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World Journal of Transplantation 2024年第4期14卷 133-139页

作者： Sophie Gharaei Hashim Abbas Durga Anil Kanigicherla Manchester Medical School University of ManchesterManchester M139WLUnited Kingdom Department of Renal Medicine Manchester University NHS Foundation TrustManchester M139WLUnited Kingdom

BACKGROUND Focal segmental glomerulosclerosis(FSGS)often recurs after transplantation,leading to graft dysfunction and graft *** who have lost prior grafts due to recurrence are at particularly high risk of re-recurrence in subsequent *** and plasma exchange have been used pre-emptively to prevent post-transplant ***,the efficacy of such preventative measures remains *** To investigate the outcomes of preventative rituximab and plasma exchange for recurrent FSGS in transplant recipients after prior graft *** We conducted a systematic review of 11 studies with 32 patients who had experienced prior graft loss due to post-transplant FSGS recurrence and were treated with either pre-emptive plasma exchange alone,rituximab alone,or a combination of *** Overall,47%of the 32 patients experienced recurrence despite prophylactic ***-recurrence was seen in 25%(1/4)with pre-emptive rituximab alone,and 45%recurrence(9/20)with plasma exchange ***-recurrence was noted in 63%with the use of combined plasma exchange and *** There is a paucity of available evidence in the literature to draw clear conclusions on the benefits of pre-emptive measures to prevent FSGS *** small sample sizes and variations in protocols call for larger and controlled studies to serve this patient population at high risk of recurrence and graft loss.

关键词： Focal segmental glomerulosclerosis Glomerular disease Plasma exchange Rituximab Transplantation

Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2689-2701页

作者： Lewis A Hall Duncan Loader Santiago Gouveia Marta Burak James Halle-Smith Peter Labib Moath Alarabiyat Ravi Marudanayagam Bobby V Dasari Keith J Roberts Syed S Raza Michail Papamichail David C Bartlett Robert P Sutcliffe Nikolaos A Chatzizacharias Department of Hepatopancreatobiliary Surgery and Liver Transplantation University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Institute of Immunology and Immunotherapy University of BirminghamBirmingham B152TTUnited Kingdom College of Medical and Dental Sciences University of BirminghamBirmingham B152TTUnited Kingdom Institute of Clinical Sciences University of BirminghamBirmingham B152TTUnited Kingdom

BACKGROUND The use of neoadjuvant therapy(NAT)in distal cholangiocarcinoma(dCCA)with regional arterial or extensive venous involvement,is not widely accepted and evidence is *** To synthesise evidence on NAT for dCCA and present the experience of a highvolume tertiary-centre managing dCCA with arterial *** A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received *** patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained *** characteristics,NAT type,progression to surgery and oncological outcomes were *** Twelve studies were *** definition of“unresectable”locally advanced dCCA was *** studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement.R0 resection rate ranged between 0 and 100%but without survival benefit in most *** studies considered either NAT in resectable dCCA or inclusive with extrahepatic *** presented case series includes 9 patients(median age 67,IQR 56-74 years,male:female 5:4)referred for NAT for borderline resectable or locally advanced *** patients progressed to surgery and 2 were *** patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months *** Evidence for benefit of NAT is *** on criteria for uniform definition of resectability for dCCA is *** propose using the established National-Comprehensive-Cancer-Network®criteria for pancreatic ductal adenocarcinoma.

关键词： Cholangiocarcinoma Neoadjuvant therapy Arterial involvement Locally advanced Systematic review

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枕大神经阻滞对丛集性头痛的疗效

中国康复 2024年第7期39卷 438-438页

作者：王玫懿(译) Gordon A Wolfson Centre for Age-Related Diseases Institute of Psychiatry Psychology & Neuroscience King's College london Torbay and South Devon nhs foundation trust University Hospitals Plymouth nhs trust NIHR-Wellcome trust King’s Clinical Research Facility/SLaM Biomedical Research Centre King's College Hospital

丛集性头痛被描述为患者经历过的最痛苦的情况。枕大神经阻滞是一种短期预防性治疗方法,通常包括向枕下区域注射皮质类固醇和局部麻醉剂。这项分析回顾了这种干预措施对慢性丛集性头痛患者的疗效。文献综述的研究对象包括接受枕骨神经... 详细信息

