UHCW publication: Safety and feasibility evaluation of tourniquets for total knee replacement (SAFE-TKR): study protocol

Safety and feasibility evaluation of tourniquets for total knee replacement (SAFE-TKR): study protocol
Wall, Peter Dh; Ahmed, Imran; Metcalfe, Andrew; Price, Andrew J; Seers, Kate; et al. BMJ Open Vol. 8, Iss. 4,  (April 10, 2018): e022067.

This study is designed to determine whether a full randomised controlled trial (RCT) examining the clinical effectiveness and safety of total knee replacement surgery with or without a tourniquet is warranted and feasible.


Get full text at http://bmjopen.bmj.com/content/8/4/e022067

Blue Book on the Management of Distal Radial Fractures

British Society for Surgery of the Hand publishes its Blue Book on the Management of Distal Radial Fractures


UHCW Consultant Orthopaedic Surgeon Helen Hedley and Electronic Systems & Resources Librarian Helga Perry contributed to this publication.


Obtain the full document at: http://www.bssh.ac.uk/_userfiles/pages/files/professionals/Radius/Blue%20Book%20DRF%20Final%20Document.pdf

UHCW publication: Prevalence of cam hip shape morphology: a systematic review.

Prevalence of cam hip shape morphology: a systematic review.
Osteoarthritis Cartilage. 2016 Jun;24(6):949-61
Dickenson E, Wall PD, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR


ABSTRACT
OBJECTIVE: Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. DESIGN: All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. RESULTS: Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. CONCLUSIONS: There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.


Read full text at: https://www.oarsijournal.com/article/S1063-4584(16)00005-4/fulltext

UHCW publication: Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?

Nephrol Dial Transplant. 2017 Aug 1;32(8):1402-1409. doi: 10.1093/ndt/gfw345.
Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?
Sarafidis PA, Kamperidis V, Loutradis C, Tsilonis K, Mpoutsiouki F, Saratzis A, Giannakoulas G2, Sianos G, Karvounis H.
Read PubMed abstract at https://www.ncbi.nlm.nih.gov/pubmed/27738230

UHCW publication: Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids

Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids.
Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG.
Diabetologia 2018 Feb 9. doi: 10.1007/s00125-018-4558-6. [Epub ahead of print]


Abstract
AIMS/HYPOTHESIS: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model.METHODS: Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS: Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05).CONCLUSIONS/INTERPRETATION: Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.


View details on PubMed at https://www.ncbi.nlm.nih.gov/pubmed/29427237

UHCW publication: Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma

Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma.
Chahal R, Mohite AA, Heimann H, Bansal A.

Journal of Glaucoma: February 01, 2018 Publish Ahead of Print
doi: 10.1097/IJG.0000000000000891

Abstract
Purpose: We report a previously unrecognised mechanism of secondary glaucoma due to iridescent crystalline particles released from an irradiated iris melanoma. It masqueraded as refractory hypertensive uveitis following uncomplicated phacoemulsification.
Methods: A 58-year-old gentleman had an iris melanoma that underwent successful regression following irradiation with proton beam radiotherapy (PBRT). Three years later an uncomplicated phacoemulsification with intraocular lens implant was performed and subsequently the patient presented with apparently “refractory hypertensive uveitis”. Closer examination identified unique iridescent crystalline particles originating from a disintegrating tumour and dispersing within the anterior chamber and drainage angle. The patient developed a unilateral secondary open angle glaucoma attributable to these particles. Ultrasound biomicroscopy (UBM) of the anterior segment confirmed absence of tumour recurrence or intra-scleral spread and systemic investigations ruled out distant metastases.
Results: The intra-ocular pressure (IOP) was refractory to maximal medical treatment, but was eventually controlled with trans-scleral diode laser cyclo-photocoagulation.
Conclusions: This is the first report of a secondary glaucoma attributable to trabecular blockage with iridescent crystalline particulate material released from a disintegrating, previously irradiated, iris melanoma. . PBRT and possibly phacoemulsification may have played a role in triggering the release of these previously undescribed particles from the atrophied tumour surface. This unique mechanism of secondary glaucoma needs to be kept in mind in such rare cases. Trans-scleral cyclodiode laser may be used as a good initial option in such cases to minimise potential risk of tumour seeding with incisional glaucoma surgery.


