Ghulam Nabi - Academia.edu (original) (raw)
Papers by Ghulam Nabi
Biomarkers in medicine, Jan 7, 2018
Gynecological disorders are leading public health problems in developing countries with substanti... more Gynecological disorders are leading public health problems in developing countries with substantial impact on women's quality of life. Significant proportion of maternal mortality and reproductive morbidity is attributed to misdiagnosis and mismanagement of pregnancy related lethal pathological conditions and affect women's health. Timely diagnosis is necessary to prevent maternal deaths and to manage complications. Biomarker development will create a wide window of opportunity for early diagnosis. This review discusses the current status of biomarkers and recent advances in 'omics' technology for early screening of endometriosis and pre-eclampsia because of significant global bioburden associated with these disorders. This review will also give baseline data for future biomarker development strategies.
The Journal of Urology, 1999
Endocrine Pathology, 2008
Poorly differentiated neuroendocrine carcinomas (PDNECs) of the kidney are extremely rare high-gr... more Poorly differentiated neuroendocrine carcinomas (PDNECs) of the kidney are extremely rare high-grade cancers accounting for only 42 cases reported in the literature. In this paper, we describe the morphological, immunohistochemical, ultrastructural, and for the first time, cytogenetic features of a renal PDNEC. In addition, we have reviewed the literature and compared the published clinicopathological data with our morphological and genetic results. The tumor arose within the kidney parenchyma and showed the typical histological features of a pure small cell PDNEC. Fluorescence in situ hybridization study demonstrated a complex chromosomal assessment indicative of a high degree of chromosome instability with gain of multiple chromosomes, loss of p53, and amplification of myc gene. These results suggest that renal PDNEC has a different genetic background to renal clear cell carcinoma, mainly characterized by the loss of the short arm of chromosome 3. Conversely, genetic alterations seem to resemble those of type 2 papillary renal cell carcinoma. The review of the literature demonstrated that PDNECs are associated with poor prognosis and that parenchymal tumors show some differences from those arising in the pelvis, in that parenchymal tumors are purely neuroendocrine while pelvic tumors are mostly mixed neuroendocrine-exocrine neoplasms. Keywords poorly differentiated neuroendocrine carcinoma. small cell carcinoma. kidney. FISH. cytogenetic
The British Journal of Radiology, 2012
Objectives: To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) abla... more Objectives: To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. Methods: 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m 22). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative Bmode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. Results: Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay #2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm 2 using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)50.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r50.48; 95% CI 0.11-0.73; p50.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI50.68-1.77; p,0.0001). Conclusions: HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up.
Bone, 2009
Lasofoxifene is a novel selective estrogen receptor modulator that is being developed for the tre... more Lasofoxifene is a novel selective estrogen receptor modulator that is being developed for the treatment of postmenopausal osteoporosis. Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is currently used to diagnose osteoporosis. BMD response to therapy, however, is often not apparent until at least one year following start of treatment. Biochemical markers of bone turnover may provide an early indication of BMD response in individual patients. The aims of the study were: 1) to determine the variability in bone turnover markers (BTM) to estimate a value for least significant change (LSC); 2) to determine the number of subjects with a response to lasofoxifene greater than LSC; 3) to determine the number of subjects whose bone turnover is decreased to the lower half of the reference range and 4) to evaluate the use of bone turnover markers to predict the change in bone density in response to lasofoxifene. Fifty-one postmenopausal osteopenic women, ages 55 to 77 (mean 63.7) years, were recruited with 44 women completing the 2 year follow up. Participants received either lasofoxifene (0.25 mg/d) or placebo, in a 1:1 ratio. Duplicate measurements of BTM (bone alkaline phosphatase (bone ALP), N-terminal propeptide of type I collagen (PINP), serum beta crosslinked C-telopeptides of type I collagen (sbeta-CTX), urinary crosslinked N-telopeptides of type I collagen (U-NTX)) were made at baseline and 6 months with single measurements at 4, 8 and 12 weeks. Duplicate measurements of BMD at the lumbar spine (LS), total hip (TH) and distal forearm (DF) were made by DXA at baseline, one and two years in all subjects. Almost all women (92 to 96%), treated with lasofoxifene, had a reduction in serum-based bone turnover markers greater than LSC, and 52 to 80% had serum-based bone turnover markers in the lower half of the reference range, by six months of lasofoxifene therapy. The change in mean LSBMD from baseline, was significantly greater in the lasofoxifene group compared to placebo at 1 and 2 years (+2.5% and +3.4%, respectively, P<0.0001). Change in PINP and U-NTX at 6 months correlated inversely with change in LS and TH BMD at one and two years. The use of lasofoxifene therapy leads to significant decreases in bone turnover by 4 weeks of lasofoxifene therapy as a group, with a decrease in BTM greater than LSC occurring in almost all women taking lasofoxifene by 6 months. By this time, in over half of women taking lasofoxifene, BTM reached the lower half of the reference range. Our results suggest that bone turnover markers are useful for monitoring response to lasofoxifene. Changes occur early and relate to the BMD response.
