital-Ospedali Riuniti di Ancona, Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe, Swiss Institute of Allergy and Asthma Research (SIAF), Universität Zürich [Zürich] = University of Zurich (UZH), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Allergy, Hospital Clínico Universitario, Department of Paediatrics, Respiratory and Allergic Disease Division, Medical University Graz, Allergy Division, Universidad de Alcalá - University of Alcalá (UAH)-Ramon & Cajal University Hospital, Department of Pathophysiology and Allergy Research, Medizinische Universität Wien = Medical University of Vienna-Christian Doppler Laboratory for Immunomodulation, Department of Experimental Pneumology, Ruhr University Bochum (RUB), Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa (UNIGE), Allergy Section, Department of Internal Medicine, Vall d'Hebron University Hospital [Barcelona], Department of Respiratory Diseases, Aarhus University Hospital, Service de Pneumologie-Allergologie, CHU Toulouse [Toulouse]-Hôpital Larrey [Toulouse], CHU Toulouse [Toulouse], Imperial College London-Royal Brompton Hospital-National Heart and Lung Institute [UK], Allergy Unit, Children's Hospital-Kantonsspital Aarau, Facultad de Medicina-UCM, Hospital Clínico San Carlos-IdISSC, Research Centre for Prevention and Health (RCPH), Department of Public Health [Copenhagen], Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU)-Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU)-Capital Region of Denmark, Department of Clinical Immunology, Wroclaw Medical University, Allergy & Asthma Center Westend, Outpatient Clinic Hanf, Center for Rhinology and Allergology, Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg (GU), Seccion de Alergia, Hospital Reina Sofía, Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Department of Pediatrics, Padua General Hospital, Pediatric Allergology and Pneumology, German Red Cross Clinic Westend, Department of Pediatrics, Allergy Unit, University of Messina, Allergy and Respiratory Diseases, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital [Gothenburg], Allergy Service, Verona General Hospital, Clinical Trials Center, University hospital of Zurich [Zurich], Suomen Terveystalo Allergy Clinic, Division of Respiratory Medicine, Department of Medicine, Karolinska Institutet [Stockholm], Department of Pulmonology, Intensive Care Medicine, Zentrum f. Innere Medizin, Klinik I-University Clinic Rostock, Department for Pediatric Pneumology and Immunology, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], UPC Research Laboratories, Allergy Department, Università degli studi di Genova = University of Genoa (UniGe), Service Pneumologie-Allergologie [CHU Toulouse], Pôle Clinique des Voies respiratoires [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH)-Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH)-Capital Region of Denmark, Wrocław Medical University, and BMC, Ed.
- Subjects
Pulmonary and Respiratory Medicine ,Quality of life ,medicine.medical_specialty ,Allergy ,[SDV.IMM] Life Sciences [q-bio]/Immunology ,Immunology ,Alternative medicine ,Declaration ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Position Article and Guidelines ,Epidemiology ,Pandemic ,medicine ,Immunology and Allergy ,030212 general & internal medicine ,Rhinitis ,Health economics ,business.industry ,Public health ,RC581-607 ,medicine.disease ,Asthma ,3. Good health ,030228 respiratory system ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Family medicine ,Immunotherapy ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Immunologic diseases. Allergy ,business - Abstract
Allergy today is a public health concern of pandemic proportions, affecting more than 150 million people in Europe alone. In view of epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) predicts that within the next few decades, more than half of the European population may at some point in their lives experience some type of allergy. Not only do allergic patients suffer from a debilitating disease, with the potential for major impact on their quality of life, career progression, personal development and lifestyle choices, but they also constitute a significant burden on health economics and macroeconomics due to the days of lost productivity and underperformance. Given that allergy triggers, including urbanization, industrialization, pollution and climate change, are not expected to change in the foreseeable future, it is imperative that steps are taken to develop, strengthen and optimize preventive and treatment strategies. Allergen specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease. Years of basic science research, clinical trials, and systematic reviews and meta-analyses have convincingly shown that allergen specific immunotherapy can achieve substantial results for patients, improving the allergic individuals’ quality of life, reducing the long-term costs and burden of allergies, and changing the course of the disease. Allergen specific immunotherapy not only effectively alleviates allergy symptoms, but it has a long-term effect after conclusion of the treatment and can prevent the progression of allergic diseases. Unfortunately, allergen specific immunotherapy has not yet received adequate attention from European institutions, including research funding bodies, even though this could be a most rewarding field in terms of return on investments, translational value and European integration and, a field in which Europe is recognized as a worldwide leader. Evaluation and surveillance of the full cost of allergic diseases is still lacking and further progress is being stifled by the variety of health systems across Europe. This means that the general population remains unaware of the potential use of allergen specific immunotherapy and its potential benefits. We call upon Europe’s policy-makers to coordinate actions and improve individual and public health in allergy by: Promoting awareness of the effectiveness of allergen specific immunotherapy Updating national healthcare policies to support allergen specific immunotherapy Prioritising funding for allergen specific immunotherapy research Monitoring the macroeconomic and health economic parameters of allergy Reinforcing allergy teaching in medical disciplines and specialties The effective implementation of the above policies has the potential for a major positive impact on European health and well-being in the next decade.
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- 2012
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9. FRED-UK: Multicentre UK experience of FRED and FRED Jr flow re-direction endoluminal device for intracranial aneurysms: 6 months and 1 year clinical and anatomical results.
- Author
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Taylor E, Downer J, Lamin S, Chandran A, Koumellis P, Gan C, Jadun C, Booth T, Gholkar A, Leyon J, and Lobotesis K
- Abstract
Background: Flow diverting stents (FDS) are an established endovascular treatment for intracranial aneurysms but are reported to have varying rates of adequate occlusion and thromboembolic complications. This study reports clinical safety and efficacy results of the FRED and FRED Jr FDS in clinical practice in the UK at 6 months and 1 year., Methods: The FRED-UK study is a single arm, multicentre, prospective, observational study conducted in the UK. Safety was reviewed by evaluating morbidity (modified Rankin Score ≤2) and mortality. Efficacy was assessed as adequate occlusion of the treated aneurysm. A clinical event committee and core laboratory independently assessed clinical and anatomical results., Results: Seven neurointerventional centers treated 61 patients, 57 of which met the full inclusion and exclusion criteria. Of these, 75.4% were treated with FRED and 24.6% with FRED Jr. The aneurysms were located on the cavernous or supraclinoid internal carotid artery (ICA) in 75.4%, on the anterior cerebral artery (ACA) or anterior communicating artery (Acom) in 21.1%, and on the middle cerebral artery (MCA) in 3.5%. 57.9% of aneurysms were small (<10 mm), 40.4% were large (10-24 mm) and 1.8% were giant (≥25 mm). All-cause morbidity and mortality were 0% at 6 and 12 months, and adequate occlusion was 86.7% at 12 months in the per protocol population., Conclusions: The FRED and FRED Jr devices are safe and efficacious in the treatment of intracranial aneurysms., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ET, AC, CG, CJ, AG and PK report no conflicts of interest.JD has been paid by Microvention as a consultant and paid speaking fees by Medtronic, Phenox and Microvention.JD, SL and JL have each been paid by Microvention to participate in data monitoring or clinical events committee for another Microvention study.SL and KL have been paid consulting and proctoring fees by Microvention.TB has been paid by Microvention to be part of a core laboratory for another interventional study investigating a Microvention product. TB has also been paid to give an educational lecture on an independent, non-industry sponsored study published in AJNR on the Pipeline Flow Diverter Stent.JL was paid by Microvention to adjudicate clinical events for this study as part of the clinical events committee.The study was funded by Microvention Europe who manufactures the FRED and FRED Jr stents.
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- 2024
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10. Hydroxocobalamin Versus Methylene Blue for Treatment of Vasoplegic Shock Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.
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Cadd M, Watson U, Kilpatrick T, Hardy B, Gallop L, Gerard A, and Cabaret C
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- Humans, Retrospective Studies, Treatment Outcome, Postoperative Complications drug therapy, Hydroxocobalamin administration & dosage, Hydroxocobalamin therapeutic use, Methylene Blue therapeutic use, Methylene Blue administration & dosage, Vasoplegia drug therapy, Vasoplegia etiology, Cardiopulmonary Bypass adverse effects
- Abstract
Objectives: To summarize the evidence of the hemodynamic effects and vasopressor requirements of adult cardiac surgery patients with vasoplegic shock treated with hydroxocobalamin or methylene blue., Design: Systematic review and meta-analysis., Setting: Multi-institutional., Participants: Adult cardiac surgery patients with vasoplegic shock., Interventions: Administration of hydroxocobalamin or methylene blue., Measurements and Main Results: A total of 263 patients in four retrospective observational studies were included in a pooled analysis. There was no significant difference in the primary outcome, vasopressor requirement at 1 hour (mean difference [MD]: 0.00 mcg/kg/min norepinephrine equivalent [NEE], 95% confidence interval [CI]: -0.09 to 0.08). Hydroxocobalamin was associated with a significant improvement in mean arterial pressure at 1 hour (MD: 5.30 mmHg, 95% CI: 2.98 to 7.62), total vasopressor dose at 1 hour (MD: -0.13 mcg/kg/min NEE, 95% CI: -0.25 to -0.01), total vasopressor at 6 hours (MD: -0.15 mcg/kg/min NEE, 95% CI: -0.21 to -0.08). No differences were observed in systemic vascular resistance or mortality between groups. Three studies were deemed at moderate risk of bias and one at serious risk., Conclusions: Hydroxocobalamin has been shown to have a beneficial effect on hemodynamics and vasopressor requirements in vasoplegic cardiac surgery patients compared with methylene blue, although evidence is limited, and further well-powered randomized controlled trials are required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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11. The thalamus-L-sign in hypoxic-ischemic injury likely reflects secondary circuit injury and is only a feature on delayed magnetic resonance imaging in children with established cerebral palsy: reply to Merhav et al.
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Venkatakrishna SSB, Ackermann C, Curic J, Zouvani A, Tierradentro-Garcia LO, and Andronikou S
- Abstract
Competing Interests: Declarations. Conflicts of interest: The authors declare no competing interests.
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- 2024
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12. Total videoscopic tracheal intubation: a technical modification to reduce the risk of unrecognised oesophageal intubation.