Full text available from Ovid (UHCW Athens login required) at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovft&AN=00061198-900000000-98515&PDF=y

UHCW publication: Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy

Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy.

Georgios K. Dimitriadis, Harpal S. Randeva, Saboor Aftab, Asad Ali, John G. Hattersley, Sarojini Pandey, Dimitris K. Grammatopoulos, Georgios Valsamakis

Georgios Mastorakos, T. Hugh Jones, Thomas M. Barber.

Endocrine. 2018 Feb 2. doi: 10.1007/s12020-017-1516-x
Abstract
AIM:
To explore the metabolic phenotype of obesity-related secondary hypogonadism (SH) in men pre-replacement and post-replacement therapy with long-acting intramuscular (IM) testosterone undecanoate (TU).
METHODS:
A prospective observational pilot study on metabolic effects of TU IM in male obesity-related SH (hypogonadal [HG] group, n = 13), including baseline comparisons with controls (eugonadal [EG] group, n = 15). Half the subjects (n = 7 in each group) had type 2 diabetes mellitus (T2D). Baseline metabolic assessment on Human Metabolism Research Unit: fasting blood samples; BodPod (body composition), and; whole-body indirect calorimetry. The HG group was treated with TU IM therapy for 6-29 months (mean 14.8-months [SD 8.7]), and assessment at the Human Metabolism Research Unit repeated. T-test comparisons were performed between baseline and follow-up data (HG group), and between baseline data (HG and EG groups). Data reported as mean (SD).
RESULTS:
Overall, TU IM therapy resulted in a statistically significant improvement in HbA1C (9 mmol/mol, P = 0.03), with 52% improvement in HOMA%B. Improvement in glycaemic control was driven by the HG subgroup with T2D, with 18 mmol/mol [P = 0.02] improvement in HbA1C. Following TU IM therapy, there was a statistically significant reduction in fat mass (3.5 Kg, P = 0.03) and increase in lean body mass (2.9 kg, P = 0.03). Lipid profiles and energy expenditure were unchanged following TU IM therapy. Comparisons between baseline data for HG and EG groups were equivalent apart from differences in testosterone, SHBG and basal metabolic rate (BMR).
CONCLUSION:
In men with obesity-related SH (including a subgroup with T2D), TU IM therapy improved glycaemic control, beta cell function, and body composition.

Open access full text available at: https://link.springer.com/article/10.1007/s12020-017-1516-x

UHCW publication: Micro-CT for quantitative toolmark analysis of sharp force trauma to bone

The cutting edge - Micro-CT for quantitative toolmark analysis of sharp force trauma to bone.
Norman, D G; Watson, D G; Burnett, B; Fenne, P M; Williams, M A; et al.
Forensic science international 2018 February Vol. 283: 156-172.