BJU International, 2002
ABSTRACT To assess the feasibility and intermediate-term outcome of laparoscopic radical cystecto... more ABSTRACT To assess the feasibility and intermediate-term outcome of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion in patients with organ-confined muscle-invasive carcinoma of the urinary bladder, the entire procedure undertaken intracorporeally only using laparoscopic techniques. Five patients (four men and one woman) underwent LRC with intracorporeal ileal conduit diversion in February 2000, using a six-port transperitoneal technique. LRC, ileal conduit exclusion, restoration of ileo-ileal continuity, and bilateral stented uretero-ileal anastomoses were completed intracorporeally in all patients. The follow-up data up to 2 years are reported. All procedures were completed laparoscopically with no open conversion or intraoperative complications. The mean duration of surgery was 7.5 h; the blood loss was 360 mL and no patient required perioperative blood transfusion. The mean (range) hospital stay was 7 (6-22) days; the specimen weight was 225-400 g. The surgical margins of the bladder specimen were negative in each patient. One patient developed intestinal obstruction after surgery, requiring a diverting ileostomy for 12 weeks. At a follow-up of 2 years, two patients died, both from unrelated causes (myocardial infarction and septicaemia from pulmonary infection in one each). The three surviving patients are asymptomatic with normal upper tracts and no evidence of local recurrence or metastatic disease. LRC with ileal conduit diversion undertaken completely intracorporeally is a feasible option for muscle-invasive organ-confined carcinoma of the urinary bladder, with good outcomes over a 2-year follow-up.
BJOG: An International Journal of Obstetrics and Gynaecology, 1986
The patient was a 22-year-old woman in her fourth pregnancy who presented at 36 weeks gestation w... more The patient was a 22-year-old woman in her fourth pregnancy who presented at 36 weeks gestation with a 24-h history of epigastric and right upper quadrant pain radiating to her back. Her antenatal care had been uncomplicated and specifically there had been no evidence of pre-eclampsia. Serology was negative and the patient had not travelled overseas. Four years previously she had given birth to twins after an uncomplicated pregnancy. Her next child had died of sudden infant death syndrome at 10 weeks, while a third pregnancy had ended in a first trimester abortion. There was no relevant past or family history and in particular no liver disease. She was taking no medications and smoked 10 cigarettedday. On examination she was afebrile, normotensive with a pulse rate of 80/min. Her chest was clinically clear and abdominal examination revealed mild epigastric tenderness without hepatomegaly. Bowel sounds were normal and there was no evidence of gastrointestinal obstruction. The uterine fundus was consistent with dates, non-tender and without palpable contractions or evidence of placental separation. The fetal heart rate was 140/min, the cervix 1 cm dilated with the fetal head high in the midcavity. Shortly after admission the patient vomited 500ml of undigested food followed later by 200 ml of bile-stained fluid. She was given intravenous fluids, analgesia and antiemetics. An abdominal ultrasound and cholecystosonogram, using a 3.5 MHz transducer, performed on the following day showed no visible pathology of the liver, gall bladder, biliary tree, right kidney or pancreatic region. Labour commenced spontaneously 48 h after
Actas Urológicas Españolas, 2012
La fístula vesicovaginal (FVV) es una enfermedad frecuente en países no desarrollados y afecta la... more La fístula vesicovaginal (FVV) es una enfermedad frecuente en países no desarrollados y afecta la calidad de vida de mujeres en edad media, siendo la causa más habitual la histerectomía previa. Las técnicas quirúrgicas disponibles para su reparación presentan resultados variables. Objetivos: Presentar nuestra experiencia en la reparación de FVV por vía laparoscópica con abordaje retrovesical, en una serie consecutiva de 6 pacientes. Método: análisis prospectivo descriptivo de 6 pacientes sometidos a reparación laparoscópica retrovesical de FVV supratrigonales secundarias a histerectomías. Resultados: El tiempo operatorio promedio fue de 191 minutos. Ningún paciente requirió transfusiones y el tiempo de hospitalización promedio fue de 2,5 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 15 meses. Conclusión: La reparación laparoscópica de FVV mediante técnica retrovesical es una técnica segura, poco invasiva y reproducible en manos entrenadas, que podría convertirse en la técnica de elección a futuro. De acuerdo a nuestra revisión, esta comunicación es la primera serie de reparación laparoscópica de FVV publicada en Chile.
