Publications by authors named "Brian Hogan"

46 Publications

Prevalence of bleeding and thrombosis in critically ill patients with chronic liver disease.

Thromb Haemost 2021 Oct 12. Epub 2021 Oct 12.

Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.

Introduction: Haemorrhage and venous thromboembolism (VTE) are recognised complications of chronic liver disease (CLD), but their prevalence and risk factors in critically ill patients is uncertain.

Patients And Methods: We studied a retrospective cohort of patients with CLD non-electively admitted to a specialist intensive care unit determining the prevalence and timing of major bleeding and VTE (early, present on admission/diagnosed within 48h; later diagnosed >48h post ICU admission). Associations with baseline clinical and laboratory characteristics, multi-organ failure (MOF), blood product administration and mortality were explored. Odds ratios (OR) and 95% CIs were calculated using logistic regression.

Results: Of 623 patients with median age 52, bleeding (>48 hours after admission) occurred in 87 (14%) patients. Bleeding was associated with greater illness severity and increased mortality. Gastrointestinal bleeding accounted for 72% of events, secondary to portal hypertension in >90%. Procedure-related bleeding was uncommon. VTE occurred in 125 (20%) patients: Early VTE in 80 (13%) and involving the portal vein (PVT) in 85%. Later VTE affected 45 (7.2%) patients. Hepatocellular Carcinoma (HCC) and non-alcoholic liver disease were independently associated with early VTE (OR 2.79, (95% CI 1.5 -5.2) and 2.32, (1.4 -3.9) respectively), and HCC, sepsis and cryoprecipitate use with late VTE (OR 2.45, (1.11-5.43), 2.26 (1.2-4.3) and 2.60 (1.3-5.1).

Conclusion: VTE was prevalent on admission to critical care and less commonly developed later. Bleeding was associated with MOF and increased mortality. Severe MOF was not associated with an increased rate of VTE which was linked with HCC, and specific etiologies of CLD.
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http://dx.doi.org/10.1055/a-1667-7293DOI Listing
October 2021

Transcriptome profiles of stem-like cells from primary breast cancers allow identification of ITGA7 as a predictive marker of chemotherapy response.

Br J Cancer 2021 Sep 12;125(7):983-993. Epub 2021 Jul 12.

School of Medicine, University of Leeds, Leeds, UK.

Background: Breast cancer stem cells (BCSCs) are drivers of therapy-resistance, therefore are responsible for poor survival. Molecular signatures of BCSCs from primary cancers remain undefined. Here, we identify the consistent transcriptome of primary BCSCs shared across breast cancer subtypes, and we examine the clinical relevance of ITGA7, one of the genes differentially expressed in BCSCs.

Methods: Primary BCSCs were assessed using immunohistochemistry and fluorescently labelled using Aldefluor (n = 17). Transcriptomes of fluorescently sorted BCSCs and matched non-stem cancer cells were determined using RNA-seq (n = 6). ITGA7 expression was examined in breast cancers using immunohistochemistry (n = 305), and its functional role was tested using siRNA in breast cancer cells.

Results: Proportions of BCSCs varied from 0 to 9.4%. 38 genes were significantly differentially expressed in BCSCs; genes were enriched for functions in vessel morphogenesis, motility, and metabolism. ITGA7 was found to be significantly downregulated in BCSCs, and low expression significantly correlated with reduced survival in patients treated with chemotherapy, and with chemoresistance in breast cancer cells in vitro.

Conclusions: This study is the first to define the molecular profile of BCSCs from a range of primary breast cancers. ITGA7 acts as a predictive marker for chemotherapy response, in accordance with its downregulation in BCSCs.
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http://dx.doi.org/10.1038/s41416-021-01484-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476506PMC
September 2021

The Enhanced Liver Fibrosis test maintains its diagnostic and prognostic performance in alcohol-related liver disease: a cohort study.

BMC Gastroenterol 2021 Jun 28;21(1):268. Epub 2021 Jun 28.

Institute for Liver and Digestive Health, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, UK.

Background: Alcohol is the main cause of chronic liver disease. The Enhanced Liver Fibrosis (ELF) test is a serological biomarker for fibrosis staging in chronic liver disease, however its utility in alcohol-related liver disease warrants further validation. We assessed the diagnostic and prognostic performance of ELF in alcohol-related liver disease.

Methods: Observational cohort study assessing paired ELF and histology from 786 tertiary care patients with chronic liver disease due to alcohol (n = 81) and non-alcohol aetiologies (n = 705). Prognostic data were available for 64 alcohol patients for a median of 6.4 years. Multiple ELF cut-offs were assessed to determine diagnostic utility in moderate fibrosis and cirrhosis. Survival data were assessed to determine the ability of ELF to predict liver related events and all-cause mortality.

Results: ELF identified cirrhosis and moderate fibrosis in alcohol-related liver disease independently of aminotransferase levels with areas under receiver operating characteristic curves of 0.895 (95% CI 0.823-0.968) and 0.923 (95% CI 0.866-0.981) respectively, which were non-inferior to non-alcohol aetiologies. The overall performance of ELF was assessed using the Obuchowski method: in alcohol = 0.934 (95% CI 0.908-0.960); non-alcohol = 0.907 (95% CI 0.895-0.919). Using ELF < 9.8 to exclude and ≧ 10.5 to diagnose cirrhosis, 87.7% of alcohol cases could have avoided biopsy, with sensitivity of 91% and specificity of 85%. A one-unit increase in ELF was associated with a 2.6 (95% CI 1.55-4.31, p < 0.001) fold greater odds of cirrhosis at baseline and 2.0-fold greater risk of a liver related event within 6 years (95% CI 1.39-2.99, p < 0.001).