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Wright J and Sudan S
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- 2024
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13. Timing of Aortic Valve Intervention in the Management of Aortic Stenosis.
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Maznyczka A, Prendergast B, Dweck M, Windecker S, Généreux P, Hildick-Smith D, Bax J, and Pilgrim T
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- Humans, Time Factors, Treatment Outcome, Risk Factors, Clinical Decision-Making, Severity of Illness Index, Aged, Patient Selection, Risk Assessment, Predictive Value of Tests, Recovery of Function, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Time-to-Treatment
- Abstract
Aortic stenosis (AS) affects about 12% of people aged ≥75 years. Accumulating evidence on the prognostic importance of cardiac damage in patients with asymptomatic and less than severe AS supports the proposition of advancing aortic valve replacement (AVR) to earlier disease stages. Potential benefits of earlier treatment, including prevention of cardiac damage progression and reduced cardiovascular hospitalizations, need to be balanced against the earlier procedural risk and subsequent lifetime management after AVR. Two small, randomized trials indicate that early surgical AVR may improve survival in patients with asymptomatic severe AS, and observational data suggest that AVR may reduce mortality even in patients with moderate AS. A clear understanding of the pathophysiology of cardiac damage secondary to AS is needed to develop strategies to select patients for earlier AVR. Noninvasive imaging can detect early cardiac damage, and indices such as fibrosis, global longitudinal strain, and myocardial work index have potential use to guide stratification of patients for earlier AVR. Ongoing randomized trials are investigating the safety and efficacy of AVR for patients with asymptomatic severe AS and those with moderate AS who have symptoms/evidence of cardiac damage. Pathophysiological considerations and accumulating evidence from clinical studies that support earlier timing of AVR for AS will need to be corroborated by the results of these trials. This review aims to evaluate the evidence for earlier AVR, discuss strategies to guide stratification of patients who may benefit from this approach, highlight the relevant ongoing randomized trials, and consider the consequences of earlier intervention., Competing Interests: Funding Support and Author Disclosures Dr Maznyczka is an EAPCI international structural fellow whose fellowship is funded by Edwards Lifesciences through EAPCI and not directly from Edwards Lifesciences. Dr Maznyczka has received travel grants from Edwards Lifesciences, Abbott, Boston Scientific, and Medtronic. Dr Prendergast has received lecture fees from Edwards Lifesciences; and has served on a trial steering committee for Medtronic and a data safety and monitoring committee for Valvosoft. Dr Windecker has received research and educational grants to his institution from Abbott, Amgen, AstraZeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi, Sinomed, Terumo, and V-Wave; serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, Med Alliance, Medtronic, Novartis, Polares, Sinomed, V-Wave, and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers; is a member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration; is an unpaid member of the Pfizer Research Award selection committee in Switzerland and of the Women as One Awards Committee; is member of the Clinical Study Group of the Deutsches Zentrum für Herz Kreislauf-Forschung and of the Advisory Board of the Australian Victorian Heart Institute; and is chairperson of the ESC Congress Program Committee and Associate Editor of JACC Cardiovascular Interventions. Dr Généreux has served as a consultant for Abbott Vascular, Abiomed, BioTrace Medical, Boston Scientific, CARANX Medical, Cardiovascular System Inc (PI Eclipse Trial), Edwards Lifesciences (PI EARLY-TAVR trial, PI PROGRESS trial), GE Healthcare, iRhythm Technologies, Medtronic, Opsens, Pi-Cardia, Puzzle Medical, Saranas, Shockwave, Siemens, Soundbite Medical Inc, Teleflex, and 4C Medical (PI feasibility study); has served as an advisor for Abbott Vascular, Abiomed, BioTrace Medical, Edwards Lifesciences, and Medtronic; has received speaker fees from Abbott Vascular, Abiomed, BioTrace Medical, Edwards Lifesciences, Medtronic, and Shockwave; has served as a proctor for and received an institutional research grant from Edwards Lifesciences, and has equity in Pi-Cardia, Puzzle Medical, Saranas, and Soundbite Medical Inc. Dr Hildick-Smith has served as an advisor/ proctor for Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott. Dr Bax has received speaker fees from Abbott Vascular, Edwards Lifesciences, and Omron. Dr Pilgrim has received research, travel, or educational grants to his institution without personal remuneration from Biotronik, Boston Scientific, Edwards Lifesciences, and ATSens; and has received speaker fees and consultancy fees to his institution from Biotronik, Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, Biosensors, and Highlife. Dr Dweck has reported that he has no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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14. A cutaneous sensory nerve schwannoma occluding the external auditory canal.
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Bass JA, Gupta T, Saunders N, and Bowles P
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- Humans, Male, Ear Neoplasms surgery, Ear Neoplasms pathology, Ear Neoplasms diagnosis, Ear Neoplasms diagnostic imaging, Middle Aged, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Hearing Loss, Conductive etiology, Neurilemmoma surgery, Neurilemmoma diagnostic imaging, Neurilemmoma pathology, Neurilemmoma diagnosis, Neurilemmoma complications, Ear Canal pathology, Ear Canal diagnostic imaging, Ear Canal surgery
- Abstract
Schwannomas are benign tumours derived from Schwann cells of the peripheral nerve sheaths. A schwannoma arising in the external auditory canal (EAC) is rare, with few cases reported in the literature. These tumours present a unique challenge and should be considered when patients present with persistent ear symptoms in the absence of common otological pathology. We present a case of a man in his late 60s, referred to the otolaryngology team with unilateral conductive hearing loss and a right-sided EAC mass found on otoscopy. CT and MRI of the head and neck revealed a mass occluding the right EAC, originating from a peripheral cutaneous nerve. Management including biopsy, histopathological analysis and surgical excision in its entirety resulted in a good outcome, leaving a symptom-free patient., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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15. Investigating the impact of socioeconomic status on amyotrophic lateral sclerosis.
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Shojaie A, Al Khleifat A, Garrahy S, Habash-Bailey H, Thomson R, Opie-Martin S, Javidnia S, Leigh PN, and Al-Chalabi A
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- Humans, Male, Female, Middle Aged, Aged, Adult, Age of Onset, Risk Factors, Amyotrophic Lateral Sclerosis epidemiology, Amyotrophic Lateral Sclerosis economics, Social Class
- Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the gradual death of motor neurons in the brain and spinal cord, leading to fatal paralysis. Socioeconomic status (SES) is a measure of an individual's shared economic and social status, which has been shown to have an association with health outcomes. Understanding the impact of SES on health conditions is crucial, as it can influence and be influenced by health-related variables. The role of socioeconomic status in influencing the risk and progression of ALS has not been established, and understanding the various factors that impact ALS is important in developing strategies for treatment and prevention. To investigate this relationship, we recruited 413 participants with definite, probable, or possible ALS according to the El Escorial criteria, from three tertiary centers in London, Sheffield, and Birmingham. Logistic regression was used to examine the association between case-control status, socioeconomic criteria, and ALS risk. Linear regression was used to examine the association between age of onset and socioeconomic variables. Two sensitivity analyses were performed, one using an alternative occupational classifier, and the other using Mendelian Randomization analysis to examine association. There was no significant relationship between any variables and ALS risk. We found an inverse relationship between mean lifetime salary and age of ALS onset (Beta = -0.157, p = 0.011), but no effect of education or occupation on the age of onset. The finding was confirmed in both sensitivity analyses and in Mendelian Randomization. We find that a higher salary is associated with a younger age of ALS onset taking into account sex, occupation, years of education, and clinical presentation.
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- 2024
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16. Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism.
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Jayasena CN, Devine K, Barber K, Comninos AN, Conway GS, Crown A, Davies MC, Ewart A, Seal LJ, Smyth A, Turner HE, Webber L, Anderson RA, and Quinton R
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- Humans, Female, Primary Ovarian Insufficiency diagnosis, Primary Ovarian Insufficiency therapy, Practice Guidelines as Topic, Societies, Medical standards, Hypogonadism diagnosis, Hypogonadism therapy, Endocrinology standards, Endocrinology methods
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Female hypogonadism (FH) is a relatively common endocrine disorder in women of premenopausal age, but there are significant uncertainties and wide variation in its management. Most current guidelines are monospecialty and only address premature ovarian insufficiency (POI); some allude to management in very brief and general terms, and most rely upon the extrapolation of evidence from the studies relating to physiological estrogen deficiency in postmenopausal women. The Society for Endocrinology commissioned new guidance to provide all care providers with a multidisciplinary perspective on managing patients with all forms of FH. It has been compiled using expertise from Endocrinology, Primary Care, Gynaecology and Reproductive Health practices, with contributions from expert patients and a patient support group, to help clinicians best manage FH resulting from both POI and hypothalamo-pituitary disorders, whether organic or functional., (© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd.)
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- 2024
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17. William Attree (died 1846): Royal and army surgeon who underwent amputation of the leg at Brighton, England (1807).
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Cooper MJ, Whiston B, and Cooper S
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- History, 19th Century, England, Leg surgery, Military Medicine history, Humans, Amputation, Surgical history, Surgeons history
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William Attree (1780-1846) came from a prominent family in Brighton, England. He studied medicine at St Thomas' Hospital, London, and there was unwell for nearly 6 months with severe 'spasms' of the hand/arm/chest (1801-1802). Attree qualified Member of the Royal College of Surgeons in 1803 and served as dresser to Sir Astley Paston Cooper (1768-1841). In 1806 Attree is recorded as 'Surgeon and Apothecary' of Prince's street, Westminster. In 1806 Attree's wife died in childbirth and the following year he underwent emergency amputation of the foot in Brighton following a road traffic accident. Attree served as surgeon in the Royal Horse Artillery at Hastings, presumably in a regimental or garrison hospital. He went onto become surgeon to the Sussex County Hospital, Brighton, and Surgeon Extraordinary to two Kings: George IV and William IV. In 1843 Attree was appointed as one of the original 300 Fellows of the Royal College of Surgeons. He died in Sudbury, near Harrow. His son William Hooper Attree (1817-1875) was surgeon to Don Miguel de Braganza, the former King of Portugal. The medical literature appears to lack a history of nineteenth century doctors (especially military surgeons) with physical disability. Attree's biography goes a small way towards developing this field of enquiry., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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18. Two cases of linagliptin-associated bullous pemphigoid resulting in sepsis and endocarditis.