Healthcare, 2022
This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography ... more This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer’s perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded ...
Biomedical Optics Express, 2019
This study outlines a simple fluorometric optical sensor system for the sensitive, real time meas... more This study outlines a simple fluorometric optical sensor system for the sensitive, real time measurement of volatile organic compounds (VOCs) as biomarkers of urinary bladder cancer in patients presenting with frank hematuria and confirmed to have the disease on histopathology. Arrays of 24 sensor points based on fluorescence VOC sensitive materials were made. Urine samples of 38 consecutive patients with pathologically confirmed bladder tumours and 41 age and gender matched healthy controls were recruited and analysed using this sensor array. This system correctly classified 68 out of 79 urine samples with 84.21% sensitivity and 87.80% specificity; the system also achieved 66.67% sensitivity and 75.00% specificity for classification of high-grade and low-grade bladder cancer patients. This study showed promising results in the detection of urinary bladder cancer as well as to classify high grade versus low grade bladder cancers.
The British journal of radiology, 2018
To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population ... more To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. A total of 20 studies were included wi...
European Journal of Oncology Nursing, 2018
A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention fo... more A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. 2018 PATERSON, C., PRIMEAU, C. and NABI, G. 2018. A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. European journal of oncology nursing [online], 37, pages 65-73.
Surgical endoscopy, Jan 14, 2018
To evaluate pre-surgical quantitative transrectal shear wave elastography (SWE) in the detection ... more To evaluate pre-surgical quantitative transrectal shear wave elastography (SWE) in the detection and characterisation of radioresistant prostate cancer. Twelve men with recurrent prostate cancer following external beam radiotherapy were included in a prospective protocol-driven study. All underwent MR imaging and quantitative shear wave elastographic assessment of recurrent disease prior to salvage laparoscopic radical prostatectomy procedures. Images were used to construct 3D mold printing and histopathological processing of surgical specimen. Statistical analyses including ROC were generated using software programmes. There were 48 cancer foci identified on final histopathology using patient-specific mold-based approach in 12 patients. Mean number of lesion was 3.4 (range 2-4). Quantitative transrectal SWE showed a sensitivity and specificity 0.77 (95% CI 0.627-0.880) and 0.82 (95% CI 0.642-0.942), respectively. The diagnostic accuracy increased with increasing size of the lesions...
Laboratory investigation; a journal of technical methods and pathology, Jan 18, 2017
Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) i... more Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) imaging are novel high-resolution imaging modalities for characterization of biological tissues. Following our preliminary experience, we hypothesized that OCE and SHG imaging would delineate the microstructure of prostate tissue and aid in distinguishing cancer from the normal benign prostatic tissue. Furthermore, these approaches may assist in characterization of the grade of cancer, as well. In this study, we confirmed a high diagnostic accuracy of OCE and SHG imaging in the detection and characterization of prostate cancer for a large set of biopsy tissues obtained from men suspected to have prostate cancer using transrectal ultrasound (TRUS). The two techniques and methods described here are complementary, one depicts the stiffness of tissues and the other illustrates the orientation of collagen structure around the cancerous lesions. The results showed that stiffness of cancer tissu...
International Journal of Urological Nursing, 2016
Biomedical optics express, 2016
Muscle invasive urinary bladder cancer is one of the most lethal cancers and its detection at the... more Muscle invasive urinary bladder cancer is one of the most lethal cancers and its detection at the time of transurethral resection remains limited and diagnostic methods are urgently needed. We have developed a muscle invasive transitional cell carcinoma (TCC) model of the bladder using porcine bladder scaffold and the human bladder cancer cell line 5637. The progression of implanted cancer cells to muscle invasion can be monitored by measuring changes in the spectrum of endogenous fluorophores such as reduced nicotinamide dinucleotide (NADH) and flavins. We believe this could act as a useful tool for the study of fluorescence dynamics of developing muscle invasive bladder cancer in patients. Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.