Conclusions: ELF accurately stages liver fibrosis independently of transaminase elevations as a marker of inflammation and has superior prognostic performance to biopsy in alcohol-related liver disease.
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http://dx.doi.org/10.1186/s12876-021-01795-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240375PMC
June 2021

Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction.

Plast Reconstr Surg Glob Open 2020 Dec 17;8(12):e3312. Epub 2020 Dec 17.

Department of Oncoplastic Breast and Reconstructive Surgery, St. James's University Hospital, Leeds, United Kingdom.

This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery.

Methods: Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013-2016).

Results: In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; = 0.086).

Conclusions: Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
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http://dx.doi.org/10.1097/GOX.0000000000003312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787276PMC
December 2020

Identification of factors that influence the decision to take chemoprevention in patients with a significant family history of breast cancer: results from a patient questionnaire survey.

Breast Cancer Res Treat 2021 May 3;187(1):207-213. Epub 2021 Jan 3.

Department of Oncoplastic Breast and Reconstructive Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.

Purpose: Chemoprevention reduces the risk of developing breast cancer in women with increased family history (FH) risk of breast cancer. However, chemoprevention uptake remains low and the reasons for this remain unclear.

Methods: Patients with moderate- or high-risk FH of breast cancer were counselled about chemoprevention (n = 1620; September 2015 to July 2018) in breast clinics. A postal questionnaire survey was subsequently sent to these patients in order to explore the potential factors influencing their decision on chemoprevention uptake.

Results: 518 patients (32%) completed the questionnaire survey; 75% were pre-menopausal and the majority had moderate as opposed to high-risk FH (87.5% vs. 12.5%). Breast cancer chemoprevention uptake rate was 10.8% (56/518). The identified incentives were more commonly stated for patients who took chemoprevention when compared to those who refused chemoprevention. The commonest incentives were breast cancer prevention (89.3% vs. 61.7%; p = 0.001), belief in the effectiveness of chemoprevention (76.8% vs. 63.4%; p = 0.048), and personal perception of breast cancer risk (67.9% vs. 45.5%; p = 0.002). Similarly, the identified barriers were more commonly stated for patients who refused chemoprevention when compared to those who took chemoprevention. The commonest barriers were side effects (79.4% vs. 55.4%; p = 0.001) and lack of information (53% vs. 28.6%; p = 0.001).

Conclusion: Despite its proven efficacy, chemoprevention uptake in patients with a significant FH of breast cancer remains low. We have identified important factors which influence the patient's decision making. Future clinic consultations should focus on exploring these factors to aid patient decision making.
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http://dx.doi.org/10.1007/s10549-020-06046-xDOI Listing
May 2021

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study.

Am J Sports Med 2020 12 26;48(14):3472-3477. Epub 2020 Oct 26.

Sports Surgery Clinic, Dublin, Ireland.

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes.

Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated.

Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; > .99) or return at the same/higher level (68.2% vs 72.7%; = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( = .32).

Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.
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http://dx.doi.org/10.1177/0363546520964479DOI Listing
December 2020

Breast Cancer Surgery During the COVID-19 Pandemic Peak in the UK: Operative Outcomes.

Cureus 2020 Jul 19;12(7):e9280. Epub 2020 Jul 19.

Breast Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, GBR.

Introduction  The COVID-19 pandemic caused widespread changes in delivery of breast cancer care, aiming to protect vulnerable patients whilst minimising compromise to oncological outcomes. This multicentre observational study aimed to establish early surgical outcomes from breast cancer surgery performed during the peak of the COVID-19 pandemic.  Materials and methods  Data were collected on consecutive patients that underwent breast surgery in four units between 16 March and 24 April 2020. Outcome data at 30 days post-operation were collected, including documented COVID-19 cases in patients and reported cases in healthcare workers directly involved in their care. Recommended modifications to practice to reduce COVID-19 transmission risk, both to patients and healthcare workers in each centre, are described.  Results  A total of 202 patients underwent surgery in four hospitals delivering breast services in the West Yorkshire region over the six-week period at the peak of the pandemic. The age ranged from 28 to 91 years (median 57, interquartile range, 48-65) with 22% having co-morbidities linked to COVID-19, e.g. diabetes or respiratory disease. No patients presented post-operatively with COVID-19 symptoms and at 30 days there had not been any identified COVID-19 cases. There were no unexpected critical care admissions or deaths. One healthcare worker involved in the delivery of breast surgery was diagnosed with COVID-19 during this time and made an uneventful recovery.  Conclusion  Breast cancer surgery, in selected groups and with meticulous adherence to measures designed to reduce COVID-19 transmission, does not appear to be associated with elevated risk to patients or healthcare workers.
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http://dx.doi.org/10.7759/cureus.9280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431302PMC
July 2020

Radiological audit of interval breast cancers: Estimation of tumour growth rates.

Breast 2020 Jun 1;51:114-119. Epub 2020 Apr 1.

Leeds Teaching Hospital NHS Trust, Beckett Street, Leeds, LS9 7TF, UK. Electronic address:

Introduction: This multicentre, retrospective study aimed to establish correlation between estimated tumour volume doubling times (TVDT) from a series of interval breast cancers with their clinicopathological features. The potential impact of delayed diagnosis on prognosis was also explored.