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Vanner M, Tanner A, and Chakera A
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Competing Interests: Competing interests: None declared.
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- 2024
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19. Management of First Bite Syndrome: Systematic Review of Recent Evidence.
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Ang WW, Goh ET, and Laycock J
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- 2024
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20. Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow.
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Mannan M, Eisha S, Afridi A, and Mazari MI
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Background Local depot steroid injections can consistently and predictably relieve tennis elbow pain in the short term. Prolotherapy, extracorporeal shockwave therapy, autologous blood, and local injections of platelet-rich plasma (PRP) are examples of novel treatment approaches. Objective The objective of this study is to compare the effectiveness of autologous blood injection and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow) using the visual analog scale (VAS) over 12 weeks. Methods A descriptive case series was conducted from July 10, 2019, to July 9, 2021, at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital. A total of 396 patients with tennis elbow, aged 20 to 50 years, were included (198 in each group). Patients managed with non-operative methods and those with other associated injuries in the same elbow were excluded. Group I received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution. Group II received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks. Results In Group I, the average age of the patients was 36.04 ± 8.26 years, while in Group II, it was 37.23 ± 7.32 years. The male-to-female ratio was 2.3:1; 276 (69.81%) of the 396 patients were male, while 120 (30.19%) were female. Group I's mean baseline VAS score was 6.99 ± 0.99, while Group II's mean baseline VAS score was 6.99 ± 1.06 (p = 1.000). Group I had a mean post-therapy VAS score of 3.11 ± 1.62, while Group II had a mean score of 2.48 ± 1.26 (p = 0.0001). About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis (p = 0.0001). Conclusion This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection, with a statistically significant p-value of 0.0001. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effective treatment, reducing the need for repeat procedures and improving patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethical Review Committee of the Ghurki Trust Teaching Hospital/Lahore Medical and Dental College, Lahore, Pakistan, issued approval 117/LMDC/2019. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mannan et al.)
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- 2024
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21. Saying "why?" instead of "no".
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Parachikov PI
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Competing Interests: Competing interests: None declared.
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- 2024
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22. Laparoscopic Management of Acute Small Bowel Obstruction: A Retrospective Study at a Tertiary Center in the United Kingdom.
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Subramanian A, Swaminathan C, Siby J, Singh A, and Gulab A
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Objectives To present a single-center experience of laparoscopic management of acute small bowel obstruction (ASBO) based on seven years of data and demonstrate its suitability for the United Kingdom (UK). Methods A retrospective review of case notes to evaluate postoperative outcomes was conducted. All emergency small bowel obstructions treated laparoscopically were included. The cases that were converted to a laparotomy were excluded. Demographics (age, sex), American Society of Anesthesiologists (ASA) grade, indication for surgery, duration of stay, complications, requirement of stoma, requirement of intensive treatment unit/high dependency unit (ITU/HDU), reoperation/readmissions, and 30-day mortality were noted. The results were tabulated and analyzed accordingly. Results There were 119 patients studied, with a median age of 66 (range: 17-97). The sex ratio was 62 females to 57 males. Primary etiologies of adhesion bands (49.5%, 59) and hernia (31.9%, 38) were the most common. Minor and major complications were 15 (12.6%) and 37 (31%), respectively. Three (2.5%) patients passed away within 30 days of surgery. The median length of stay (LOS) was eight days. The median LOS subgroup analysis showed nine days for adhesiolysis and six days for hernias. Discussion This study shows that there is significant heterogeneity in outcomes regarding small bowel obstruction around the world. We have demonstrated similar to better results in our center relative to other prominent centers in the UK. This can be attributed to the patient cohort, presentation, and physiological status on admission, delay to surgery, and associated co-morbidities to name a few. Conclusion This study indicates that laparoscopic surgery is a safe approach to treating ASBO, provided adequate expertise and infrastructure are available., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Subramanian et al.)
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- 2024
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23. Anticipating the need for palliative care.
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Parachikov PI
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- Humans, Health Services Needs and Demand, Palliative Care
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- 2024
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24. Breast Cancer: The Psychological Impact of Diagnosis, Treatment, and Remission.
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Graham J
- Abstract
Breast cancer affects millions of people worldwide. With physical manifestations being the predominant feature of management, healthcare professionals can overlook the psychological toll that the disease can have on the patients and their support network. This literature review examines the vast multi-factorial approach that must be taken when managing breast cancer patients from initial screening to diagnostic investigations, treatment, and remission. A literature search in PubMed from January 2000 to April 2024 was executed. Data sets in the studies filtered during the literature search were collected and analysed, looking not only at the data itself but also the entirety of the study. This included its limitations and possible biases. From screening, the possibility of cancer as a diagnosis can trigger mixed emotions including fear, depression, and anxiety. During diagnostic, patients may find themselves subject to fear of negative body image evaluation and fear of judgment. Medical professionals must be prepared to support the patient when they experience these feelings. The treatment stages can be the most difficult for the patient as side effects and complications of treatment can impact their lives in numerous ways, making management challenging. These include pain, sexual dysfunction, and alopecia. Overall, the analysis of the selected literature showed areas in clinical practice that can be optimised when providing psychological support for a patient's cancer diagnosis, management, and treatment. Being able to counsel prior to the presentation of these, and ideally prevent unnecessary cases of these can substantially increase a patient's quality of life during treatment. This literature review hopes to identify and promote awareness and further implementation of support systems by healthcare professionals., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Graham et al.)
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- 2024
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25. Detailed analysis of electrogram peak frequency to guide ventricular tachycardia substrate mapping.
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Mayer J, Al-Sheikhli J, Niespialowska-Steuden M, Patchett I, Winter J, Siang R, Lellouche N, Manoharan K, Phan TT, Calvo JJ, Porta-Sánchez A, Luque IR, Silberbauer J, and Dhanjal T
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- Humans, Male, Female, Middle Aged, Aged, Heart Rate, Action Potentials, Wavelet Analysis, Predictive Value of Tests, Cardiac Pacing, Artificial, Tachycardia, Ventricular physiopathology, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery, Electrophysiologic Techniques, Cardiac methods, Catheter Ablation methods, Algorithms
- Abstract
Aims: Differentiating near-field (NF) and far-field (FF) electrograms (EGMs) is crucial in identifying critical arrhythmogenic substrate during ventricular tachycardia (VT) ablation. A novel algorithm annotates NF-fractionated signals enabling EGM peak frequency (PF) determination using wavelet transformation. This study evaluated the algorithms' effectiveness in identifying critical components of the VT circuit during substrate mapping., Methods and Results: A multicentre, international cohort undergoing VT ablation was investigated. VT activation maps were used to demarcate the isthmus zone (IZ). Offline analysis was performed to evaluate the diagnostic performance of low-voltage area (LVA) PF substrate mapping. A total of 30 patients encompassing 198 935 EGMs were included. The IZ PF was significantly higher in sinus rhythm (SR) compared to right ventricular paced (RVp) substrate maps (234 Hz (195-294) vs. 197 Hz (166-220); P = 0.010). Compared to LVA PF, the IZ PF was significantly higher in both SR and RVp substrate maps (area under curve, AUC: 0.74 and 0.70, respectively). The LVA PF threshold of ≥200 Hz was optimal in SR maps (sensitivity 69%; specificity 64%) and RVp maps (sensitivity 60%; specificity 64%) in identifying the VT isthmus. In amiodarone-treated patients (n = 20), the SR substrate map IZ PF was significantly lower (222 Hz (186-257) vs. 303 Hz (244-375), P = 0.009) compared to amiodarone-naïve patients (n = 10). The ≥200 Hz LVA PF threshold resulted in an 80% freedom from VT with a trend towards reduced ablation lesions and radiofrequency times., Conclusion: LVA PF substrate mapping identifies critical components of the VT circuit with an optimal threshold of ≥200 Hz. Isthmus PF is influenced by chronic amiodarone therapy with lower values observed during RV pacing., Competing Interests: Conflict of interest: JS, IRL, NL, and TD receive research grants from Abbott Medical., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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26. Skull Base Chordoma and Chondrosarcoma: Neuroradiologist's Guide to Diagnosis, Surgical Management, and Proton Beam Therapy.
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Potter GM, Siripurapu R, Herwadkar A, Abdulla S, Ikotun O, Broadhurst P, Woodward M, Bhalla RK, Glancz LJ, Hammerbeck-Ward CL, Rutherford SA, Pathmanaban ON, Roncaroli F, Colaco RJ, Pan S, and Whitfield GA
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- Humans, Magnetic Resonance Imaging methods, Skull Base Neoplasms diagnostic imaging, Skull Base Neoplasms radiotherapy, Skull Base Neoplasms surgery, Chordoma diagnostic imaging, Chordoma radiotherapy, Chordoma surgery, Chondrosarcoma radiotherapy, Chondrosarcoma diagnostic imaging, Chondrosarcoma surgery, Proton Therapy methods
- Abstract
Skull base chordomas and chondrosarcomas are distinct types of rare, locally aggressive mesenchymal tumors that share key principles of imaging investigation and multidisciplinary care. Maximal safe surgical resection is the treatment choice for each, often via an expanded endoscopic endonasal approach, with or without multilayer skull base repair. Postoperative adjuvant radiation therapy is frequently administered, usually with particle therapy such as proton beam therapy (PBT). Compared with photon therapy, PBT enables dose escalation while limiting damage to dose-limiting neurologic structures, particularly the brainstem and optic apparatus, due to energy deposition being delivered at a high maximum with a rapid decrease at the end of the penetration range (Bragg peak phenomenon). Essential requirements for PBT following gross total or maximal safe resection are tissue diagnosis, minimal residual tumor after resection, and adequate clearance from PBT dose-limiting structures. The radiologist should understand surgical approaches and surgical techniques, including multilayer skull base repair, and be aware of evolution of postsurgical imaging appearances over time. Accurate radiologic review of all relevant preoperative imaging examinations and of intraoperative and postoperative MRI examinations plays a key role in management. The radiology report should reflect what the skull base surgeon and radiation oncologist need to know, including distance between the tumor and PBT dose-limiting structures, tumor sites that may be difficult to access via the endoscopic endonasal route, the relationship between intradural tumor and neurovascular structures, and tumor sites with implications for postresection stability.
© RSNA, 2024 Supplemental material is available for this article.- Published
- 2024
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27. The Impact of National Radiotherapy Guidelines: The UK Anal Cancer Story.