丛集性头痛被描述为患者经历过的最痛苦的情况。枕大神经阻滞是一种短期预防性治疗方法,通常包括向枕下区域注射皮质类固醇和局部麻醉剂。这项分析回顾了这种干预措施对慢性丛集性头痛患者的疗效。文献综述的研究对象包括接受枕骨神经阻滞治疗的丛集性头痛患者。治疗效果被定义为头痛频率、严重程度和持续时间的变化。

关键词：丛集性头痛皮质类固醇预防性治疗局部麻醉剂神经阻滞治疗枕大神经阻滞干预措施持续时间

Utility of current thrombophilia screening in young patients with stroke and TIA

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Stroke & Vascular Neurology 2018年第4期3卷 231-236页

作者： Vafa Alakbarzade Alice Taylor Marie Scully Robert Simister Arvind Chandratheva Hyper-acute Stroke Unit University College London Hospitals NHS Foundation TrustLondonUK Department of Haematology University College London Hospitals NHS Foundation TrustLondonUK

Introduction Approximately 40%of strokes in young adults are *** diagnostic yield of thrombophilia screening remains *** aimed to determine utility of current thrombophilia testing for young patients with stroke and transient ischaemic attack(TIA).Methods We present a retrospective review of all patients with stroke and TIA≤60 years presenting to University College london Hospital stroke unit and daily TIA clinic from 1 January 2015 to 1 August *** clinical records and thrombophilia tests,including factor V Leiden(FVL),prothrombin G20210A mutation(PGM),antiphospholipid antibody(APA),and protein S,C and antithrombin(AT)levels,were *** The mean age of 628 patients with stroke and TIA was 49.1 years(SD 9.2).Thrombophilia testing was performed in 360(57%)patients,including 171 with stroke and 189 with *** tests were found in 50(14%)patients,of whom 24 patients were<50 *** results were found in 36(10%)with acute ischaemic stroke,4(1%)with haemorrhagic stroke and 10(3%)with *** patients(4%)had homozygous/heterozygous FVL or PGM,and 27(7.5%)had positive APA(anticardiolipin antibody,anti-β2 glycoprotein antibody or lupus anticoagulant).Of 27(7.5%)patients with protein C,S or AT deficiency,10(2.8%)had primary deficiency,presumed hereditary with other secondary causes excluded.9%of patients with protein C,S or AT and 27%with APA were followed by confirmatory *** Thrombophilia testing was positive in only 14%of cases *** mutations and protein C,S or AT abnormalities were found rarely and were very uncommon in patients with ***-up of abnormal results was generally poor for all groups,which further limited the impact of the thrombophilia testing policy.

关键词： patients testing TIA

Identification of patients with pancreatic adenocarcinoma due to inheritable mutation:Challenges of daily clinical practice

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World Journal of Gastrointestinal Oncology 2019年第2期11卷 102-116页

作者： Alexander JP Fulton Angela Lamarca Christina Nuttall Lynne McCallum Rille Pihlak Derek O'Reilly Fiona Lalloo Mairéad G McNamara Richard A Hubner Tara Clancy Juan W Valle Department of Medical Oncology The Christie NHS Foundation Trust Hepato-pancreato-biliary Surgical Department Manchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation Trust Manchester Centre for Genomic Medicine Central Manchester University Hospitals NHS Foundation Trust Saint Mary's Hospital

BACKGROUND Identification of germ-line mutations in pancreatic ductal adenocarcinoma(PDAC) could impact on patient/*** To assess the referral pathways for genetic consultations in *** Electronic records of PDAC patients were reviewed retrospectively. Patients eligible for genetic consultation referral were identified following the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer(EUROPAC)*** Four-hundred patients were eligible. Of 113 patients(28.3%) meeting EUROPAC criteria, 8.8% were referred for genetic opinion. Germ-line mutations were identified in 0.75% of the whole *** referrals and increased awareness may be able to overcome the low rate of successful genetic appointments.