Materials And Methods: Interval cancers, where screening mammograms demonstrated changes that were retrospectively classified as either uncertain or suspicious, were reviewed from five screening units within the UK NHS Breast Screening Programme (NHSBSP). Data collected included the time interval between screening mammogram and cancer diagnosis, the size of the initial mammographic abnormality and of the subsequent cancer, demographics, mammographic density and tumour biology. We estimated volume doubling times and the estimated change in size and node status, which would have followed if these cancers had been detected at the previous screen.

Results: 306 interval cancers meeting the inclusion criteria were identified. Average time from screening to diagnosis was 644 days (SD 276 days). 19% were diagnosed in the first twelve months, 42% in the subsequent twelve months and 39% thereafter. Overall average estimated TVDT was 167 days (95% CI 151-186). Significant differences were noted with age (p = 0.01), grade (p < 0.001) and ER status (p < 0.001) with women under 60, grade 3 cancers and ER negative cancers having shorter TVDTs. HER2 positive tumours had shorter doubling times than HER2 negative, but this difference was not statistically significant. It was estimated that diagnosing these cancers at the previous screen would have increased ten-year survival from 82% to 86%.

Conclusion: High grade, ER negativity and younger age were associated with shorter durations of TVDT. The role of HER2 status on interval cancer growth rate requires further assessment. It is likely that the delayed diagnosis of interval cancers confers a 4% reduction in ten-year survival.
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http://dx.doi.org/10.1016/j.breast.2020.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375675PMC
June 2020

Comment on Comparison of three transfusion protocols prior to central venous catheterisation in patients with cirrhosis; a randomised controlled trial.

J Thromb Haemost 2020 03;18(3):753-754

Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1111/jth.14732DOI Listing
March 2020

Positive predictive value of optic disc haemorrhages for open angle glaucoma.

Eye (Lond) 2020 11 26;34(11):2029-2035. Epub 2019 Nov 26.

Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, 45 Chalmers Street, Edinburgh, EH3 9HA, UK.

Objectives: To determine the positive predictive value (PPV) of disc haemorrhages (DHs) for the diagnosis of open angle glaucoma (OAG).

Methods: A retrospective review of 618 consecutive new referrals by community optometrists to a hospital glaucoma service, including 54 patients with DHs. All patients had a comprehensive eye examination. The primary outcome was whether the patient was diagnosed with OAG in either eye, with a secondary outcome of whether they were discharged at the first visit (first visit discharge rate, FVDR).

Results: 54 of 618 patients (8.7%) had a DH noted at the time of referral, including 21 referred with DH alone. 29 patients with DHs were diagnosed with OAG for a PPV of 54% (95% CI 40-67%), falling to 24% (95% CI 8-47%) in those with DH alone. The overall FVDR was 35%, increasing to 57% in those referred due to DH alone. The FVDR for those referred with DH alone was significantly higher than the FDVR of 25% among the 564 patients referred with suspected glaucoma without a DH (P = 0.001). The FVDR decreased to 35% for patients with a DH plus one other feature of glaucoma and to 0% for patients with a DH and at least two other features suggestive of glaucoma.

Conclusions: Almost 60% of patients referred due to isolated DHs were discharged at the first visit to the glaucoma clinic, however almost one in four was diagnosed with OAG. Patients with DH and other features suggestive of glaucoma had a higher probability of glaucoma diagnosis.
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http://dx.doi.org/10.1038/s41433-019-0711-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784928PMC
November 2020

Bloody Nipple Discharge in a Man with Benign Papillomas: A Case Report.

Cureus 2019 Apr 11;11(4):e4431. Epub 2019 Apr 11.

Breast Surgery, Leeds Teaching Hospitals Trust, Leeds, GBR.

Blood-stained nipple discharge in a man would usually be proved to be male breast cancer. We present a case where this unusual presentation was associated with benign intraductal papillomas, managed with simple duct excision, preserving the patient's nipple whilst adequately investigating and managing the condition.
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http://dx.doi.org/10.7759/cureus.4431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559693PMC
April 2019

Mid-infrared optical sensing using sub-wavelength gratings.

Opt Express 2019 Feb;27(3):3169-3179

Optical sensing has shown great potential for both quantitative and qualitative analysis of compounds. In particular sensors which are capable of detecting changes in refractive index at a surface as well as in bulk material have received much attention. Much of the recent research has focused on developing technologies that enable such sensors to be deployed in an integrated photonic device. In this work we demonstrate experimentally, using a sub-wavelength grating the detection of ethanol in aqueous solution by interrogating its large absorption band at 9.54 μm. Theoretical investigation of the operating principle of our grating sensor shows that in general, as the total field interacting with the analyte is increased, the corresponding absorption is also increased. We also theoretically demonstrate how sub-wavelength gratings can detect changes in the real part of the refractive index, similar to conventional refractive index (RI) sensors.
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http://dx.doi.org/10.1364/OE.27.003169DOI Listing
February 2019

Accuracy of detection of patients with narrow angles by community optometrists in Scotland.

Ophthalmic Physiol Opt 2019 03 1;39(2):104-112. Epub 2019 Jan 1.

Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK.

Aim: To examine the accuracy of referrals by community optometrists for suspected primary angle closure, including primary angle closure suspects, primary angle closure and primary angle closure glaucoma.

Methods: A retrospective review of 769 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital in Scotland. Ninety-five of 715 eligible subjects (13%) were referred due to suspected angle closure. All subjects had a comprehensive eye examination in the glaucoma clinic, including gonioscopy, with angle closure defined according to the International Society of Geographical and Epidemiological Ophthalmology classification as iridotrabecular contact over at least 270 degrees.