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Adams R, Drinkwater K, Gilbert DC, Hawkins MA, Sebag-Montefiore D, Thorpe N, and Muirhead R
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- Humans, United Kingdom, Anus Neoplasms radiotherapy, Practice Guidelines as Topic
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- 2024
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28. Peak frequency analysis for epicardial contact mapping: How (in)frequent is epicardial adipose tissue?
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Tonko JB, Silberbauer J, and Lambiase PD
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- Humans, Catheter Ablation methods, Epicardial Adipose Tissue, Adipose Tissue, Pericardium diagnostic imaging, Epicardial Mapping methods
- Abstract
Competing Interests: Disclosures The authors have no conflicts of interest to declare in direct relation to this manuscript. Dr Silberbauer received speaker fees from Abbott Laboratories.
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- 2024
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29. Xanthogranulomatous osteomyelitis of the cervical spine.
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Perera A, Rus M, Thom M, and Critchley G
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- Humans, Female, Aged, Spinal Cord Compression surgery, Spinal Cord Compression etiology, Treatment Outcome, Xanthomatosis surgery, Xanthomatosis pathology, Xanthomatosis diagnosis, Magnetic Resonance Imaging, Granuloma surgery, Granuloma pathology, Osteomyelitis surgery, Osteomyelitis diagnosis, Cervical Vertebrae surgery
- Abstract
Background: Xanthogranulomatous Osteomyelitis is a rare form of chronic inflammation described in a handful of cases in the reported literature involving the long bones of the axial skeleton. To the authors knowledge it has not been reported in the spinal column., Case: We report a case of a 65 year old female presenting with features of metastatic cord compression and an expansile lesion affecting the 5th -7th cervical vertebrae. She underwent vertebrectomy, insertion of an expandable cage and plating to good effect. A histological diagnosis of Xanthogranulomatous Osteomyelitis was made., Conclusions: We report what the authors believe to be the first case in the literature of xanthogranulomatous osteomyelitis affecting the spine. In this case the patient was managed with a vertebrectomy without the need for antibiotics.
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- 2024
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30. Pulmonary Hypertension in Interstitial Lung Disease: A Systematic Review and Meta-Analysis.
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Ang HL, Schulte M, Chan RK, Tan HH, Harrison A, Ryerson CJ, and Khor YH
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- Humans, Cardiac Catheterization methods, Echocardiography methods, Prognosis, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary epidemiology, Hypertension, Pulmonary etiology, Hypertension, Pulmonary therapy, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial diagnosis
- Abstract
Background: Pulmonary hypertension (PH) is a key complication in interstitial lung disease (ILD), with recent therapeutic advances., Research Question: What are the diagnostic evaluation, epidemiologic features, associated factors, prognostic significance, and outcome measures in interventional trials for PH in patients with ILD in the current literature?, Study Design and Methods: The Ovid MEDLINE, Embase, and CENTRAL databases were searched for original research evaluating PH in participants with ILD of any cause. The definition of PH was based on the investigators' criteria., Results: Three hundred two studies were included, with varying diagnostic evaluations used to define PH. Commonly used diagnostic tests were right heart catheterization (56%) and transthoracic echocardiography (50%). The pooled prevalence for PH in general populations with ILD was 36% (95% CI, 30%-42%) using right heart catheterization and 34% (95% CI, 29%-38%) using transthoracic echocardiography. Lower diffusion capacity of the lungs for carbon monoxide, worse oxygenation status, reduced exercise capacity, increased pulmonary artery to aorta ratio and pulmonary artery diameter, and elevated serum brain natriuretic peptide consistently were associated with the presence of PH in at least 60% of reported studies. The presence of PH was associated with increased symptom burden and worse prognosis. Outcome measures in interventional trials of PH in ILD focused on changes in pulmonary vascular hemodynamics and 6-min walk distance., Interpretation: PH is a common complication in ILD with significant health impacts. A standardized definition with prospective evaluation of risk-stratified assessments for PH using identified associated risk factors is warranted. Our findings provide an evidence base for validation as surrogate end points in future PH interventional trials in ILD., Trial Registry: International Prospective Register of Systematic Reviews; No.: CRD42021255394; URL: https://www.crd.york.ac.uk/prospero/., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: Y. H. K. reports fellowship support from an NHMRC Investigator Grant, Austin Medical Research Foundation, and Royal Australasian College of Physicians, and grants from Boehringer Ingelheim during the conduct of the study. C. J. R. reports grants from Boehringer Ingelheim during the conduct of the study, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Hoffmann-La Roche, personal fees from Veracyte, personal fees from Pliant Therapeutics, personal fees from Astra Zeneca, and personal fees from Cipla Ltd. outside the submitted work. None declared (H. L. A., M. S., R. K. C., H. H. T., A. H.)., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
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- 2024
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31. Digitally Recording Comfort Observations in the Last Days of Life.
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Stewart E, Ford-Dunn S, Bass S, Ede C, Elliott J, Peters D, Caputo R, Moreira L, Savage E, and Minton O
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- Humans, Patient Comfort, Female, Male, Electronic Health Records, Adult, Patient Care Team organization & administration, Terminal Care organization & administration, Palliative Care organization & administration
- Abstract
Background: 37.5% of deaths in our area occur in hospital. There are known high unmet needs of adult patients dying in hospital, this unmet need can be reduced by using an individualised care plan and specialist palliative care review. Intervention: In 2022 UHSussex developed an electronic comfort observation chart and individualised care plan, with a centralised dashboard allowing Palliative Care Teams (SPCT) to view trends, target interventions, and a rolling prospective audit. Results: 3000 patients have had their care supported with electronic comfort observations (e-comfort obs). Over 72% of all deaths in the Trust in the last 3 months have been on e-comfort obs, with 2/3 of all deaths in the first 12 months on e-comfort obs. The average length of time on e-comfort obs is 4 days resulting in 70,000 sets of e-comfort obs recorded since launch. Seven percent of e-comfort obs record moderate or severe symptoms. We have identified benefits to people who are dying, those important to them, ward staff, SPCT and on a systems level. Conclusion: E-comfort obs can be successfully embedded in a large acute Trust. This development should improve quality of end of life care in our hospitals both for individuals and for future patients, through on-going targeted education and intervention. Further work is needed to develop the system further including integrating data from electronic prescribing., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2025
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32. Intragallbladder versus intravenous indocyanine green (ICG) injection for enhanced bile duct visualization by fluorescent cholangiography during laparoscopic cholecystectomy: a retrospective cohort study.
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Cai Y, Chen Q, Cheng K, Chen Z, Wu S, Wu Z, Wang X, Li Y, Balla A, Singh A, Cai H, Gao P, Cai Y, and Peng B
- Abstract
Background: Iatrogenic bile duct injuries (BDIs) prevention during laparoscopic cholecystectomy (LC) relies on meticulous anatomical dissections through direct visualization. Near-infrared fluorescence (NIRF) with indocyanine green (ICG) improves the visualization of extrahepatic biliary structures. Although ICG can be administered either intravenously or intragallbladder, there remains uncertainty regarding the optimal method for different patient populations. This study sought to assess the suitability of each method for specific patient groups., Methods: Between October 2021 and May 2022, 59 consecutive patients underwent fluorescence-guided LC at West China Hospital of Sichuan University. Among them, 32 patients received an intravenous injection of ICG (10 mg) 10 to 12 hours prior to surgery (Group A: the intravenous group), while 27 patients received an intragallbladder injection of ICG (10 mg) (Group B: the intragallbladder group). Baseline clinical factors, inclusion criteria, and measurements of parameters and complications were assessed. Data were retrospectively collected and analyzed to evaluate the comparability of the two groups and the clinical outcomes., Results: Groups A and B included 32 patients (18 males, 14 females), and 27 patients (13 men, 14 women), respectively. In our statistical analysis, significant differences were observed in preoperative diagnoses between the two groups (P=0.041), but the majority of other baseline clinical factors were comparable. Notably, no statistically significant differences were found in complication rates. However, Group A had a shorter operative time (60.38±9.35 vs. 66.78±9.88 min, P=0.01) and superior bile duct fluorescence (P=0.04) than Group B. Interestingly, fluorescence was not observed in impacted gallbladder stones in Group B. Additionally, patients with cirrhosis (P=0.008) and fatty liver (P=0.005) in Group B had higher common bile duct-to-liver ratios (BLRs) than those in Group A., Conclusions: ICG fluorescence cholangiography allows to visualize extrahepatic biliary anatomical structures with both administration methods. However, the efficacy of bile duct fluorescence varies with different administration routes in diverse patient populations. Hence, appropriate administration route selection for ICG should be tailored to individual patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-198/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)
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- 2024
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33. Dose-escalated Adaptive Radiotherapy for Bladder Cancer: Results of the Phase 2 RAIDER Randomised Controlled Trial.