Urologic oncology, Aug 12, 2016
Assess early oncological and functional outcomes following radical treatment of men with high-ris... more Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had posi...
European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2015
Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known a... more Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known about the optimal type of social support, or its mechanism effect between coping and emotional outcome in men affected by this disease to identify areas for clinical intervention. This study aimed to empirically test the propositions of social support theory in "real time" within individual men living with and beyond prostate cancer. Purposeful sub-sample from a larger prospective longitudinal study of prostate cancer survivors, took part in real time data collection using mobile technology. Self-reports were collected for 31 days prompted by an audio alarm 3 times per day (a total of 93 data entries) for each of the 12 case studies. Electronic data were analysed using time series analysis. Majority of response rates were >90%. Men reported a lack of satisfaction with their support over time. Testing the propositions of social support theory "within individuals" ove...
European Urology Supplements, 2012
To test the propositions of social support theory (see figure 1) and to detail the actual selfman... more To test the propositions of social support theory (see figure 1) and to detail the actual selfmanagement behaviours of men affected by prostate cancer over time.
Biomarkers in medicine, Jan 7, 2018
Gynecological disorders are leading public health problems in developing countries with substanti... more Gynecological disorders are leading public health problems in developing countries with substantial impact on women's quality of life. Significant proportion of maternal mortality and reproductive morbidity is attributed to misdiagnosis and mismanagement of pregnancy related lethal pathological conditions and affect women's health. Timely diagnosis is necessary to prevent maternal deaths and to manage complications. Biomarker development will create a wide window of opportunity for early diagnosis. This review discusses the current status of biomarkers and recent advances in 'omics' technology for early screening of endometriosis and pre-eclampsia because of significant global bioburden associated with these disorders. This review will also give baseline data for future biomarker development strategies.
The Journal of Urology, 1999
Endocrine Pathology, 2008
Poorly differentiated neuroendocrine carcinomas (PDNECs) of the kidney are extremely rare high-gr... more Poorly differentiated neuroendocrine carcinomas (PDNECs) of the kidney are extremely rare high-grade cancers accounting for only 42 cases reported in the literature. In this paper, we describe the morphological, immunohistochemical, ultrastructural, and for the first time, cytogenetic features of a renal PDNEC. In addition, we have reviewed the literature and compared the published clinicopathological data with our morphological and genetic results. The tumor arose within the kidney parenchyma and showed the typical histological features of a pure small cell PDNEC. Fluorescence in situ hybridization study demonstrated a complex chromosomal assessment indicative of a high degree of chromosome instability with gain of multiple chromosomes, loss of p53, and amplification of myc gene. These results suggest that renal PDNEC has a different genetic background to renal clear cell carcinoma, mainly characterized by the loss of the short arm of chromosome 3. Conversely, genetic alterations seem to resemble those of type 2 papillary renal cell carcinoma. The review of the literature demonstrated that PDNECs are associated with poor prognosis and that parenchymal tumors show some differences from those arising in the pelvis, in that parenchymal tumors are purely neuroendocrine while pelvic tumors are mostly mixed neuroendocrine-exocrine neoplasms. Keywords poorly differentiated neuroendocrine carcinoma. small cell carcinoma. kidney. FISH. cytogenetic
The British Journal of Radiology, 2012
Objectives: To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) abla... more Objectives: To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. Methods: 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m 22). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative Bmode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. Results: Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay #2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm 2 using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)50.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r50.48; 95% CI 0.11-0.73; p50.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI50.68-1.77; p,0.0001). Conclusions: HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up.
