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| 2. |
- Drake, Thomas M., et al.
(författare)
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Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction
- 2019
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 45:12, s. 2319-2324
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology Introduction: Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods: A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results: 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions: Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.
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- Mock, Alyssa, et al.
(författare)
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Anisotropy, band-to-band transitions, phonon modes, and oxidation properties of cobalt-oxide core-shell slanted columnar thin films
- 2016
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Ingår i: Applied Physics Letters. - : AMER INST PHYSICS. - 0003-6951 .- 1077-3118. ; 108:5, s. 051905-
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Tidskriftsartikel (refereegranskat)abstract
- Highly ordered and spatially coherent cobalt slanted columnar thin films (SCTFs) were deposited by glancing angle deposition onto silicon substrates, and subsequently oxidized by annealing at 475 degrees C. Scanning electron microscopy, Raman scattering, generalized ellipsometry, and density functional theory investigations reveal shape-invariant transformation of the slanted nanocolumns from metallic to transparent metal-oxide core-shell structures with properties characteristic of spinel cobalt oxide. We find passivation of Co-SCTFs yielding Co-Al2O3 core-shell structures produced by conformal deposition of a few nanometers of alumina using atomic layer deposition fully prevents cobalt oxidation in ambient and from annealing up to 475 degrees C. (C) 2016 AIP Publishing LLC.
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- Muir, Derek, et al.
(författare)
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Identifying further chemicals of emerging arctic concern based on ‘in silico’ screening of chemical inventories
- 2019
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Ingår i: Emerging Contaminants. - : Elsevier BV. - 2405-6650 .- 2405-6642. ; 5, s. 201-210
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Tidskriftsartikel (refereegranskat)abstract
- In the past 12 years several studies have screened lists of thousands of chemicals available in the industrial chemical inventories of the European Union, the USA and Canada with the goal of identifying and prioritizing chemicals which are persistent (P), bioaccumulative (B) and toxic (T). Most studies have selected chemicals based on whether their predicted P and B properties and their long-range transport potential exceed guideline thresholds for evaluation of persistent organic pollutants (POPs). A major goal of this study was to review this recent literature on computer-based or ‘in silico’ screening for POPs. A second goal was to review other approaches for finding previously unidentified chemicals of concern including targeted and non-target analytical approaches that might use lists of suspect chemicals developed from ‘in silico’ screening studies. Eight studies were reviewed along with several others which examined the screening process and its uncertainties. From these studies we assembled a list of 3421 chemicals, after removing duplicates and substances already on the Stockholm Convention on POPs. About 52% of these were halogenated, while 48% consisted of a broad range of non-halogenated organics. This list was then further analysed by calculating an overall “POPs score” for transport and accumulation in the Arctic for each substance using predicted partition coefficients, overall persistence, transfer efficiency, and bioaccumulation factor. A shorter list of twenty-five substances was developed based on their POPs score ranking. These substances had not been previously analysed in environmental media but were nevertheless on current or recent chemical inventories indicating significant commercial use.
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- Stewart, Derek, et al.
(författare)
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Guidance to manage inappropriate polypharmacy in older people : systematic review and future developments.
- 2017
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Ingår i: Expert Opinion on Drug Safety. - : Informa UK Limited. - 1474-0338 .- 1744-764X. ; 16:2, s. 203-213
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.
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| 6. |
- Torchia, Jonathon, et al.
(författare)
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Molecular subgroups of atypical teratoid rhabdoid tumours in children : an integrated genomic and clinicopathological analysis
- 2015
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Ingår i: The Lancet Oncology. - 1470-2045 .- 1474-5488. ; 16:5, s. 569-582
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Tidskriftsartikel (refereegranskat)abstract
- Background Rhabdoid brain tumours, also called atypical teratoid rhabdoid tumours, are lethal childhood cancers with characteristic genetic alterations of SMARCB1/hSNF5. Lack of biological understanding of the substantial clinical heterogeneity of these tumours restricts therapeutic advances. We integrated genomic and clinicopathological analyses of a cohort of patients with atypical teratoid rhabdoid tumours to find out the molecular basis for clinical heterogeneity in these tumours. Methods We obtained 259 rhabdoid tumours from 37 international institutions and assessed transcriptional profiles in 43 primary tumours and copy number profiles in 38 primary tumours to discover molecular subgroups of atypical teratoid rhabdoid tumours. We used gene and pathway enrichment analyses to discover group-specific molecular markers and did immunohistochemical analyses on 125 primary tumours to evaluate clinicopathological significance of molecular subgroup and ASCL1-NOTCH signalling. Findings Transcriptional analyses identified two atypical teratoid rhabdoid tumour subgroups with differential enrichment of genetic pathways, and distinct clinicopathological and survival features. Expression of ASCL1, a regulator of NOTCH signalling, correlated with supratentorial location (p=0.004) and superior 5-year overall survival (35%, 95% CI 13-57, and 20%, 6-34, for ASCL1-positive and ASCL1-negative tumours, respectively; p=0.033) in 70 patients who received multimodal treatment. ASCL1 expression also correlated with superior 5-year overall survival (34%, 7-61, and 9%, 0-21, for ASCL1-positive and ASCL1-negative tumours, respectively; p=0.001) in 39 patients who received only chemotherapy without radiation. Cox hazard ratios for overall survival in patients with differential ASCL1 enrichment treated with chemotherapy with or without radiation were 2.02 (95% CI 1.04-3.85; p=0.038) and 3.98 (1.71-9.26; p=0.001). Integrated analyses of molecular subgroupings with clinical prognostic factors showed three distinct clinical risk groups of tumours with different therapeutic outcomes. Interpretation An integration of clinical risk factors and tumour molecular groups can be used to identify patients who are likely to have improved long-term radiation-free survival and might help therapeutic stratification of patients with atypical teratoid rhabdoid tumours.
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