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Huddart R, Hafeez S, Griffin C, Choudhury A, Foroudi F, Syndikus I, Hindson B, Webster A, McNair H, Birtle A, Varughese M, Henry A, McLaren DB, Parikh O, Nikapota A, Tang C, Patel E, Miles E, Warren-Oseni K, Kron T, Hill C, Philipps L, Vassallo-Bonner C, Cheung KC, Gribble H, Lewis R, and Hall E
- Abstract
Background and Objective: Delivering radiotherapy to the bladder is challenging as it is a mobile, deformable structure. Dose-escalated adaptive image-guided radiotherapy could improve outcomes. RAIDER aimed to demonstrate the safety of such a schedule., Methods: RAIDER is an international phase 2 noncomparative randomised controlled trial (ISRCTN26779187). Patients with unifocal T2-T4a urothelial bladder cancer were randomised (1:1:2) to standard whole bladder radiotherapy (WBRT), standard-dose adaptive radiotherapy (SART), or dose-escalated adaptive radiotherapy (DART). Two fractionation (f) schedules recruited independently. WBRT and SART dose was 55 Gy/20f or 64 Gy/32f, and DART dose was 60 Gy/20f or 70 Gy/32f. For SART and DART, a radiotherapy plan (small, medium, or large) was chosen daily. The primary endpoint was the proportion of patients with radiotherapy-related late Common Terminology Criteria for Adverse Events grade ≥3 toxicity; the trial was designed to rule out >20% toxicity with DART., Key Findings and Limitations: A total of 345 patients were randomised between October 2015 and April 2020: 41/46 WBRT, 41/46 SART, and 81/90 DART patients in the 20f/32f cohorts, respectively. The median age was 72/73 yr; 78%/85% had T2 tumours, 46%/52% had neoadjuvant chemotherapy, and 70%/71% had radiosensitising therapy. The median follow-up was 42.1/38.2 mo. Sixty-six of 77 (86%) 20f and 74 of 82 (90%) 32f participants planned for DART met the mandatory medium plan dose constraints. Radiotherapy-related grade ≥3 toxicity was reported in one of 58 patients (90% confidence interval [CI] 0.1, 7.9) with 20f DART and zero of 56 patients with 32f DART. Two-year overall survival was 77% (95% CI 69, 82) for WBRT + SART and 80% (95% CI 73, 85) for DART (hazard ratio = 0.84, 95% CI 0.59, 1.21, p = 0.4). Thirteen of 345 (3.8%) participants had salvage cystectomy., Conclusions and Clinical Implications: Grade ≥3 late toxicity was low. DART was safe and feasible to deliver, meeting preset toxicity thresholds. Disease-related outcomes are promising for dose-escalated treatments, with a low salvage cystectomy rate and overall survival similar to that seen in cystectomy cohorts., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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34. Patient-Reported Outcomes After Switching to a 2-Drug Regimen of Fixed-Dose Combination Dolutegravir/Lamivudine: 48-Week Results from the SALSA Study.
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Kumar P, Clarke AE, Jonsson-Oldenbüttel C, Deltoro MG, Di Giambenedetto S, Brites C, Hocqueloux L, Lu PL, Oyee J, Oglesby A, Wynne B, Jones B, Evitt LA, Fox D, Kisare M, and Priest J
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Patient-reported outcomes (PROs) facilitate communication between patients and providers, enhancing patient-centered care. We report PROs for virologically suppressed people living with HIV-1 who switched to dolutegravir/lamivudine (DTG/3TC) or continued their 3- or 4-drug current antiretroviral regimen (CAR) in the phase 3 SALSA study. Secondary endpoints included change from baseline in HIV Treatment Satisfaction Questionnaire (status version; HIVTSQs) and HIV Symptom Distress Module (HIV-SDM) at Weeks 4, 24, and 48. A post hoc analysis assessed change in HIVTSQs and HIV-SDM by age (≥ 50 and < 50 years). Higher HIVTSQs scores represent greater treatment satisfaction (range, 0-60); lower HIV-SDM scores indicate less symptom bother (range, 0-80). Participants in the DTG/3TC (n = 246) and CAR (n = 247) groups reported comparable baseline HIVTSQs total scores (mean [SD], 55.2 [6.5] and 55.8 [5.5], respectively). Beginning at Week 4, mean HIVTSQs scores in the DTG/3TC group further increased vs. CAR and were sustained through Week 48. Baseline mean (SD) HIV-SDM symptom bother scores were comparable between the DTG/3TC (9.0 [9.9]) and CAR (7.9 [9.3]) groups. Small improvements in HIV-SDM scores favoring DTG/3TC were observed at Weeks 4 and 24 and sustained through Week 48 (though not significant between groups). Participants aged ≥ 50 and < 50 years who switched to DTG/3TC reported higher satisfaction and less symptom distress vs. CAR; these results were generally comparable between age groups. Participants who switched to DTG/3TC reported rapid and sustained improvements in treatment satisfaction compared with those who continued CAR, reinforcing the benefits of DTG/3TC beyond virologic suppression (NCT04021290; registration date, 7/11/2019)., (© 2024. The Author(s).)
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- 2024
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35. Leaflet modification before transcatheter aortic valve implantation in patients at risk for coronary obstruction: the ShortCut study.
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Dvir D, Tchétché D, Leon MB, Généreux P, Seguy B, Makkar R, Pibarot P, Gada H, Nazif T, Hildick-Smith D, Kempfert J, Dumonteil N, Unbehaun A, Modine T, Whisenant B, Caussin C, Conradi L, Waggoner T, Mishell JM, Chetcuti SJ, Kar S, Rinaldi MJ, Szerlip M, Ramana RK, Blackman DJ, Ben-Dor I, Kornowski R, Waksman R, Gerckens U, Denti P, Kukucka M, Ternacle J, Skaf S, Kovac J, Jilaihawi H, Patel V, Jubeh R, Abdel-Wahab M, and Kodali S
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- Humans, Female, Male, Aged, Prospective Studies, Prosthesis Failure, Prosthesis Design, Aged, 80 and over, Aortic Valve surgery, Aortic Valve diagnostic imaging, Treatment Outcome, Coronary Occlusion surgery, Postoperative Complications epidemiology, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Bioprosthesis
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Background and Aims: This trial sought to assess the safety and efficacy of ShortCut, the first dedicated leaflet modification device, prior to transcatheter aortic valve implantation (TAVI) in patients at risk for coronary artery obstruction., Methods: This pivotal prospective study enrolled patients with failed bioprosthetic aortic valves scheduled to undergo TAVI and were at risk for coronary artery obstruction. The primary safety endpoint was procedure-related mortality or stroke at discharge or 7 days, and the primary efficacy endpoint was per-patient leaflet splitting success. Independent angiographic, echocardiographic, and computed tomography core laboratories assessed all images. Safety events were adjudicated by a clinical events committee and data safety monitoring board., Results: Sixty eligible patients were treated (77.0 ± 9.6 years, 70% female, 96.7% failed surgical bioprosthetic valves, 63.3% single splitting and 36.7% dual splitting) at 22 clinical sites. Successful leaflet splitting was achieved in all [100%; 95% confidence interval (CI) 94%-100.0%, P < .001] patients. Procedure time, including imaging confirmation of leaflet splitting, was 30.6 ± 17.9 min. Freedom from the primary safety endpoint was achieved in 59 [98.3%; 95% CI (91.1%-100%)] patients, with no mortality and one (1.7%) disabling stroke. At 30 days, freedom from coronary obstruction was 95% (95% CI 86.1%-99.0%). Within 90 days, freedom from mortality was 95% [95% CI (86.1%-99.0%)], without any cardiovascular deaths., Conclusions: Modification of failed bioprosthetic aortic valve leaflets using ShortCut was safe, achieved successful leaflet splitting in all patients, and was associated with favourable clinical outcomes in patients at risk for coronary obstruction undergoing TAVI., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2024
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36. Geographical Inequality in Access to Aortic Valve Intervention in England: A Report from the UK Transcatheter Aortic Valve Implantation Registry and National Adult Cardiac Surgery Audit.
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Aktaa S, Ali N, Ludman PF, Curzen N, Goodwin AT, Hildick-Smith D, Kharbanda RK, Jones PD, Manuel S, Phanthala S, and Blackman DJ
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Background: For patients with severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is a less invasive but equally effective treatment option compared with surgical aortic valve replacement (SAVR). In 2019, we reported low rates of TAVI in the UK compared with other countries in western Europe and highlighted profound geographical variation in TAVI care. Here, we provide contemporary data on access to aortic valve replacement by either TAVI or SAVR across clinical commissioning groups in England., Methods: We obtained aggregated data from the UK TAVI registry and the National Adult Cardiac Surgery Audit between 2019 and 2023. Rates of TAVI and SAVR procedures per million population were reported by clinical commissioning groups. The relationship between TAVI and SAVR rates was determined using Pearson correlation coefficients., Results: In 2022/23, the rates of TAVI and SAVR in England were 136 per million population and 60 per million population, respectively. The observed increase in TAVI rates since 2019/20 corresponded with a decline in SAVR rates. There remains substantial variation in access to both procedures, with an over tenfold variation in TAVI rates, and an over fourfold variation in SAVR rates across clinical commissioning groups in England. No relationship was identified between the rates of TAVI and those for SAVR (correlation coefficient 0.06)., Conclusion: Geographical heterogeneity in access to TAVI persists over time, with the low rates of TAVI in many areas not compensated for by higher rates of SAVR, indicating an overall inequality in the treatment of severe aortic stenosis., Competing Interests: Disclosure: SA has received an educational grant from the European Society of Cardiology. NA has received speaker fees from Abbott and Medtronic. NC has received grants from Boston Scientific, Beckman Coulter, Heartflow and Haemonetics, consulting fees from Abbott Vascular, speaker fees from HeartFlow and Abbott Vascular, educational meeting support from Abbott and Edwards and is on the Interventional Cardiology editorial board; this did not influence peer review. ATG is the Clinical Lead of the UK National Adult Cardiac Surgery Audit and a member of the Society for Cardiothoracic Surgeons. DHS is the president of the British Cardiovascular Intervention Society and a proctor/advisory to Medtronic, Abbott, Boston and Edwards. RKK has received institutional grants for trials from Boston Scientific, speaker fees from Boston and Medtronic and is on the advisory board for Boston Scientific and Medtronic. DJB has received institutional research grants from Medtronic and consulting fees from Abbott Vascular and Medtronic and speaker fees from Abbott Vascular and Medtronic. All other authors have no conflicts of interest to declare. Data availability: These data are available as part of the series of annual reports of the National Cardiac Audit Program produced by NICOR. Authors’ contributions: Conceptualisation: DJB, DHS, PFL, RKK, ATG; data curation: SA, PDJ; formal analysis: PDJ, SM, SP; investigation: DJB, SA, NA; methodology: DJB, SA, NA; resources: PFL, RKK; software: PDJ, SM, SP; supervision: DJB; validation: DJB, DHS, PFL, RKK, ATG; writing – original draft preparation: SA, NA; writing – review & editing: DB, SA, NA, PL, NC, AG, DHS, RK, PJ, SM, SP. Ethics: This is an observational study. The NICOR Research Committee has confirmed that no ethical approval is required. Consent: All National Institute for Cardiovascular Outcomes Research (NICOR) audits and registries have approval under Section 251 of the NHS Act 2006 to use patient data, without obtaining patient consent., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)
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- 2024
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37. Consideration of inequalities in digital access to medical records.
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Fisher M
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- Humans, Access to Information, Socioeconomic Factors, United Kingdom, Electronic Health Records
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Competing Interests: Competing interests: None declared.
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- 2024
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38. Empathy, sympathy, compassion… but don't forget 'tenderness'.