Bone, 2009
Lasofoxifene is a novel selective estrogen receptor modulator that is being developed for the tre... more Lasofoxifene is a novel selective estrogen receptor modulator that is being developed for the treatment of postmenopausal osteoporosis. Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is currently used to diagnose osteoporosis. BMD response to therapy, however, is often not apparent until at least one year following start of treatment. Biochemical markers of bone turnover may provide an early indication of BMD response in individual patients. The aims of the study were: 1) to determine the variability in bone turnover markers (BTM) to estimate a value for least significant change (LSC); 2) to determine the number of subjects with a response to lasofoxifene greater than LSC; 3) to determine the number of subjects whose bone turnover is decreased to the lower half of the reference range and 4) to evaluate the use of bone turnover markers to predict the change in bone density in response to lasofoxifene. Fifty-one postmenopausal osteopenic women, ages 55 to 77 (mean 63.7) years, were recruited with 44 women completing the 2 year follow up. Participants received either lasofoxifene (0.25 mg/d) or placebo, in a 1:1 ratio. Duplicate measurements of BTM (bone alkaline phosphatase (bone ALP), N-terminal propeptide of type I collagen (PINP), serum beta crosslinked C-telopeptides of type I collagen (sbeta-CTX), urinary crosslinked N-telopeptides of type I collagen (U-NTX)) were made at baseline and 6 months with single measurements at 4, 8 and 12 weeks. Duplicate measurements of BMD at the lumbar spine (LS), total hip (TH) and distal forearm (DF) were made by DXA at baseline, one and two years in all subjects. Almost all women (92 to 96%), treated with lasofoxifene, had a reduction in serum-based bone turnover markers greater than LSC, and 52 to 80% had serum-based bone turnover markers in the lower half of the reference range, by six months of lasofoxifene therapy. The change in mean LSBMD from baseline, was significantly greater in the lasofoxifene group compared to placebo at 1 and 2 years (+2.5% and +3.4%, respectively, P<0.0001). Change in PINP and U-NTX at 6 months correlated inversely with change in LS and TH BMD at one and two years. The use of lasofoxifene therapy leads to significant decreases in bone turnover by 4 weeks of lasofoxifene therapy as a group, with a decrease in BTM greater than LSC occurring in almost all women taking lasofoxifene by 6 months. By this time, in over half of women taking lasofoxifene, BTM reached the lower half of the reference range. Our results suggest that bone turnover markers are useful for monitoring response to lasofoxifene. Changes occur early and relate to the BMD response.
BJU International, 2002
ABSTRACT To assess the feasibility and intermediate-term outcome of laparoscopic radical cystecto... more ABSTRACT To assess the feasibility and intermediate-term outcome of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion in patients with organ-confined muscle-invasive carcinoma of the urinary bladder, the entire procedure undertaken intracorporeally only using laparoscopic techniques. Five patients (four men and one woman) underwent LRC with intracorporeal ileal conduit diversion in February 2000, using a six-port transperitoneal technique. LRC, ileal conduit exclusion, restoration of ileo-ileal continuity, and bilateral stented uretero-ileal anastomoses were completed intracorporeally in all patients. The follow-up data up to 2 years are reported. All procedures were completed laparoscopically with no open conversion or intraoperative complications. The mean duration of surgery was 7.5 h; the blood loss was 360 mL and no patient required perioperative blood transfusion. The mean (range) hospital stay was 7 (6-22) days; the specimen weight was 225-400 g. The surgical margins of the bladder specimen were negative in each patient. One patient developed intestinal obstruction after surgery, requiring a diverting ileostomy for 12 weeks. At a follow-up of 2 years, two patients died, both from unrelated causes (myocardial infarction and septicaemia from pulmonary infection in one each). The three surviving patients are asymptomatic with normal upper tracts and no evidence of local recurrence or metastatic disease. LRC with ileal conduit diversion undertaken completely intracorporeally is a feasible option for muscle-invasive organ-confined carcinoma of the urinary bladder, with good outcomes over a 2-year follow-up.