Abstract
Toolmark analysis involves examining marks created on an object to identify the likely tool responsible for creating those marks (e.g., a knife). Although a potentially powerful forensic tool, knife mark analysis is still in its infancy and the validation of imaging techniques as well as quantitative approaches is ongoing. This study builds on previous work by simulating real-world stabbings experimentally and statistically exploring quantitative toolmark properties, such as cut mark angle captured by micro-CT imaging, to predict the knife responsible. In Experiment 1 a mechanical stab rig and two knives were used to create 14 knife cut marks on dry pig ribs. The toolmarks were laser and micro-CT scanned to allow for quantitative measurements of numerous toolmark properties. The findings from Experiment 1 demonstrated that both knives produced statistically different cut mark widths, wall angle and shapes. Experiment 2 examined knife marks created on fleshed pig torsos with conditions designed to better simulate real-world stabbings. Eight knives were used to generate 64 incision cut marks that were also micro-CT scanned. Statistical exploration of these cut marks suggested that knife type, serrated or plain, can be predicted from cut mark width and wall angle. Preliminary results suggest that knives type can be predicted from cut mark width, and that knife edge thickness correlates with cut mark width. An additional 16 cut marks walls were imaged for striation marks using scanning electron microscopy with results suggesting that this approach might not be useful for knife mark analysis. Results also indicated that observer judgements of cut mark shape were more consistent when rated from micro-CT images than light microscopy images. The potential to combine micro-CT data, medical grade CT data and photographs to develop highly realistic virtual models for visualisation and 3D printing is also demonstrated. This is the first study to statistically explore simulated real-world knife marks imaged by micro-CT to demonstrate the potential of quantitative approaches in knife mark analysis. Findings and methods presented in this study are relevant to both forensic toolmark researchers as well as practitioners. Limitations of the experimental methodologies and imaging techniques are discussed, and further work is recommended.


Full text available at

https://auth.elsevier.com/ShibAuth/institutionLogin?entityID=https%3A%2F%2Fidp.eduserv.org.uk%2Fopenathens&appReturnURL=https%3A%2F%2Fwww.clinicalkey.com%2F%23!%2Fcontent%2Fjournal%2F1-s2.0-S0379073817305558 (UHCW Athens login required)

UHCW publication: Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario.
C. F. Pairaudeau, C. Mendonca, C. Hillermann, I. Qazi, P. A. Baker, R. E. Hodgson, S. Radhakrishna

Anaesthesia 2018 Jan 19. doi: 10.1111/anae.14218
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.


Full text PDF available at  http://onlinelibrary.wiley.com/doi/10.1111/anae.14218/epdf (UHCW Athens login required)

UHCW publication: Hepatic amyloidosis: a cause of rapidly progressive jaundice

Images in ... Hepatic amyloidosis: a cause of rapidly progressive jaundice.
Mark Ford, Benjamin Disney, Veena Shinde, Sauid Ishaq.
BMJ Case Reports 2018; doi:10.1136/bcr-2017-222942


Full text available at http://casereports.bmj.com/content/2018/bcr-2017-222942.full (UHCW OpenAthens login required)

UHCW publication: pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract

Aims: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

Patients and Methods: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions.

Results: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups.

Conclusion: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00010&D=ovft&PDF=y (UHCW Athens login required)

UHCW publication: Meniscal transplantation is beneficial at one year

Infographic: Meniscal transplantation is beneficial at one year.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1): 64–65


Menisci protect the knee joint from wear by distributing load, providing stability, and improving congruency. Partial and complete meniscectomies are widely performed for patients with meniscal tears that are not repairable, but meniscal loss increases contact pressures and predisposes patients to degenerative change. Meniscal allograft transplantation (MAT) aims to improve symptoms, increase function, and reduce the development of osteoarthritis in patients with a symptomatic, meniscal deficient knee. However, outcomes following MAT have never been definitively tested. We performed a comprehensive cohort study with a pilot randomized controlled trial (RCT) designed to assess the benefits of MAT over a programme of personalised physiotherapy. In this small study, we demonstrate that patients undergoing meniscal allograft transplantation using a ‘soft-tissue’ technique show better patient-reported outcome measures at one year. A long-term multicentre RCT is now required to confirm these promising early findings and to evaluate whether MAT can slow the progression to osteoarthritis and improve function in the long term.


Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00011&D=ovft&PDF=y (UHCW Athens login required)

UHCW publication: Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers

Effect of a lateral glide mobilisation with movement of the hip on vibration threshold in healthy volunteers.
Smith, Darren A; Saranga, Jacob; Pritchard, Andrew; Kommatas, Nikolaos A; Punnoose, Shinu Kovelal; et al.
Journal of bodywork and movement therapies Vol. 22, Iss. 1, (January 2018): 13-17.