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Cooper M, Fernandes C, and Cooper S
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- Humans, Physician-Patient Relations, Students, Medical psychology, Empathy
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- 2024
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39. HIV-1 infection kinetics, drug resistance, and long-term safety of pre-exposure prophylaxis with emtricitabine plus tenofovir alafenamide (DISCOVER): week 144 open-label extension of a randomised, controlled, phase 3 trial.
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Wohl DA, Spinner CD, Flamm J, Hare CB, Doblecki-Lewis S, Ruane PJ, Molina JM, Mills A, Brinson C, Ramgopal M, Clarke A, Crofoot G, Martorell C, Carter C, Cox S, Hojilla JC, Shao Y, Das M, Kintu A, Baeten JM, Grant RM, Mounzer K, and Mayer K
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- Humans, Male, Female, Adult, Drug Resistance, Viral, Middle Aged, Viral Load drug effects, Young Adult, RNA, Viral blood, Europe epidemiology, HIV Infections drug therapy, HIV Infections virology, HIV Infections prevention & control, Tenofovir administration & dosage, Tenofovir adverse effects, Tenofovir analogs & derivatives, Pre-Exposure Prophylaxis methods, Emtricitabine administration & dosage, Emtricitabine adverse effects, Emtricitabine therapeutic use, HIV-1 drug effects, HIV-1 genetics, Anti-HIV Agents administration & dosage, Anti-HIV Agents adverse effects, Anti-HIV Agents therapeutic use, Alanine administration & dosage, Adenine analogs & derivatives, Adenine administration & dosage, Adenine adverse effects, Adenine therapeutic use
- Abstract
Background: Data characterising the long-term use and safety of emtricitabine plus tenofovir disoproxil fumarate as daily oral pre-exposure prophylaxis (PrEP) are scarce and there are uncertainties regarding the value of routine HIV-1 RNA testing during oral PrEP follow-up., Methods: The DISCOVER trial was a randomised, controlled, phase 3 trial in which cisgender men and transgender women aged 18 years and older with a high likelihood of acquiring HIV were recruited from 94 clinics in Europe and North America and randomly assigned to receive either emtricitabine plus tenofovir disoproxil fumarate (200/25 mg) tablets daily, with matched placebo tablets, or emtricitabine plus tenofovir alafenamide (200/300 mg) tablets daily, with matched placebo tablets, for at least 96 weeks. After completion of the trial, participants were offered enrolment in this 48-week open-label extension study of emtricitabine plus tenofovir alafenamide. In participants diagnosed with HIV during the randomised and open-label phases of the study, we characterised HIV-1 test results and measured HIV-1 RNA viral load retrospectively when available. Adherence based on tenofovir diphosphate concentrations in dried blood spots and genotypic resistance were assessed in participants diagnosed with HIV. Safety assessments included adverse events, laboratory parameters, and, in a subset of participants, bone mineral density. HIV-1 incidence in participants initially randomly assigned to receive emtricitabine plus tenofovir alafenamide was estimated using a Poisson distribution. Changes from baseline in safety endpoints were described in participants assigned to received emtricitabine plus tenofovir alafenamide and in those who switched from emtricitabine plus tenofovir disoproxil fumarate during the open-label phase. This trial is registered with ClinicalTrials.gov, NCT02842086, and is ongoing., Findings: Between Sept 13, 2016, and June 30, 2017, 5399 participants were enrolled and randomly assigned in DISCOVER. 2699 were assigned to receive emtricitabine plus tenofovir disoproxil fumarate and 2700 were assigned to receive emtricitabine plus tenofovir alafenamide, of whom 2693 and 2694, respectively, received at least one dose of study drug. 2115 (79%) assigned to emtricitabine plus tenofovir disoproxil fumarate switched to emtricitabine plus tenofovir alafenamide in the open-label phase, and 2070 (77%) continued with emtricitabine plus tenofovir alafenamide in the open-label phase. As of data cutoff (Dec 10, 2020), after 15 817 person-years of follow-up, 27 new HIV-1 diagnoses were observed across the total study period, with three occurring during the open-label phase. In participants who were initially assigned to emtricitabine plus tenofovir alafenamide, the incidence was 0·13 per 100 person-years (95% CI 0·061-0·23; ten of 2670). Stored plasma samples were available for 23 of 27 participants, including 22 with incident infection. In four (17%) of 23 participants, retrospective testing detected HIV-1 RNA before serological HIV-1 test positivity; one was a suspected baseline infection. Of the three incident cases, all three were non-adherent to PrEP and none developed drug resistance. Among participants taking emtricitabine plus tenofovir alafenamide for up to 144 weeks, markers of glomerular filtration and proximal renal tubule dysfunction (β2-microglobulin to creatinine ratio and retinol-binding protein to creatinine ratio) improved or remained stable at 144 weeks compared with baseline, bone mineral density in hip and lumbar spine increased or remained stable from baseline to week 144 (n=191), cholesterol and glucose concentrations remained stable, and median bodyweight increased by less than 1 kg per year. In participants who switched from emtricitabine plus tenofovir disoproxil fumarate during the open-label phase (2115 [79%] of 2693), markers of glomerular filtration and proximal renal tubule dysfunction improved or remained stable, bone mineral density increased, cholesterol concentrations increased, glucose concentrations were similar, and median bodyweight increased more compared with those who remained on emtricitabine and tenofovir alafenamide., Interpretation: Routine HIV-1 RNA testing for follow-up of individuals on daily oral PrEP provides modest additional clinical benefit. Long-term use of emtricitabine and tenofovir alafenamide as daily oral PrEP is safe and well tolerated and can be an especially appropriate choice for people with bone or renal morbidities., Funding: Gilead Sciences., Competing Interests: Declaration of interests DAW has received grants, consulting fees, and speaker honoraria from Gilead Sciences; grants from Merck; consulting fees and speaker honoraria from ViiV Healthcare; and consulting fees and speaker honoraria from Janssen Pharmaceuticals. CDS has received funding, grants, consulting fees, and non-financial support from Gilead Sciences; grants and speaker honoraria from AbbVie; grants and personal fees from Janssen-Cilag; grants and personal fees from MSD, ViiV Healthcare, BioNtech, and Eli Lilly; grants from Cepheid; grants, personal fees, and non-financial support from B Braun Melsungen; consulting fees from AstraZeneca; personal fees, non-financial support, and other support outside the submitted work from Apeiron Biologics; and personal fees from GSK, Formycon, Moderna, Molecular Partners, Novartis, Roche, Sobi, and Pfizer. JF, PJR, and RMG have received research funding from Gilead Sciences. CBH has received research grant support from Gilead Sciences. SD-L has received research grant support (paid to their institution) from Gilead Sciences and Merck. J-MM has received grants (paid to their institution) from Gilead Sciences and Merck; consulting fees from Gilead Sciences, Merck, and ViiV Healthcare; and payments for participation on an advisory board from AELIX Therapeutics. AM has received research funding (paid to their institution) from Gilead Sciences, ViiV Healthcare, Merck, GSK, AbbVie, and TaiMed Biologics; speaker honoraria from Gilead Sciences, ViiV Healthcare, and EMD Serono; and payments for participation on an advisory board from Gilead Sciences and ViiV Healthcare. CB has received funding and speaker honoraria from Gilead Sciences; speaker honoraria from ViiV Healthcare; and support for attending principal investigator meetings from Gilead Sciences, ViiV Healthcare, GSK, PPD (Thermo Fisher Scientific), Merck, Viking Therapeutics, Syneos Health, Novo Nordisk, AbbVie, Regeneron Pharmaceuticals, Janssen, and Shionogi. MR has received funding and speaker and consulting fees from Gilead Sciences, speaker and consulting fees from ViiV Healthcare, consulting fees from MSD and Abbott, and speaker honoraria from AbbVie and Janssen. AC has received advisory boards fees from Gilead Sciences, ViiV Healthcare, MSD, and Theratechnologies; funding for clinical trials (paid to their institution) from Gilead Sciences, MSD, GSK, ViiV Healthcare, and Pfizer; speaker fees from MSD; and support for congress attendance from Gilead Sciences and ViiV Healthcare. GC has received research funding (paid to their institution) from Gilead Sciences for conducting research discussed in this manuscript. CM has received funding and speaker fees from Gilead Sciences and grants and speaker fees from ViiV Healthcare and Theratechnologies. CC, SC, JCH, YS, MD, AK, and JMB are shareholders and employees of Gilead Sciences. KMo has received funding from Gilead Sciences; speaker fees and advisory board fees from Gilead Sciences, ViiV Healthcare, Janssen Therapeutics, Theratechnologies, and Epividian; and funding for clinical trials (paid to their institution) from Gilead Sciences, ViiV Healthcare, and Janssen Therapeutics. KMa has received research funding from Gilead Sciences, and unrestricted grants and advisory board fees from Gilead Sciences and Merck., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
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40. Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study.
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Connor MJ, Genie M, Dudderidge T, Wu H, Sukumar J, Beresford M, Bianchini D, Goh C, Horan G, Innominato P, Khoo V, Klimowska-Nassar N, Madaan S, Mangar S, McCracken S, Ostler P, Paisey S, Robinson A, Rai B, Sarwar N, Srihari N, Jayaprakash KT, Varughese M, Winkler M, Ahmed HU, and Watson V
- Abstract
Background and Objective: Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions., Methods: A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes., Key Findings and Limitations: A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively., Conclusions and Clinical Implications: Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue., Patient Summary: We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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41. Impact of commissural versus coronary alignment on risk of coronary obstruction following transcatheter aortic valve implantation.