BJOG: An International Journal of Obstetrics and Gynaecology, 1986
The patient was a 22-year-old woman in her fourth pregnancy who presented at 36 weeks gestation w... more The patient was a 22-year-old woman in her fourth pregnancy who presented at 36 weeks gestation with a 24-h history of epigastric and right upper quadrant pain radiating to her back. Her antenatal care had been uncomplicated and specifically there had been no evidence of pre-eclampsia. Serology was negative and the patient had not travelled overseas. Four years previously she had given birth to twins after an uncomplicated pregnancy. Her next child had died of sudden infant death syndrome at 10 weeks, while a third pregnancy had ended in a first trimester abortion. There was no relevant past or family history and in particular no liver disease. She was taking no medications and smoked 10 cigarettedday. On examination she was afebrile, normotensive with a pulse rate of 80/min. Her chest was clinically clear and abdominal examination revealed mild epigastric tenderness without hepatomegaly. Bowel sounds were normal and there was no evidence of gastrointestinal obstruction. The uterine fundus was consistent with dates, non-tender and without palpable contractions or evidence of placental separation. The fetal heart rate was 140/min, the cervix 1 cm dilated with the fetal head high in the midcavity. Shortly after admission the patient vomited 500ml of undigested food followed later by 200 ml of bile-stained fluid. She was given intravenous fluids, analgesia and antiemetics. An abdominal ultrasound and cholecystosonogram, using a 3.5 MHz transducer, performed on the following day showed no visible pathology of the liver, gall bladder, biliary tree, right kidney or pancreatic region. Labour commenced spontaneously 48 h after
Actas Urológicas Españolas, 2012
La fístula vesicovaginal (FVV) es una enfermedad frecuente en países no desarrollados y afecta la... more La fístula vesicovaginal (FVV) es una enfermedad frecuente en países no desarrollados y afecta la calidad de vida de mujeres en edad media, siendo la causa más habitual la histerectomía previa. Las técnicas quirúrgicas disponibles para su reparación presentan resultados variables. Objetivos: Presentar nuestra experiencia en la reparación de FVV por vía laparoscópica con abordaje retrovesical, en una serie consecutiva de 6 pacientes. Método: análisis prospectivo descriptivo de 6 pacientes sometidos a reparación laparoscópica retrovesical de FVV supratrigonales secundarias a histerectomías. Resultados: El tiempo operatorio promedio fue de 191 minutos. Ningún paciente requirió transfusiones y el tiempo de hospitalización promedio fue de 2,5 días. No se presentaron complicaciones ni recidivas, con un seguimiento promedio de 15 meses. Conclusión: La reparación laparoscópica de FVV mediante técnica retrovesical es una técnica segura, poco invasiva y reproducible en manos entrenadas, que podría convertirse en la técnica de elección a futuro. De acuerdo a nuestra revisión, esta comunicación es la primera serie de reparación laparoscópica de FVV publicada en Chile.
Healthcare, 2022
This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography ... more This exploratory study investigates the cost-effectiveness of ultrasound shear wave elastography (SWE) imaging in comparison to pre-biopsy multiparametric magnetic resonance imaging (mpMRI) in men with suspected prostate cancer. This research is motivated by the early evidence of the good performance of SWE in distinguishing cancerous from benign prostate tissues. We used a decision analysis model representing the care-pathways of men referred with a high prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) in a UK setting from the payer’s perspective with results reported in 2016 GBP. We then appraised the cost-effectiveness of a novel approach based on SWE compared to the more conventional and widely practiced mpMRI-based approaches using data reported in the literature. Deterministic and probabilistic sensitivity analyses were used to address uncertainty regarding the parameter values utilised. Our exploratory results implied that SWE approach yielded ...
Biomedical Optics Express, 2019
This study outlines a simple fluorometric optical sensor system for the sensitive, real time meas... more This study outlines a simple fluorometric optical sensor system for the sensitive, real time measurement of volatile organic compounds (VOCs) as biomarkers of urinary bladder cancer in patients presenting with frank hematuria and confirmed to have the disease on histopathology. Arrays of 24 sensor points based on fluorescence VOC sensitive materials were made. Urine samples of 38 consecutive patients with pathologically confirmed bladder tumours and 41 age and gender matched healthy controls were recruited and analysed using this sensor array. This system correctly classified 68 out of 79 urine samples with 84.21% sensitivity and 87.80% specificity; the system also achieved 66.67% sensitivity and 75.00% specificity for classification of high-grade and low-grade bladder cancer patients. This study showed promising results in the detection of urinary bladder cancer as well as to classify high grade versus low grade bladder cancers.
The British journal of radiology, 2018
To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population ... more To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. A total of 20 studies were included wi...
European Journal of Oncology Nursing, 2018
A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention fo... more A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. 2018 PATERSON, C., PRIMEAU, C. and NABI, G. 2018. A pilot randomised controlled trial of a multimodal supportive care (ThriverCare) intervention for managing unmet supportive care needs in men with metastatic prostate cancer on hormonal treatment and their partner/caregivers. European journal of oncology nursing [online], 37, pages 65-73.