Results: Fifty-nine of 95 subjects referred due to suspected angle closure were confirmed to have an occludable angle, while 36 of 95 (38%) had open angles (positive predictive value = 62%). Of 620 patients referred to the glaucoma clinic for reasons other than narrow angles, 601 (97%) had open angles on gonioscopy and 19 (3%) had narrow angles. Using the 620 patients referred with 'open angles' as a control group, sensitivity was estimated as 76% and specificity 94%. Eleven of 95 (12%) patients referred for possible angle closure were discharged at the first visit compared to 156 of 620 (25%) referred to the glaucoma clinic for other reasons (p = 0.003). In a multivariable model, suspect angle closure detected by the optometrist (OR = 56.0, 95% CI 35.2-89.2, p < 0.001) and female gender (OR = 1.9, 95% CI 1.2-3.1, p = 0.008) were associated with increased odds of angle closure on gonioscopy.

Conclusion: Community optometrists had good ability to detect eyes at risk of angle closure. There was also greater accuracy of referrals for suspected angle closure than for other glaucoma referrals.
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http://dx.doi.org/10.1111/opo.12601DOI Listing
March 2019

Comparison of central corneal thickness measurements obtained by community optometrists to those obtained in secondary care.

Eye (Lond) 2018 11 23;32(11):1760-1765. Epub 2018 Jul 23.

Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK.

Purpose: Corneal central thickness (CCT) is an important risk factor for glaucoma, which also influences intraocular pressure (IOP) measurements. Recently, all community optometrists in Scotland were provided with pachymeters. This study examined the accuracy of CCT measured by community optometrists compared to measurements in the glaucoma clinic.

Methods: A retrospective analysis of consecutive patients referred to the glaucoma clinic at a university hospital between June and November 2016. 142 of 715 (19.9%) patients had CCT measurements included in the referral, all of whom had repeat measurements in the glaucoma clinic. CCT was measured using the PachPen (Accutome Inc) which generates a CCT reading by automatically taking the average of up to 9 measurements. Measurements were compared using Bland-Altman analysis.

Results: CCT measured by community optometrists was slightly thicker than CCT in the glaucoma clinic (558.3 ± 41.5 vs. 552.6 ± 58.8 µm, P < 0.001), however the mean difference was only 13.8 ± 18.0 µm. In 223 of 284 eyes (78.5%), CCT measurements taken by community optometrists were within 20 µm of those obtained in the glaucoma clinic. 61 of 284 (21.5%) differed by >20 µm, 40 (14.1%) by >30 µm and 17 (6.0%) by >50 µm. There was no significant relationship between difference in CCT and IOP (-0.02, 95% CI -0.05 to 0.002, P = 0.077), gender (0.00, 95%CI -0.01 to 0.01, P = 0.805), or age (-0.01, 95% CI -0.08 to 0.06, P = 0.791).

Conclusions: There was good overall agreement between CCT measured by community optometrists and measurements obtained in the glaucoma clinic. The tendency for thicker CCT measurements by community optometrists may be due to more peripheral or non-perpendicular positioning of the pachymeter relative to the cornea.
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http://dx.doi.org/10.1038/s41433-018-0169-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224573PMC
November 2018

Pipeline Embolization Device Flow Diversion for a Dissecting Ruptured Posterior Cerebral Artery Aneurysm in a Pediatric Patient.

World Neurosurg 2018 Sep 15;117:255-260. Epub 2018 Jun 15.

Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA. Electronic address:

Background: Intracranial aneurysms (IAs) are rare in the pediatric population and are usually considered difficult to treat with traditional microsurgery owing to their complex morphology. Endovascular techniques have become the standard option for treating IAs in adults. More recently, flow diverters, such as the Pipeline embolization device (PED), are being widely adopted for unruptured IAs, with proven safety and efficacy in adults; however, their use in the pediatric population is not well defined. Here we report a pediatric patient with a ruptured posterior cerebral artery (PCA) aneurysm successfully treated with a PED, and provide a review of the literature on the current status of PED use in this subset of patients.

Case Description: A previously healthy 4-year old boy presented to the emergency department with a subarachnoid hemorrhage. Magnetic resonance angiography (MRA) suggested a ruptured dissecting aneurysm in the right PCA. After discussing treatment options with the child's parents, off-label use of the PED device was chosen. A single PED device was successfully deployed within 24 hours of onset. At a 6-month follow-up, the patient was fully recovered, with a modified Rankin Scale score of 0, and MRA showed complete occlusion of the aneurysm and patency of the parent vessel.

Conclusions: Even though the PED has not received Food and Drug Administration approval to treat IAs in children, the literature reports favorable outcomes with this application. Thus, the PED may be a feasible option for treating challenging cases occurring more frequently in the pediatric population. Further studies in pediatric populations are needed to determine whether this technology is a viable and durable option for treating aneurysms in children.
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http://dx.doi.org/10.1016/j.wneu.2018.06.031DOI Listing
September 2018

Resonant gratings with an etch-stop layer and a fabrication-error tolerant design.

Opt Express 2018 May;26(10):13205-13213

Sub-wavelength gratings (SWG) have shown much promise for applications such as lightweight high bandwidth reflectors, polarising filters and focusing lenses. Unfortunately, grating performance may be rapidly degraded through variability in grating dimensions. We demonstrate, in particular, how an error in depth of etch can be detrimental to the performance of zero contrast grating reflectors. We mitigate the impact of this fabrication error through the introduction of an etch stop layer and in so doing we experimentally realise a high bandwidth reflector based on this modified structure. Another common fabrication error is variation in the duty-cycle of fabricated gratings. This duty-cycle variation can weaken grating performance, however we demonstrate that grating designs that exhibit tolerance to duty-cycle fluctuation can be identified through simulation. Finally, we discuss the impact of lateral etching and the resulting sidewall concavity. We present our approach for numerically predicting the spectral response from such a grating and also for convenience we outline an approach for quickly approximating grating performance. Good agreement is observed between these numerical predictions and measurements made on a HCG with concave sidewalls.
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http://dx.doi.org/10.1364/OE.26.013205DOI Listing
May 2018

MRI investigation for groin pain in athletes: is radiological terminology clarifying or confusing?