关键词： Genetic counselling Pancreatic adenocarcinoma Genetic consultation BRCA Germline

Use of the reported Edmonton frail scale in the assessment of patients for transcatheter aortic valve replacement： a possible selection tool in very high-risk patients？

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Journal of Geriatric Cardiology 2018年第6期15卷 463-466页

作者： Louis Koizia Sarosh Khan Angela Frame Ghada W Mikhail Sayan Sen Neil Ruparelia Geriatric Medicine St Mary's Hospital Praed Street London UK Department of Cardiology Western Sussex Hospitals NHS Foundation Trust West Sussex UK Department of Cardiology lmperial College Healthcare NHS Trust London UK

Transcatheter aortic valve replacement （TAVR） has revolutionised the treatment of patients with aortic stenosis （AS） over the last 15 *** is a well-established procedure for the treatment of patients considered high risk for open surgery. Results from the PARTNER （Placement of AoRTic traNscathetER） trial showed that inoperable patients randomly assigned to TAVR, had a 20% reduction in all-cause mortality, as well as hospitalisation, at one year compared to best medical management.

关键词： Edmonton frail scale Frailty Transcatheter aortic valve replacement

Characterisation and risk assessment of venous thromboembolism in gastrointestinal cancers

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World Journal of Gastrointestinal Oncology 2017年第9期9卷 363-371页

作者： Robert L Metcalf Eamon Al-Hadithi Nicholas Hopley Thomas Henry Clare Hodgson Antony McGurk Wasat Mansoor Jurjees Hasan Department of Medical Oncology the Christie NHS Foundation Trust the University of Manchester Department of Biostatistics the Christie NHS Foundation Trust Department of Quality and Standards the Christie NHS Foundation Trust

AIM To characterise venous thromboembolism(VTE) in gastrointestinal cancer and assess the clinical utility of risk stratification scoring. METHODS We performed a retrospective analysis using electronic patient records of 910 gastro-oesophageal(GO) cancer and 1299 colorectal cancer(CRC) patients referred to a tertiary cancer centre to identify the incidence of VTE, its relationship to chemotherapy and impact on *** risk scores were calculated using the Khorana index. Patients were classified as low risk(0 points), intermediate risk(1 to 2 points) or high risk(3 points). Data was analysed to determine the sensitivity of the Khorana score to predict VTE. RESULTS The incidence of VTE was 8.9% for CRC patients and 9.7% for GO cancer patients. Pulmonary emboli(PE) were more common in advanced than in localised CRC(50% vs 21% of events respectively) and lower limb deep vein thrombosis(DVT) were more common in localised than in advanced CRC(62% vs 39% of events respectively). The median time to VTE from cancer diagnosis was 8.3 mo for CRC patients compared to 6.7 mo in GO cancer. In localised CRC median time to VTE was 7.1 mo compared with 10.1 mo in advanced CRC. In contrast in GO cancer, the median time to VTE was 12.5 mo in localised disease and 6.8 mo in advanced disease. No survival difference was seen between patients with and without VTE in this cohort. The majority of patients with CRC in whom VTE was diagnosed had low or intermediate Khorana risk score(94% for localised and 97% in advanced CRC). In GO cancer, all patients scored either intermediate or high risk due to the primary site demonstrating a limitation of the risk assessment score in discriminating high and low risk patients with GO cancers. Additional risk factors were identified in this cohort including surgery, chemotherapy or hospital admission. Overall, 81% of patients with CRC and 77% of patients with GO cancer had one or more of these factors within 4 wk prior to diagnosis VTE. These should

关键词： Thrombo-embolism Deep venous thrombosis Pulmonary embolism Colorectal cancer Oesophageal cancer Gastro-oesophageal cancer

In search of a pan-coronavirus vaccine:next-generation vaccine design and immune mechanisms

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Cellular & Molecular Immunology 2024年第2期21卷 103-118页

作者： S.Cankat M.U.Demael L.Swadling Division of Infection and Immunity Institute of Immunity and TransplantationUniversity College LondonPears BuildingLondon NW32PPUK