Abstract

Background
Mulligan's mobilisation-with-movement (MWM) techniques are proposed to achieve their clinical benefit via neurophysiological mechanisms. However, previous research has focussed on responses in the sympathetic nervous system only, and is not conclusive. An alternative measure of neurophysiological response to MWM is required to support or refute this mechanism of action. Recently, vibration threshold (VT) has been used to quantify changes in the sensory nervous system in patients experiencing musculoskeletal pain.

Objective
To investigate the effect of a lateral glide MWM of the hip joint on vibration threshold compared to a placebo and control condition in asymptomatic volunteers.

Methods
Fifteen asymptomatic volunteers participated in this single-blinded, randomised, within-subject, placebo, control design. Participants received each of three interventions in a randomised order; a lateral glide MWM of the hip joint into flexion, a placebo MWM, and a control intervention. Vibration threshold (VT) measures were taken at baseline and immediately after each intervention. Mean change in VT from baseline was calculated for each intervention and then analysed for between group differences using a one-way analysis of variance (ANOVA).

Results
A one-way ANOVA revealed no statistically significant differences between the three experimental conditions (P = 0.812).

Conclusion
This small study found that a lateral glide MWM of the hip did not significantly change vibration threshold compared to a placebo and control intervention in an asymptomatic population. This study provides a method of using vibration threshold to investigate the potential neurophysiological effects of a manual therapy intervention that should be repeated in a larger, symptomatic population.

UHCW publication: subtle tardive dyskinesia with paliperidone palmitate

The importance of clinical observation: A case of subtle tardive dyskinesia with paliperidone palmitate.
Omer, Hisham; Thompson, Andrew D
Aust N Z J Psychiatry. 2018 Jan 1:4867417750758. doi: 10.1177/0004867417750758.[letter - no abstract available]

UHCW publication: Gin, tonic water and the sun

Image Gallery: Gin, tonic water and the sun.
Chan SA, Shim TN
British journal of dermatology Vol. 177, Iss. 6, (December 2017): e349
Full text available at http://onlinelibrary.wiley.com/doi/10.1111/bjd.15891/epdf (UHCW Athens login required)

UHCW publication: Hemodynamic instability during dialysis

Hemodynamic instability during dialysis: is intra-dialytic exercise the answer?
Scott McGuire, Elizabeth Horton, Derek Renshaw, Alfonso Jimenez, Nithya S. Krishnan, Gordon McGregor
BioMed Research International 2018 Jan


Abstract
Acute haemodynamic instability is a natural consequence of disordered cardiovascular physiology during haemodialysis (HD). Prevalence of intra-dialytic hypotension (IDH) can be as high as 20-30%, contributing to sub-clinical, transient myocardial ischemia. In the long term, this results in progressive, maladaptive cardiac remodelling and impairment of left ventricular function. This is thought to be a major contributor to increased cardiovascular mortality in end stage renal disease (ESRD). Medical strategies to acutely attenuate haemodynamic instability during HD are sub-optimal. Whilst a programme of intra-dialytic exercise training appears to facilitate numerous chronic adaptations, little is known of the acute physiological response to this type of exercise. In particular, the potential for intra-dialytic exercise to acutely stabilise cardiovascular hemodynamics, thus preventing IDH and myocardial ischemia, has not been explored. This narrative review aims to summarise the characteristics and causes of acute haemodynamic instability during HD, with an overview of current medical therapies to treat IDH. Moreover, we discuss the acute physiological response to intra-dialytic exercise with a view to determining the potential for this non-medical intervention to stabilise cardiovascular haemodynamics during HD, improve coronary perfusion and reduce cardiovascular morbidity and mortality in ESRD.