Br J Sports Med 2017 Aug 2;51(16):1185-1186. Epub 2017 Feb 2.

Centre for Health, Exercise and Sports Medicine (CHESM), University of Melbourne, Melbourne, Australia.

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http://dx.doi.org/10.1136/bjsports-2016-096973DOI Listing
August 2017

Noninvasive markers of liver fibrosis: on-treatment changes of serum markers predict the outcome of antifibrotic therapy.

Eur J Gastroenterol Hepatol 2017 Mar;29(3):289-296

aDivision of Medicine, Institute for Liver and Digestive Health, University College London bDepartment of Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London cDepartment of Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK dDepartment of Medicine 1, University of Erlangen, Erlangen eInstitute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry fDepartment of Medicine, Research Center for Immunology (FZI), University of Mainz, Mainz, Germany gInstitute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria hDivision of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.

Aim: The utility of noninvasive serum markers to longitudinally monitor liver fibrosis is not established.

Methods: A total of 70 patients with chronic hepatitis C who had previously failed antiviral therapy were randomized to receive pegylated interferon with or without silymarin for 24 months. Enhanced Liver Fibrosis (ELF) tests (hyularonic acid, terminal peptide of procollagen III, tissue inhibitor of matrix metaloproteinase-1) were performed on patient sera obtained before, during and at the end of the study (0, 12, 24 months) and liver histology obtained before and at the end of the study.

Results: At 24 months, absolute changes in Ishak fibrosis stage and ELF ranged from -4 to +4 and from -2.41 to +2.68, respectively. Absolute changes in ELF at 12 months were significantly associated with changes in both ELF and histology at 24 months. A model combining both baseline ELF and change of ELF at 12 months could predict the 24-month ELF (R=0.609, P<1×10), a decrease in ELF at 24 months [area under the curve (AUC): 0.80-0.85] and an increase in ELF at 24 months (AUC: 0.81-0.85). Furthermore, a model combining both baseline histologic stage and ELF together with the change of ELF at 12 months could predict 24-month histology (R=0.601, P<1×10, AUC: 0.88-0.92), histologic fibrosis regression (AUC: 0.81-0.84) and progression (AUC: 0.86-0.91).

Conclusion: Our observations suggest that a change in the serum marker ELF predicts changes in liver fibrosis over a longer period. These data support the use of ELF as a surrogate marker of liver fibrosis evolution in monitoring antifibrotic treatments, thus permitting 'response-guided' therapy by the early identification of patients who will benefit from prolonged treatment.
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http://dx.doi.org/10.1097/MEG.0000000000000789DOI Listing
March 2017

Evaluation of coronary artery disease in potential liver transplant recipients.

Liver Transpl 2017 03;23(3):386-395

Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, UK.

Improvements in the management of patients undergoing liver transplantation (LT) have resulted in a significant increase in survival in recent years. Cardiac disease is now the leading cause of early mortality, and the stress of major surgery, hemodynamic shifts, and the possibilities of hemorrhage or reperfusion syndrome require the recipient to have good baseline cardiac function. The prevalence of coronary artery disease (CAD) is increasing in LT candidates, especially in those with nonalcoholic fatty liver disease. In assessing LT recipients, we suggest a management paradigm of "quadruple assessment" to include (1) history, examination, and electrocardiogram; (2) transthoracic echocardiogram; (3) functional testing; and (4) where appropriate, direct assessment of CAD. The added value of functional testing, such as cardiopulmonary exercise testing, has been shown to be able to predict posttransplant complications independently of the presence of CV disease. This approach gives the assessment team the greatest chance of detecting and preventing complications related to CAD. Liver Transplantation 23 386-395 2017 AASLD.
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http://dx.doi.org/10.1002/lt.24679DOI Listing
March 2017

Realization of high-contrast gratings operating at 10  μm.

Opt Lett 2016 Nov;41(21):5130-5133

We present a new material pairing that can be used to realize high-contrast gratings at wavelengths of 10 μm and greater. Using only optical lithography, the material pair solves the absorption issue limiting the popular Si/SiO2 pairing from operation above 6 μm. We describe the obstacles that exist with the currently used grating materials for this wavelength range and outline why our chosen materials overcome this obstacle. We numerically demonstrate that gratings utilizing these materials are capable of wideband high reflectivity. We experimentally show that the spectral response of gratings that are fabricated using such a process show good agreement with theoretically predicted performance.
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http://dx.doi.org/10.1364/OL.41.005130DOI Listing
November 2016

Biomarkers of Hepatic Fibrosis in Chronic Hepatitis C: A Comparison of 10 Biomarkers Using 2 Different Assays for Hyaluronic Acid.

J Clin Gastroenterol 2017 Mar;51(3):268-277

*Institute for Liver & Digestive Health, University College London ‡Department of Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London †Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK §Department of Medicine 1, University of Erlangen, Erlangen ¶Institute of Molecular and Translational Medicine #Department of Medicine **Research Center for Immunology (FZI), University of Mainz, Mainz, Germany ∥Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Muellner Hauptstrasse 48, 5020 Salzburg, Austria ††Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Background: Advancing fibrosis is regarded as the most important factor when stratifying patients with chronic hepatitis C for retreatment.