Surgical endoscopy, Jan 14, 2018
To evaluate pre-surgical quantitative transrectal shear wave elastography (SWE) in the detection ... more To evaluate pre-surgical quantitative transrectal shear wave elastography (SWE) in the detection and characterisation of radioresistant prostate cancer. Twelve men with recurrent prostate cancer following external beam radiotherapy were included in a prospective protocol-driven study. All underwent MR imaging and quantitative shear wave elastographic assessment of recurrent disease prior to salvage laparoscopic radical prostatectomy procedures. Images were used to construct 3D mold printing and histopathological processing of surgical specimen. Statistical analyses including ROC were generated using software programmes. There were 48 cancer foci identified on final histopathology using patient-specific mold-based approach in 12 patients. Mean number of lesion was 3.4 (range 2-4). Quantitative transrectal SWE showed a sensitivity and specificity 0.77 (95% CI 0.627-0.880) and 0.82 (95% CI 0.642-0.942), respectively. The diagnostic accuracy increased with increasing size of the lesions...
Laboratory investigation; a journal of technical methods and pathology, Jan 18, 2017
Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) i... more Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) imaging are novel high-resolution imaging modalities for characterization of biological tissues. Following our preliminary experience, we hypothesized that OCE and SHG imaging would delineate the microstructure of prostate tissue and aid in distinguishing cancer from the normal benign prostatic tissue. Furthermore, these approaches may assist in characterization of the grade of cancer, as well. In this study, we confirmed a high diagnostic accuracy of OCE and SHG imaging in the detection and characterization of prostate cancer for a large set of biopsy tissues obtained from men suspected to have prostate cancer using transrectal ultrasound (TRUS). The two techniques and methods described here are complementary, one depicts the stiffness of tissues and the other illustrates the orientation of collagen structure around the cancerous lesions. The results showed that stiffness of cancer tissu...
International Journal of Urological Nursing, 2016
Biomedical optics express, 2016
Muscle invasive urinary bladder cancer is one of the most lethal cancers and its detection at the... more Muscle invasive urinary bladder cancer is one of the most lethal cancers and its detection at the time of transurethral resection remains limited and diagnostic methods are urgently needed. We have developed a muscle invasive transitional cell carcinoma (TCC) model of the bladder using porcine bladder scaffold and the human bladder cancer cell line 5637. The progression of implanted cancer cells to muscle invasion can be monitored by measuring changes in the spectrum of endogenous fluorophores such as reduced nicotinamide dinucleotide (NADH) and flavins. We believe this could act as a useful tool for the study of fluorescence dynamics of developing muscle invasive bladder cancer in patients. Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.
Urologic oncology, Aug 12, 2016
Assess early oncological and functional outcomes following radical treatment of men with high-ris... more Assess early oncological and functional outcomes following radical treatment of men with high-risk prostate cancer and aged more than 70 years. A total of 335 men with high-risk prostate cancer (prostate-specific antigen ≥20ng/ml or biopsy Gleason score 8 to 10 or≥cT2c) received radical treatment between 2007 and 2014. Men were identified from comprehensive clinical databases hosted at a tertiary cancer center in the UK. The data included basic demographics, and follow-up on functional and oncological outcomes using validated patient-reported outcome questionnaires. Univariate and multivariate analyses were used. In all, 117 patients received radical radiotherapy (RT) alone, 167 patients received neoadjuvant hormone therapy and RT, and 54 patients underwent radical prostatectomy with extended lymph node dissection. Mean age was 72.8, standard deviation (SD) = 2.1, mean follow-up of 40.9 months, SD = 25.5 months. Patients who underwent laparoscopic prostatectomy = 24 (44.4%) had posi...
European journal of oncology nursing : the official journal of European Oncology Nursing Society, 2015
Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known a... more Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known about the optimal type of social support, or its mechanism effect between coping and emotional outcome in men affected by this disease to identify areas for clinical intervention. This study aimed to empirically test the propositions of social support theory in "real time" within individual men living with and beyond prostate cancer. Purposeful sub-sample from a larger prospective longitudinal study of prostate cancer survivors, took part in real time data collection using mobile technology. Self-reports were collected for 31 days prompted by an audio alarm 3 times per day (a total of 93 data entries) for each of the 12 case studies. Electronic data were analysed using time series analysis. Majority of response rates were >90%. Men reported a lack of satisfaction with their support over time. Testing the propositions of social support theory "within individuals" ove...
European Urology Supplements, 2012
To test the propositions of social support theory (see figure 1) and to detail the actual selfman... more To test the propositions of social support theory (see figure 1) and to detail the actual selfmanagement behaviours of men affected by prostate cancer over time.