Members of the coronaviridae family are endemic to human populations and have caused several epidemics and pandemics in recent *** this review,we will discuss the feasibility of and progress toward the ultimate goal of creating a pan-coronavirus vaccine that can protect against infection and disease by all members of the coronavirus *** will detail the unmet clinical need associated with the continued transmission of SARS-CoV-2,MERS-CoV and the four seasonal coronaviruses(HCoV-OC43,NL63,HKU1 and 229E)in humans and the potential for future zoonotic *** will highlight how first-generation SARS-CoV-2 vaccines and natural history studies have greatly increased our understanding of effective antiviral immunity to coronaviruses and have informed next-generation vaccine *** will then consider the ideal properties of a pan-coronavirus vaccine and propose a blueprint for the type of immunity that may offer ***,we will describe a subset of the diverse technologies and novel approaches being pursued with the goal of developing broadly or universally protective vaccines for coronaviruses.

关键词： Vaccine Coronavirus Cross-reactive immunity Cross-protection Universal

Efficacy and safety of bimatoprost in glaucoma and ocular hypertension in non-responder patients

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International Journal of Ophthalmology(English edition) 2017年第8期10卷 1251-1254页

作者： Nicholas Brennan Mohammad H Dehabadi Sandhya Nair Aria Quartilho Catey Bunce Ian Reekie Raal Obikpo Moorfields Eye Hospital nhs foundation trust LondonEC 1V 2PD UK london north west Healthcare nhs trust London HA1 3UJUK north Middlesex University Hospital nhs trust LondonN18 1QX UK NIHR Biomedical Research Centre Moorfields Eye HospitalNHS Foundation Trust and UCL Institute of OphthalmologyLondon EC1V 2PD UK

AIM： To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension （OHT） patients with inadequate intraocular pressure （lOP） on current therapy. METHODS： Pre- and post-switch lOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in lOP post-pre switch was analyzed using a 2-sided Student＇s paired t-test at the 5% significance level. RESULTS： There was a statistically significant mean reduction in lOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment （P〈0.001）. Subgroup analysis also demonstrated a statistically significant mean reduction in lOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy （P〈0.001）. CONCLUSION： This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.

关键词： glaucoma ocular hypertension bimatoprost latanoprost

Healthcare staff well-being and use of support services during COVID-19:a UK perspective

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General Psychiatry 2021年第3期34卷 143-153页

作者： Anika R Petrella Luke Hughes Lorna A Fern Lisa Monaghan Benjamin Hannon Adam Waters Rachel M Taylor Cancer Division University College London Hospitals NHS Foundation TrustLondonUK Staff Psychological and Welfare Service University College London Hospitals NHS Foundation TrustLondonUK Centre for Nurse Midwife and AHP Led Research(CNMAR)University College London Hospitals NHS Foundation TrustLondonUK

Background The COVID-19 pandemic has drastically increased demands on healthcare workers(HCWs)leaving them vulnerable to acute psychological distress,burnout and post-traumatic *** response,supportive services in a central london hospital mobilised mental health support specifically for *** This rapid evaluation assessed HCW psychological welfare during the acute phase of the COVID-19 pandemic and their use of supportive services made *** During the acute phase of COVID-19(April to May 2020)all staff working for the hospital were invited to complete an online survey assessing well-being(self-rated health,moral distress exposure,symptoms of burnout and psychological distress)and use of available supportive services(awareness of,use and perceived helpfulness).Associations among personal characteristics and psychological well-being were explored using correlations and linear *** A total of 1127 staff participated in the rapid *** average,psychological distress was high(mean(SD):22(7.57))regardless of role,with 84%of this sample scoring above the general population mean(14.5).Nearly half of the sample reported feeling emotionally drained and a profile emerged displaying higher levels of psychological distress and burnout in those who were younger and exposed to morally distressing situations,with this group also exhibiting greater support service *** levels of burnout were associated with increased psychological distress when controlling for personal *** this acute phase of the pandemic,majority of staff used at least one service and rated it as *** HCWs experienced high levels of psychological distress requiring continued support as the COVID-19 pandemic *** HCWs were aware of supportive services,uptake *** order to mitigate the risk of burnout and post-traumatic stress,long-term,effective strategies that facilitate staff accessing support are urgently required.

关键词： distress younger staff