Goals: (1) To compare the performance of 10 biomarkers of fibrosis, including patented tests, among patients with chronic hepatitis C and treatment failure; and (2) to assess the impact on biomarker performance of using 2 different assays of hyaluronic acid (HA).

Study: For 80 patients, liver histology (Metavir) was compared with biomarker scores using sera obtained within 6 months of liver biopsy (indirect biomarkers: AST:ALT ratio, APRI, Forns index, FIB-4, Fibrometer V3G; direct biomarkers: ELF, Fibrospect II, Hyaluronic acid-HA, Fibrometer V2G, Hepascore). Direct biomarker scores were calculated using 2 validated assays for HA (ELISA and radiometric).

Results: Using the ELISA assay for HA to calculate the direct panels, all 10 of the biomarkers exhibited comparable overall discriminatory performance (unweighted Obuchowski measure, ordROC 0.92-0.94, P-value>0.05) except AST:ALT ratio and APRI (ordROC 0.86-0.88, P-value<0.05). For the detection of moderate (F2-4) and advanced (F3-4) fibrosis, the AUROC of Fibrometer 2G were significantly higher than AST:ALT ratio and APRI but none of the other biomarkers. Good correlation was observed between the 2 HA assays (intraclass correlation coefficient=0.873) with the ELISA assay exhibiting superior diagnostic performance (ordROC 0.92 vs. 0.88, P-value=0.003). Importantly, the performance of many of the direct biomarkers at their diagnostic thresholds was heavily influenced by the choice of HA assay.

Conclusions: Although many biomarkers exhibited good diagnostic performance for the detection of advancing fibrosis, our results indicate that diagnostic performance may be significantly affected by the selection of individual component assays.
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http://dx.doi.org/10.1097/MCG.0000000000000581DOI Listing
March 2017

95% prevalence of abnormality on hip MRI in elite academy level rugby union: A clinical and imaging study of hip disorders.

J Sci Med Sport 2016 Nov 8;19(11):893-897. Epub 2016 Feb 8.

Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Ireland. Electronic address:

Objectives: To identify the prevalence of hip disorders in elite level academy rugby union players using clinical and radiological investigation comparing findings to active controls.

Design: Cross-sectional, controlled study.

Methods: Participants were assessed clinically using validated questionnaire (HAGOS) and physical testing procedures. Active ROM of all hip movements were measured using a goniometer and hip-specific clinical tests including the FABER and the Thomas test examined functional hip motion. Physical tests were compared to age, gender and activity matched controls. The rugby-playing participants underwent dedicated non-arthrographic 3T MRI imaging of the hip in axial oblique, sagittal and coronal planes to assess anatomical abnormality.

Results: The rugby cohort had significantly reduced ROM of internal/external rotation, extension and FABER scores compared to the controls. Symptoms were reported by 65% of rugby players (HAGOS symptom score <89.3) versus 15% in controls. There was a 95% prevalence of abnormality on MRI (19 of 20 players); 80% of the elite rugby players had labral pathology, 55% had a cam deformity (45% left sided 30% right-sided) and 25% had either unilateral or bilateral chondral wear.

Conclusions: The prevalence of abnormality on MRI of the hip is high in rugby players at 95% of study participants. The percentage reporting symptoms was lower at 65% of the cohort although this was significantly higher than (non-rugby) matched controls at 15% of participants. Rugby players demonstrated significantly reduced ROM of the hip compared to controls. Further prospective research is required to investigate the long term sequelae of these findings.
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http://dx.doi.org/10.1016/j.jsams.2016.01.005DOI Listing
November 2016

Defective monocyte oxidative burst predicts infection in alcoholic hepatitis and is associated with reduced expression of NADPH oxidase.

Gut 2017 03 9;66(3):519-529. Epub 2016 Feb 9.

Department of Hepatology and Gastroenterology, Imperial College, London, UK.

Objective: In order to explain the increased susceptibility to serious infection in alcoholic hepatitis, we evaluated monocyte phagocytosis, aberrations of associated signalling pathways and their reversibility, and whether phagocytic defects could predict subsequent infection.

Design: Monocytes were identified from blood samples of 42 patients with severe alcoholic hepatitis using monoclonal antibody to CD14. Phagocytosis and monocyte oxidative burst (MOB) were measured ex vivo using flow cytometry, luminometry and bacterial killing assays. Defects were related to the subsequent development of infection. Intracellular signalling pathways were investigated using western blotting and PCR. Interferon-γ (IFN-γ) was evaluated for its therapeutic potential in reversing phagocytic defects. Paired longitudinal samples were used to evaluate the effect of in vivo prednisolone therapy.

Results: MOB, production of superoxide and bacterial killing in response to were markedly impaired in patients with alcoholic hepatitis. Pretreatment MOB predicted development of infection within two weeks with sensitivity and specificity that were superior to available clinical markers. Accordingly, defective MOB was associated with death at 28 and 90 days. Expression of the gp91 subunit of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase was reduced in patients with alcoholic hepatitis demonstrating defective MOB. Monocytes were refractory to IFN-γ stimulation and showed high levels of a negative regulator of cytokine signalling, suppressor of cytokine signalling-1. MOB was unaffected by 7 days in vivo prednisolone therapy.

Conclusions: Monocyte oxidative burst and bacterial killing is impaired in alcoholic hepatitis while bacterial uptake by phagocytosis is preserved. Defective MOB is associated with reduced expression of NADPH oxidase in these patients and predicts the development of infection and death.
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http://dx.doi.org/10.1136/gutjnl-2015-310378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534772PMC
March 2017

Role of self-expanding metal stents in the management of variceal haemorrhage: Hype or hope?