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Pavitt C, Arunothayaraj S, Broyd C, Michail M, Cockburn J, and Hildick-Smith D
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- Humans, Male, Risk Factors, Female, Aged, Aged, 80 and over, Treatment Outcome, Retrospective Studies, Risk Assessment, Predictive Value of Tests, Coronary Vessels diagnostic imaging, Heart Valve Prosthesis, Multidetector Computed Tomography, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve physiopathology, Coronary Occlusion diagnostic imaging, Coronary Occlusion etiology, Coronary Occlusion physiopathology, Coronary Occlusion therapy, Computed Tomography Angiography, Coronary Angiography, Severity of Illness Index
- Abstract
Transcatheter aortic valve implantation (TAVI) with commissural alignment aims to limit the risk of coronary occlusion and maintain good coronary access. However, due to coronary origin eccentricity within the coronary cusp, coronary-commissural overlap (CCO) may still occur. TAVI using coronary alignment, rather than commissural alignment, may further improve coronary access. To compare rates of CCO after TAVI using commissural versus coronary alignment methodology. Cardiac CT scans from 102 patients with severe (tricuspid) aortic stenosis referred for TAVI were analysed. Native cusp asymmetry and coronary eccentricity were defined and used to simulate TAVI using commissural versus coronary alignment. Rates of optimal coronary alignment (< 10° from cusp centre) and severe misalignment (< 15° from coronary-commissural overlap) were compared. Additionally, the impact of valve misalignment during implantation was assessed. The native right coronary artery (RCA) origin was 15.8° (9.5 to 24°) closer to the right coronary cusp/non-coronary cusp (RCC-NCC) commissure than the centre of the right coronary cusp. The native left coronary artery (LCA) origin was 4.5° (0 to 11.5°) closer to the left coronary cusp/non-coronary cusp (LCC-NCC) commissure than the centre of the left coronary cusp (p < 0.01). Compared to commissural alignment, coronary alignment doubled the proportion of optimally-aligned RCAs (62/102 [60.8%] vs. 31/102 [30.4%]; p < 0.001), without a significant change in optimal LCA alignment (62/102 [60.8% vs. 74/102 [72.6%]; p = 0.07). There were no cases of severe misalignment with either strategy. Simulating 15° of valve misalignment resulted in severe RCA compromise risk in 7/102 (6.9%) of commissural alignment cases, compared to none using coronary alignment. Fluoroscopic projection was similar with both approaches. Coronary alignment resulted in a 2-fold increase of optimal TAVI positioning relative to the RCA ostium when compared to commissural alignment without impacting the LCA. Use of coronary alignment rather than commissural alignment may improve coronary access after TAVI and is less sensitive to valve rotational error, particularly for the right coronary artery., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
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- 2024
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42. Maintenance durvalumab after first-line chemotherapy in patients with HER2-negative advanced oesophago-gastric adenocarcinoma: results from the randomised PLATFORM study.
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Fong C, Patel B, Peckitt C, Bourmpaki E, Satchwell L, Cromarty S, Kidd S, von Loga K, Uhlik M, Begum R, Rana T, Waddell T, Darby S, Bradshaw A, Roques T, Morgan C, Rees C, Herbertson R, Das P, Thompson C, Hewish M, Petty R, Thistlethwaite F, Rao S, Starling N, Chau I, and Cunningham D
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- Humans, Male, Female, Middle Aged, Aged, Adult, Antineoplastic Agents, Immunological therapeutic use, Antineoplastic Agents, Immunological pharmacology, Receptor, ErbB-2 metabolism, Aged, 80 and over, Progression-Free Survival, Stomach Neoplasms drug therapy, Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal pharmacology, Adenocarcinoma drug therapy, Esophageal Neoplasms drug therapy
- Abstract
Background: PLAnning Treatment For Oesophago-gastric Cancer: a Randomised Maintenance Therapy Trial (PLATFORM) is an adaptive phase II study assessing the role of maintenance therapies in advanced oesophago-gastric (OG) adenocarcinoma. We evaluated the role of the anti-programmed death-ligand 1 (PD-L1) inhibitor durvalumab in these patients., Patients and Methods: Patients with human epidermal growth factor receptor 2-negative locally advanced or metastatic OG adenocarcinoma with disease control or response to 18 weeks of platinum-based first-line chemotherapy were randomised to active surveillance or maintenance durvalumab. The primary endpoint was progression-free survival (PFS). Safety was assessed in all patients who had commenced surveillance visits or received at least one dose of durvalumab. Exploratory survival analyses according to PD-L1 Combined Positive Score (CPS) and immune (biomarker-positive) or angiogenesis dominant (biomarker-negative) tumour microenvironment (TME) phenotypes were conducted., Results: Between March 2015 and April 2020, 205 patients were randomised to surveillance (n = 100) and durvalumab (n = 105). No significant differences were seen in PFS [hazard ratio (HR) 0.84, P = 0.13] and overall survival (OS; HR 0.98, P = 0.45) between surveillance and durvalumab. Five patients randomised to durvalumab demonstrated incremental radiological responses compared with none with surveillance. Treatment-related adverse events occurred in 77 (76.2%) durvalumab-assigned patients. A favourable effect in OS with durvalumab over surveillance in CPS ≥5 and immune biomarker-positive patients was observed compared with CPS <5 and biomarker-negative subgroups, respectively: CPS ≥5 versus <5: HR 0.63, 95% confidence interval (CI) 0.32-1.22 versus HR 0.93, 95% CI 0.44-1.96; biomarker-positive versus negative: HR 0.60, 95% CI 0.29-1.23 versus HR 0.84, 95% CI 0.42-1.65., Conclusion: Maintenance durvalumab does not improve PFS in patients with OG adenocarcinoma who respond to first-line chemotherapy but induced incremental radiological responses in a subset of patients. TME characterisation could refine patient selection for anti-PD-L1 therapy above PD-L1 CPS alone., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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43. Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills.
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Wood TC, Maqsood S, Saunders A, Sancha W, Nanavaty MA, Wearne M, and Rajak S
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- Humans, Education, Medical, Graduate methods, Posterior Capsular Rupture, Ocular, Cataract Extraction education, Intraoperative Complications, Male, Female, Internship and Residency, Clinical Competence, Simulation Training methods, Ophthalmology education
- Abstract
Objectives: To analyse development of individual nontechnical skills (NTS) domains after undertaking a previously developed simulation-based training model and analyse the relationship between technical skills (TS) and NTS in ophthalmic surgery., Methods: The simulation-based training model involved a cataract surgery case complicated by intraoperative posterior capsule rupture. Cataract surgeons underwent the simulation twice, separated by a training intervention. Two blinded independent experts assessed participants' NTS using HUFOES, NOn-Technical Skills for Surgeons (NOTSS), and the OSATS global rating scale for TS. Paired t-tests assessed differences in individual NTS domains, with p < 0.05 indicating significance. The Pearson Product Moment Correlation Coefficient was used to assess the correlation between scores from each scoring system., Results: All NTS domains within HUFOES and NOTSS demonstrated statistically significant improvements secondary to the training intervention. Positive correlations were demonstrated between HUFOES and OSATS scores in the pre- and post-training simulations, r = 0.870 (p < 0.001) and r = 0.861 (p < 0.001), respectively. Positive correlations were also demonstrated between NOTSS and OSATS scores in pre- and post-training simulations, r = 0.849 (p < 0.001) and r = 0.757 (p = 0.001), respectively. Positive correlations were demonstrated between HUFOES and NOTSS scores; r = 0.979 (p < 0.001) (n = 17) and r = 0.959 (p < 0.001) for pre- and post-training simulations, respectively., Conclusion: All NTS domains contained within HUFOES and NOTSS demonstrated significant increases following the completion of the simulation-based training model. Positive correlations exist between an ophthalmic surgeon's TS and NTS. This is the first study to report these findings within ophthalmic surgery., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)
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- 2024
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44. Assessing the Quality and Readability of Web-Based Information on Otoplasty.
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Wa Katolo H, Derex-Briggs J, Seymour N, Watts S, and Bowles P
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- Humans, Search Engine, Health Literacy, Plastic Surgery Procedures, Comprehension, Internet, Consumer Health Information standards
- Abstract
Introduction: As health care-related internet use expands, parents and patients considering otoplasty frequently turn to online resources for further information to aid their decision making. Objective: In online resources related to otoplasty, what is the quality of the information and how readable is it based on standardized tests? Methods: A web search was performed on the three major search engines, using search terms related to otoplasty. The top 20 results from each search engine were selected. The DISCERN instrument was applied to assess the quality of health information, whereas the Flesch-Kincaid readability tests were used to assess readability. Results: The mean DISCERN score was 28.7 out of a possible score of 80 (poor quality) and commercial bias was common. The Flesch-Kincaid readability test results were significantly higher than the average reading level for adults in the United Kingdom. On the largest search engine, there was a correlation between search engine ranking and both readability and quality. Conclusion: Online patient information resources on otoplasty are generally of poor quality and difficult to read for the average patient.
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- 2024
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45. Improved Recovery after Vestibular Schwannoma Excision with Intratympanic Gentamicin Prehabilitation.
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Trudel M, Stapleton EJ, Wadeson AM, Spiller W, North HJ, Heal C, Sebastian J, Freeman SR, Rutherford SA, Entwistle H, Hammerbeck-Ward CL, Pathmanaban O, King AT, and Lloyd SKW
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Adult, Injection, Intratympanic, Treatment Outcome, Retrospective Studies, Recovery of Function, Anti-Bacterial Agents administration & dosage, Vertigo etiology, Vertigo prevention & control, Vestibular Function Tests, Length of Stay statistics & numerical data, Gentamicins administration & dosage, Neuroma, Acoustic surgery, Preoperative Care methods
- Abstract
Objective: Translabyrinthine excision of a vestibular schwannoma is associated with acute vestibular failure. Preoperative intratympanic gentamicin (ITG) injections can improve objective balance function after surgery but its clinical benefits remain to be established., Methods: Adult patients undergoing translabyrinthine removal of a vestibular schwannoma between January 2014 and February 2018 underwent preoperative vestibular function testing. Patients were divided in to 3 groups, those with vestibular function (VF) who received ITG injections, those with VF but did not receive ITG and those with no VF. Groups were compared according to degree of vertigo, length of stay, time to unassisted mobilization, and postoperative anti-emetic consumption., Results: Forty six patients had ITG injections (Group 1), 7 had residual VF but refused treatment (Group 2), 21 had no VF (Group 3). Group 1 had a significant improvement in vertigo over time whereas groups 2 and 3 did not. There was a statistically significant 70% decrease in time to independent mobilization between Group 1 and other groups and a 19% decrease in length of stay in Group 1 compared to other groups although this did not reach statistical significance. Two patients had injection-related complications. Group 1 used less anti-emetics than other groups but this was not statistically significant., Conclusion: Preoperative intratympanic gentamicin injection with vestibular rehabilitation exercises is associated with less postoperative vertigo and earlier postoperative mobilization. There was reduced duration of hospitalization and decreased consumption of anti-emetic but not significantly so possibly because of low numbers of patients in the no treatment group., Level of Evidence: 2 Laryngoscope, 134:3316-3322, 2024., (© 2024 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2024
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46. All-cause and AIDS-related mortality among people with HIV across Europe from 2001 to 2020: impact of antiretroviral therapy, tuberculosis and regional differences in a multicentre cohort study.