Full text PDF available at http://downloads.hindawi.com/journals/bmri/aip/8276912.pdf (free access)

UHCW publication: distant metastasis in colorectal cancer

Novel digital tissue phenotypic signatures of distant metastasis in colorectal cancer
Korsuk Sirinukunwattana, David Snead, David Epstein, Zia Aftab, Imaad Mujeeb, Yee Wah Tsang, Ian Cree, and Nasir Rajpoot
[no publication details given]


Abstract
Distant metastasis is the major cause of death in colorectal cancer (CRC). Patients at high risk of developing distant metastasis could benefit from appropriate adjuvant and follow-up treatments if stratified accurately at an early stage of the disease. Studies have increasingly recognized the role of diverse cellular components within the tumor microenvironment in the development and progression of CRC tumors. In this paper, we show that a new method of automated analysis of digitized images from colorectal cancer tissue slides can provide important estimates of distant metastasis-free survival (DMFS, the time before metastasis is first observed) on the basis of details of the microenvironment. Specifically, we determine what cell types are found in the vicinity of other cell types, and in what numbers, rather than concentrating exclusively on the cancerous cells. We then extract novel tissue phenotypic signatures using statistical measurements about tissue composition. Such signatures can underpin clinical decisions about the advisability of various types of adjuvant therapy.

PDF full text available at https://arxiv.org/pdf/1801.07451.pdf

UHCW publication: Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes

Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes
Weickert MO, Pfeiffer, AFH
The Journal of Nutrition, Volume 148, Issue 1, 1 January 2018, Pages 7–12
Abstract
Large prospective cohort studies consistently show associations of a high dietary fiber intake (>25 g/d in women and >38 g/d in men) with a 20–30% reduced risk of developing type 2 diabetes (T2D), after correction for confounders. It is less well recognized that these effects appear to be mainly driven by high intakes of whole grains and insoluble cereal fibers, which typically are nonviscous and do not relevantly influence postprandial glucose responses [i.e., glycemic index (GI)] or are strongly fermented by the gut microbiota in the colon. In contrast, a dietary focus on soluble, viscous, gel-forming, more readily fermentable fiber intakes derived from fruit and certain vegetables yields mixed results and generally does not appear to reduce T2D risk. Although disentangling types of fiber-rich foods and separating these from possible effects related to the GI is an obvious challenge, the common conclusion that key metabolic effects of high-fiber intake are explained by mechanisms that should mainly apply to the soluble, viscous type can be challenged. More recently, studies in humans and animal models focused on gaining mechanistic insights into why especially high-cereal-fiber (HCF) diets appear to improve insulin resistance (IR) and diabetes risk. Although effects of HCF diets on weight loss are only moderate and comparable to other types of dietary fibers, possible novel mechanisms have emerged, which include the prevention of the absorption of dietary protein and modulation of the amino acid metabolic signature. Here we provide an update of our previous review from 2008, with a focus on mechanistic insights of how HCF diets may improve IR and the risk of developing T2D.


Read the full article at https://academic.oup.com/jn/article/148/1/7/4823705 (free access)

UHCW publication: Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid

Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid Simon Tso, Gabriela Petrof, Simon Unter, Frances Humphreys
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223507
http://casereports.bmj.com/content/2018/bcr-2017-223507.full



You can publish in BMJ Case Reports with the UHCW Fellowship Code. Ask in the CSB Library for more details.

UHCW publication: gastric acid-reducing drugs following renal transplantation

Do stop me now: gastric acid-reducing drugs following renal transplantation

I Held, R Pyart J Kidney Care 2018 Jan 3(1):6-13

Abstract

Proton pump inhibitors (PPIs) can counteract the risk of gastrointestinal bleeds, but can also be harmful. University Hospitals Coventry and Warwickshire NHS Trust's renal transplant drug protocol recommends that patients take omeprazole if they have a history of peptic ulcers or indigestion. Ines Held and Rhodri Pyart share the findings of two audits on PPIs in renal transplant patients.

Full text available with UHCW Openathens login at https://www.magonlinelibrary.com/doi/10.12968/jokc.2018.3.1.6