Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

The efficacy and safety of continued hydroxycarbamide therapy versus switching to ruxolitinib in patients with polycythaemia vera: a randomized, double-blind, double-dummy, symptom study (RELIEF)

Abstract: Summary The randomized, double-blind, double-dummy, phase 3b RELIEF trial evaluated polycythaemia vera (PV)-related symptoms in patients who were well controlled with a stable dose of hydroxycarbamide (also termed hydroxyurea) but reported PV-related symptoms. Patients were randomized 1:1 to ruxolitinib 10 mg BID (n = 54) or hydroxycarbamide (prerandomization dose/schedule; n = 56); crossover to ruxolitinib was permitted after Week 16. The primary endpoint, ≥50% improvement from baseline in myeloproliferative neoplasm -symptom assessment form total symptom score cytokine symptom cluster (TSS-C; sum of tiredness, itching, muscle aches, night sweats, and sweats while awake) at Week 16, was achieved by 43·4% vs. 29·6% of ruxolitinib- and hydroxycarbamide-treated patients, respectively (odds ratio, 1·82; 95% confidence interval, 0·82–4·04; P = 0·139). The primary endpoint was achieved by 34% of a subgroup who maintained their hydroxycarbamide dose from baseline to Weeks 13–16. In a post hoc analysis, the primary endpoint was achieved by more patients with stable screening-to-baseline TSS-C scores (ratio ≤ 2) receiving ruxolitinib than hydroxycarbamide (47·4% vs. 25·0%; P = 0·0346). Ruxolitinib treatment after unblinding was associated with continued symptom score improvements. Adverse events were primarily grades 1/2 with no unexpected safety signals. Ruxolitinib was associated with a nonsignificant trend towards improved PV-related symptoms versus hydroxycarbamide, although an unexpectedly large proportion of patients who maintained their hydroxycarbamide dose reported symptom improvement.

Selection of the order of autoregressive models for spectral analysis of doppler ultrasound signals

Abstract: Autoregressive modelling includes a model identification procedure, that is, it is necessary to choose the order of the autoregressive (AR) process that best describes the given finite record (frame) of the signal. Four previously suggested procedures to choose the "best order" of AR processes have been tested: The "first zero crossing" of the autocorrelation function (FZC), the "final prediction error" (FPE), "Akaike's information criterion" (AIC), and the "criterion autoregressive transfer-function" (CAT). It was found that: (i) For more than 98% of the 1280 frames of Doppler signals analyzed the order selected by the various criteria was ten or less. (ii) For the same records of Doppler signals, FPE, AIC and CAT behave in a very similar manner, but the FZC criterion underestimates the order in relation to the others. (iii) For true AR processes, the order selected is frequently different from the true AR order when frames of 64 samples are used. When more samples are used FPE, AIC and CAT tend to select the correct order. (iv) The effect on the spectral estimate of using too high a model order is usually insignificant, while using too low an order can change the estimate more dramatically, that is, overestimating the model order is better than underestimating it.

Predicting aortic complications after endovascular aneurysm repair.

Abstract: Background Lifelong surveillance is standard after endovascular repair of abdominal aortic aneurysm (EVAR), but remains costly, heterogeneous and poorly calibrated. This study aimed to develop and validate a scoring system for aortic complications after EVAR, informing rationalized surveillance. Methods Patients undergoing EVAR at two centres were studied from 2004 to 2010. Preoperative morphology was quantified using three-dimensional computed tomography according to a validated protocol, by investigators blinded to outcomes. Proportional hazards modelling was used to identify factors predicting aortic complications at the first centre, and thereby derive a risk score. Sidak tests between risk quartiles dichotomized patients to low- or high-risk groups. Aortic complications were reported by Kaplan–Meier analysis and risk groups were compared by log rank test. External validation was by comparison of aortic complications between risk groups at the second centre. Results Some 761 patients, with a median age of 75 (interquartile range 70–80) years, underwent EVAR. Median follow-up was 36 (range 11–94) months. Physiological variables were not associated with aortic complications. A morphological risk score incorporating maximum aneurysm diameter (P < 0·001) and largest common iliac diameter (measured 10 mm from the internal iliac origin; P = 0·004) allocated 75 per cent of patients to a low-risk group, with excellent discrimination between 5-year rates of aortic complication in low- and high-risk groups at both centres (centre 1: 12 versus 31 per cent, P < 0·001; centre 2: 12 versus 45 per cent, P = 0·002). Conclusion The risk score uses commonly available morphological data to stratify the rate of complications after EVAR. The proposals for rationalized surveillance could provide clinical and economic benefits.

Guidelines on the investigation and management of follicular lymphoma.

Abstract: The guideline group was selected to be representative of UK-based medical experts and patient’s representatives. MEDLINE and EMBASE were searched systematically for publications in English from 1980–2010 using the key words follicular lymphoma, non-Hodgkin lymphoma and low-grade lymphoma. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology Task Force of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of approximately 50 UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with follicular lymphoma. The guidance is not appropriate for patients with other lymphoma subtypes and in all cases individual patient circumstances may dictate an alternative approach. Grading of evidence: These guidelines have used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) nomenclature for assessing levels of evidence and providing recommendations in the guidelines. See Appendix 1.