World J Gastrointest Endosc 2016 Jan;8(1):23-9

Brian J Hogan, James P O'Beirne, Institute for Liver and Digestive Health, UCL, Royal Free Hospital, London NW3 2QG, United Kingdom.

Despite the advances of medical, endoscopic and radiological therapy over recent years the mortality rates of acute variceal haemorrhage are still 16%-20% and the medium term outcome has not improved in the last 25 years. Early transjugular intrahepatic portosystemic shunt has proved to be an effective therapy for selected groups of patients with a high risk of re-bleeding and moderate liver disease. However, there is an unmet need for a therapy that can be applied in patients with a high risk of re-bleeding and advanced liver disease either as definitive therapy or as a bridge to permanent therapy. Self-expanding metal stents can be placed without the need for endoscopic or fluoroscopic control and, once in place, will provide effective haemostasis and allow a route for oral fluids and nutrition. They can remain in place whilst liver function recovers and secondary prophylaxis is initiated. We review the results of 6 case series including a total of 83 patients and the first randomised controlled trial of self-expanding metal stents vs balloon tamponade (BT) in the management of refractory variceal haemorrhage. We report that self-expanding metal stents provide effective haemostasis and perform better than BT in refractory bleeding, where they are associated with fewer complications. Whilst the most effective place for self-expanding metal stents in the management algorithm needs to be determined by further randomised controlled trials, currently they provide an effective alternative to BT in selected patients.
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http://dx.doi.org/10.4253/wjge.v8.i1.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707320PMC
January 2016

Lack of agreement for defining 'clinical suspicion of rejection' in liver transplantation: a model to select candidates for liver biopsy.

Transpl Int 2015 Apr 16;28(4):455-64. Epub 2015 Jan 16.

Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain.

The gold standard to diagnose acute cellular rejection (ACR) after liver transplantation (LT) is histological evaluation, but there is no consensus to select patients for liver biopsy. We aimed to evaluate the agreement among clinicians to select candidates for liver biopsy early after LT. From a protocol biopsy population (n = 690), we randomly selected 100 LT patients in whom the biopsy was taken 7-10 days after LT. The clinical information between LT and protocol biopsy was given to nine clinicians from three transplant centres who decided whether a liver biopsy was needed. The agreement among clinicians to select candidates for liver biopsy was poor: κ = 0.06-0.62, being κ < 0.40 in 76% of comparisons. The concordance between indication for liver biopsy and moderate-severe ACR in the protocol biopsy was κ < 0.30 in all cases. A multivariate model based on the product age-by-MELD (OR = 0.81; P = 0.013), delta eosinophils (OR = 1.5; P = 0.002) and mean tacrolimus trough concentrations <6 ng/ml within the prior 4 days (OR = 11.4; P = 0.047) had an AUROC = 0.84 to diagnose moderate-severe histological ACR. In conclusion, the agreement among clinicians to select patients for liver biopsy is very poor. If further validated the proposed model would provide an objective method to select candidates for liver biopsy after LT.
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http://dx.doi.org/10.1111/tri.12514DOI Listing
April 2015

High sensitivity of diesel soot morphological and optical properties to combustion temperature in a shock tube.

Environ Sci Technol 2014 Jun 16;48(11):6444-52. Epub 2014 May 16.

Department of Chemistry & Industrial Hygiene, University of North Alabama , Florence, Alabama 35632-5049, United States.

Carbonaceous particles produced from combustion of fossil fuels have strong impacts on air quality and climate, yet quantitative relationships between particle characteristics and combustion conditions remain inadequately understood. We have used a shock tube to study the formation and properties of diesel combustion soot, including particle size distributions, effective density, elemental carbon (EC) mass fraction, mass-mobility scaling exponent, hygroscopicity, and light absorption and scattering. These properties are found to be strongly dependent on the combustion temperature and fuel equivalence ratio. Whereas combustion at higher temperatures (∼2000 K) yields fractal particles of a larger size and high EC content (90 wt %), at lower temperatures (∼1400 K) smaller particles of a higher organic content (up to 65 wt %) are produced. Single scattering albedo of soot particles depends largely on their organic content, increasing drastically from 0.3 to 0.8 when the particle EC mass fraction decreases from 0.9 to 0.3. The mass absorption cross-section of diesel soot increases with combustion temperature, being the highest for particles with a higher EC content. Our results reveal that combustion conditions, especially the temperature, may have significant impacts on the direct and indirect climate forcing of atmospheric soot aerosols.
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http://dx.doi.org/10.1021/es405589dDOI Listing
June 2014

Circulating microRNA profiles reflect the presence of breast tumours but not the profiles of microRNAs within the tumours.

Cell Oncol (Dordr) 2012 Aug 21;35(4):301-8. Epub 2012 Jul 21.

Gene Regulation and Cancer Group, Leeds Institute of Molecular Medicine, University of Leeds, St. James's University Hospital, UK.

Background: Extra-cellular microRNAs have been identified within blood and their profiles reflect various pathologies; therefore they have potential as disease biomarkers. Our aim was to investigate how circulating microRNA profiles change during cancer treatment. Our hypothesis was that tumour-related profiles are lost after tumour resection and therefore that comparison of profiles before and after surgery would allow identification of biomarker microRNAs. We aimed to examine whether these microRNAs were directly derived from tumours, and whether longitudinal expression monitoring could provide recurrence diagnoses.