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Kraef C, Tusch E, Singh S, Østergaard L, Fätkenheuer G, Castagna A, Moreno S, Kusejko K, Szetela B, Kuznetsova A, Tomažič J, Ranin J, Zangerle R, Mansson F, Marchetti G, De Wit S, Clarke A, Gerstoft J, Podlekareva D, Peters L, Reekie J, and Kirk O
- Abstract
Background: All-cause and AIDS-mortality in Europe has been decreasing between 1996 and 2020. However, regional differences as well as their drivers remain unclear. This study investigates mortality differences and their drivers, including usage of and response to antiretroviral therapy (ART) and active tuberculosis (TB), among people with HIV across Europe., Methods: People with HIV enrolled in EuroSIDA were followed from 2001 through 2020. Immunologic-virologic status (IVS) was categorized as poor (CD4-cell count ≤350 cells/mm
3 and viral load (VL) > 200 copies/ml), good (CD4 ≥ 500 and VL < 200), or intermediate (remaining combinations). Participants missing either CD4-cell count or VL were categorized as unknown. Regional differences in mortality were analyzed using multivariable Poisson regression with interaction analyses between regions of Europe and IVS, ART, or TB status., Findings: 20,364 people with HIV were included: 13,715/20,346 (67.3%) from Western, 3020/20,364 (14.8%) from Central Eastern, and 3629/20,364 (17.8%) from Eastern Europe. At enrolment, median age was 40 years (inter-quartile range (IQR): 33-48), median CD4-cell count 449 cells/mm3 (IQR: 291-638), and most were male 14,993/20,346 (73.3%). A total of 2639 died during 192,591 person-years of follow-up (crude mortality rate 13.7/1000 person-years, 95% CI: 13.2-14.2), 519/2639 (19.7%) from AIDS (2.7/1000 person-years, 2.5-2.9). All-cause and AIDS-mortality rates decreased over time but remained higher in Eastern Europe after adjusting for confounders. Being off ART (aIRR 2.42; 95% CI 2.14-2.74), poor IVS (aIRR 4.2; 95% CI 3.39-5.20) and prior TB (aIRR 3.33; 95% CI 2.75-4.03) were associated with higher all-cause mortality. For all-cause mortality the effect of ART (test for interaction: p < 0.001) and IVS (p = 0.02), but not TB (p = 0.5) varied across regions., Interpretation: Overall mortality and AIDS-mortality rates decreased over time, but remained higher in Eastern Europe. A poor IVS, being off ART and prior active TB were related to higher mortality. Eastern Europe had the highest proportion of people with poor or unknown IVS, emphasizing the continued need to improve HIV care with a focus on early diagnosis, ART initiation, and adherence., Funding: EuroSIDA has received funding from ViiV Healthcare LLC, Janssen Scientific Affairs, Janssen R&D, Bristol-Myers Squibb Company, Merck Sharp & Dohme Corp, Gilead Sciences and the European Union's Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement n˚ 260694. The study is also supported by a grant from the Danish National Research Foundation and by the International Cohort Consortium of Infectious Disease (RESPOND)., Competing Interests: OK, BS, AC, GM have research grants, personal fees for lectures and consultancy, meeting support from Gilead, MSD and ViiV outside the submitted work. AC has received consulting fees participation on data monitoring board, personal fees for lectures and consultancy, meeting support from Gilead, MSD Jannsen Cilag and ViiV outside the submitted work. CK received payment for a lecture from Gilead outside the submitted work. ET, SS, LØ, GF, SM, KK, AK, JT, JR, RZ, FM, SW, JG, DP, LP, and JR declare no competing interests., (© 2024 The Author(s).)- Published
- 2024
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47. A Systematic Review and Meta-Analysis of the Management of Gallstone Cholecystitis and Common Biliary Duct Stones to Reduce the Incidence of Complications in Elderly Patients.
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Bhaskaran P, Swaminathan C, Krasicka D, Gilbert JA, Bhaskaran IP, and Khan M
- Abstract
As the age increases particularly above the age of 50 years, there is a significantly higher risk of developing gallstone-related complications especially cholecystitis and common bile duct stones with its associated consequences. Complications that arise after surgical operations for cholecystitis have been reported to have negative impacts on senior patients. These effects include a higher rate of complications, a longer hospital stay, higher expenditures, and decreased patient satisfaction. Therefore, finding the most effective treatment for cholecystitis in older patients is still a challenge. The aim of the study was carried out in order to identify many approaches that can be taken in the treatment of cholecystitis and stones in the common bile duct in older patients. A search was conducted through Medline (PubMed), EMBASE, ProQuest, and Cochrane using relevant Medical Subject Heading (MeSH) terms and keywords (elderly, age over 50, cholecystitis, bile duct stones, cholecystectomy, ERCP, surgical, conservative management, and open). The searches were limited to studies on elderly individuals over 50 who had cholecystectomy and endoscopic retrograde cholangiopancreatography between January 2000 and December 2022. The meta-analysis used the Mantel-Haenszel odds ratio (MHOR) and 95% confidence interval (CI). Aries Systems Corporation's Editorial Manager® (Aries Systems Corporation, North Andover, USA) and ProduXion Manager® (Aries Systems Corporation, North Andover, USA) facilitated the study. Out of 102 citations, 39 studies were selected for further study. After that, 18 studies were eliminated, leaving 21 for meta-analysis. The study found a protective risk of cholecystitis in cholecystectomy patients (MHOR = 0.16; 95%, CI = 0.10 to 0.25; p 0.001). Developing cholecystitis was substantially lower in early cholecystectomy patients (MHOR = 0.16; 95%, CI = 0.10 to 0.25; p 0.001). There was no significant difference in cholecystitis risk between open and laparoscopic surgery (MHOR = 0.65; 95%, CI = 0.41 to 1.04; p 0.07). Cholecystectomy performed at an earlier stage protects elderly patients from developing recurrent cholecystitis. In contrast to late cholecystitis, in which the patient would experience several attacks of cholecystitis, early cholecystectomy protects against the recurrence of the condition., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bhaskaran et al.)
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- 2024
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48. The development of inherited cardiac conditions services: current position and future perspectives.
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Alway T, Bastiaenen R, Pantazis A, Robert L, Akilapa R, Whitaker J, Page SP, and Carr-White G
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- Humans, State Medicine organization & administration, SARS-CoV-2, Heart Diseases therapy, Genetic Testing, United Kingdom, Telemedicine organization & administration, COVID-19 epidemiology
- Abstract
Background: Over the last two decades, inherited cardiac conditions (ICC) centres have emerged with the aim of improving outcomes for patients and their families, through early diagnosis, genetic testing, risk assessment and specialist treatment., Sources of Data: A literature search was performed using PubMed (https://pubmed.ncbi.nlm.nih.gov/). Commissioned ICC service reviews from NHS England, NHS Improvement and PHG Foundation were evaluated., Areas of Agreement: ICC patient management requires a multi-disciplinary approach. ICC services are predominantly based within tertiary centres. Despite expansion, provision of care remains inadequate to meet rising demands. Access to services is inconsistent, partly due to geographic variation and lack of standardized pathways., Areas of Controversy: The optimal ICC care model remains undecided, although there is growing interest in 'hub-and-spoke' networks, which could aid secondary and tertiary service integration and repatriation of care., Growing Points: Genetic mainstreaming is a priority for the Genomic Medicine Service Alliance. The benefits of telehealth and virtual clinics have been validated by their use during the COVID-19 pandemic. Other innovations to improve resource efficiency, such as clinical scientist-led and nurse-led clinics, show promise., Areas Timely for Developing Research: An update for the NHS ICC service specifications is planned that appears well timed given the rapid evolution of the ICC landscape in the decade since last review. This has the potential to address needs including national audit, standardized pathways and ICC networks to improve governance and equity of care. Delegation of commissioning for specialist services to integrated care systems may also provide opportunity for increased regional direction., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2024
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49. A Prospective Study of Sutured Versus Non-sutured Subcutaneous Fat Tissue in Laparotomy Wound Closure.
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Padinhare Madathil J, Kumar RP, Haridas TV, Job J, Chandran P, and Siby J
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Background This study was conducted to determine the wound-related complications, such as wound dehiscence, delayed post-operative stay, and reinterventions in both groups, and compare the incidence of surgical site infection in elective laparotomy wounds in two groups - those with closing subcutaneous fat tissue and those without. Methods At the Government Medical College, Thrissur, 248 patients undergoing elective abdominal surgeries during the period from August 2019 to August 2020 participated in this one-year prospective cross-sectional study. The institutional ethics committee approved the study, and participants provided written informed consent. Patients were randomly assigned to the subcutaneous closure group (S) and the non-closure group (N). Post-operative events were then systematically documented. Results The group with no subcutaneous suture (N) had a considerably greater percentage of patients with seromas (12 patients, 9%), hematomas (13 patients, 10.5%), superficial surgical site infection and total wound dehiscence as compared to the subcutaneous tissue closure group (S). Groups N and S displayed comparable numbers of suture sinus developments and partial wound dehiscence. Group N and Group S had similar hospital stays, according to the overall length of stay displayed. Conclusion Subcutaneous suturing during elective laparotomy wound closure significantly reduced superficial surgical site infection, hematoma, seroma, and total wound dehiscence; in the remaining categories, subcutaneous and non-subcutaneous sutures did not differ significantly. It also did not help to reduce hospital stays., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB) of Government Medical College, Thrissur issued approval IEC/GMCTSR/046/2021. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Padinhare Madathil et al.)
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- 2024
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50. Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group.
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Evison M, Robinson SD, Sharman A, Datta S, Rammohan K, Duerden R, Montero-Fernandez MA, and Gilligan D
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- Humans, Diagnosis, Differential, Mediastinum diagnostic imaging, Thymoma diagnostic imaging, Algorithms, Magnetic Resonance Imaging methods, Mediastinal Neoplasms diagnostic imaging, Thymus Neoplasms diagnostic imaging
- Abstract
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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