Methods: Plasma was obtained from ten breast cancer patients before and at two time-points after resection. Tumour tissue was also obtained. Quantitative PCR were used to determine levels of 367 miRNAs. Relative expressions were determined after normalisation to miR-16, as is typical in the field, or to the mean microRNA level.

Results: 210 microRNAs were detected in at least one plasma sample. Using miR-16 normalisation, we found few consistent changes in circulating microRNAs after resection, and statistical analyses indicated that this normalisation was not justifiable. However, using data normalised to mean microRNA expression we found a significant bias for levels of individual circulating microRNAs to be reduced after resection. Potential biomarker microRNAs were identified, including let-7b, let-7g and miR-18b, with higher levels associated with tumours. These microRNAs were over-represented within the more highly expressed microRNAs in matched tumours, suggesting that circulating populations are tumour-derived in part. Longitudinal monitoring did not allow early recurrence detection.

Conclusions: We concluded that specific circulating microRNAs may act as breast cancer biomarkers but methodological issues are critical.
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http://dx.doi.org/10.1007/s13402-012-0089-1DOI Listing
August 2012

Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit.

J Burn Care Res 2012 May-Jun;33(3):371-8

The San Antonio Military Medical Center (SAMMC), Texas 78234, USA.

Severe burn injury is accompanied by a systemic inflammatory response, making traditional indicators of sepsis both insensitive and nonspecific. To address this, the American Burn Association (ABA) published diagnostic criteria in 2007 to standardize the definition of sepsis in these patients. These criteria include temperature (>39°C or <36°C), progressive tachycardia (>110 beats per minute), progressive tachypnea (>25 breaths per minute not ventilated or minute ventilation >12 L/minute ventilated), thrombocytopenia (<100,000/μl; not applied until 3 days after initial resuscitation), hyperglycemia (untreated plasma glucose >200 mg/dl, >7 units of insulin/hr intravenous drip, or >25% increase in insulin requirements over 24 hours), and feed intolerance >24 hours (abdominal distension, residuals two times the feeding rate, or diarrhea >2500 ml/day). Meeting >3 of these criteria should "trigger" concern for infection. In this initial assessment of the ABA sepsis criteria correlation with infection, the authors evaluated the ABA sepsis criteria's correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue infections, and blood cultures are typically obtained due to concern for ongoing infections falling within the definition of "septic." A retrospective electronic records review was performed to evaluate episodes of bacteremia in the United States Army Institute of Research from 2006 through 2007. A total of 196 patients were admitted during the study period who met inclusion criteria. The first positive and negative cultures, if present, from each patient were evaluated. This totaled 101 positive and 181 negative cultures. Temperature, heart rate, insulin resistance, and feed intolerance criteria were significant on univariate analysis. Only heart rate and temperature were found to significantly correlate with bacteremia on multivariate analysis. The receiver operating characteristic curve area for meeting >3 ABA sepsis criteria is 0.638 (95% confidence interval 0.573-0.704; P < .001). Among severe burn patients, the ABA trigger for sepsis did not correlate strongly with bacteremia in this retrospective chart review.
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http://dx.doi.org/10.1097/BCR.0b013e3182331e87DOI Listing
September 2012

Surgery induced immunosuppression.

Surgeon 2011 Feb 16;9(1):38-43. Epub 2010 Sep 16.

Department of Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom.

Surgery and anaesthesia result in a variety of metabolic and endocrine responses, which result in a generalised state of immunosuppression in the immediate post-operative period. Surgery induced immunosuppression has been implicated in the development of post-operative septic complications and tumour metastasis formation. In addition the effectiveness of many treatments in the adjuvant setting is dependent on a functioning immune system. By understanding the mechanisms contributing to surgery-induced immunosuppression, surgeons may undertake strategies to minimise its effect and reduce potential short-term and long-term consequences to patients.
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http://dx.doi.org/10.1016/j.surge.2010.07.011DOI Listing
February 2011

Perioperative reductions in circulating lymphocyte levels predict wound complications after excisional breast cancer surgery.

Ann Surg 2011 Feb;253(2):360-4

Department of Surgery, Leeds General Infirmary, University of Leeds, Leeds, UK.

Objective: Postoperative wound complications after excisional surgery for primary breast cancer can result in patients requiring additional treatments and delay adjuvant therapy and are associated with worse prognoses.We investigated factors that might predispose patients to wound complications.

Background: A number of patient characteristics have been associated with wound complications, but there is currently no quantitative measure of the risk of their occurrence. Our hypothesis was that wound complications are related, in part, to the immune status of patients.

Methods: We recruited patients undergoing surgery for primary breast cancer and determined their circulating levels of various immune cells shortly before and after surgery as a measure of immune status.

Results: One hundred seventeen patients were recruited; 16 (13.7%) developed wound complications. The following patient and tumor characteristics were associated with higher wound complication rates: diabetes (P = 0.02); larger tumors (T2/3 vs T1; P = 0.02); metastatic axillary nodes (P = 0.006). With respect to immune status, no significant differences in preoperative levels of circulating immune cells were detected between patients who developed wound complications and those who did not. However, patients who developed complications showed greater reductions in lymphocyte levels 4 hours postoperatively than those who did not (P <0.001). Multivariate analyses demonstrated that falls in lymphocyte levels of greater than 20% or 50% 4 hours postoperatively acted as a significant and independent predictor of wound complications (P < 0.005 and P < 0.0001,respectively).

Conclusions: Perioperative changes in lymphocyte levels could provide a practical predictive marker for wound complications on which selective antibiotic prophylaxis could be based.
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http://dx.doi.org/10.1097/SLA.0b013e318207c139DOI Listing
February 2011
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