The Belfast Health and Social Care Trust (BHSCT) is a health organisation covering Belfast, Northern Ireland. The trust is one of five new trusts which were created on 1 April 2007 by the then Department of Health, Social Services and Public Safety (DHSSPS). The Belfast Trust employs 22,000 staff. It has responsibility for services to over 340,000 patients, provided at various hospitals including Belfast City Hospital, the Royal Victoria Hospital, the Mater Hospital and Musgrave Park Hospital.
Mental health problems among healthcare staff have been well documented within the literature. Due to the COVID-19 pandemic and subsequent redeployment of many healthcare workers to frontline settings such as COVID intensive care units (ICUs), their mental health has been further adversely affected. To address this, a pilot service was developed that offered rapid assessment and trauma-focused cognitive behavior therapy (TF-CBT) to staff redeployed to COVID ICUs during the pandemic. Aims included reducing mental health symptoms associated with psychological trauma in this cohort and sustaining the workforce by promoting a successful return to work. Outcome measures indicated that the TF-CBT intervention led to significant improvements, with scores of many participants who completed measures moving from moderate or severe clinical categories to mild across anxiety (48%), depression (62%), and posttraumatic stress disorder (75%). These results generally held when accounting for reliable change. Additionally, 97% of staff returned to work following intervention. The average number of sessions provided was 4, with higher baseline anxiety being the only significant predictor of session duration. These results indicate that substantial therapeutic and functional gains can be achieved by offering staff experiencing trauma-related mental health symptoms a rapid access TF-CBT intervention within a limited time frame. Limitations and next steps are discussed.
BACKGROUND:Dedicated randomised studies on intravascular imaging guidance in unprotected left main coronary artery (LMCA) disease are lacking. AIMS:We aimed to investigate the clinical feasibility of optical coherence tomography (OCT) guidance in percutaneous coronary intervention (PCI) of true LMCA bifurcation lesions and to evaluate its prognostic impact compared with angiographic guidance. METHODS:Patients with true LMCA bifurcation lesions who were randomised to either OCT or angiographic guidance in the OCTOBER Trial were included. The feasibility of OCT guidance was assessed as the proportion of patients with successful and analysable OCT pullbacks before, during, and after stenting. Clinical outcomes between the two groups were compared based on the incidence of a composite of major adverse cardiac events (MACE), comprising cardiac death, any myocardial infarction, or target lesion revascularisation. RESULTS:In total, 227 patients were included (OCT: 111, angiography: 116). OCT guidance was successful, with 98% of cases having a pre-stenting pullback performed and 96% a final pullback, as per protocol. The proximal LMCA stent edge was analysable in 43% of patients, and in the remaining 57%, only 5% were limited by insufficient image quality. No statistically significant difference in MACE was observed between the two groups (OCT: 14.4% vs angiography: 18.4%, hazard ratio 0.78, 95% confidence interval: 0.39-1.51). CONCLUSIONS:OCT-guided PCI in true LMCA bifurcation lesions was clinically feasible, but visibility of the LMCA ostium was limited by short pullbacks, insufficient clearance, or guide catheter shadowing. OCT guidance was associated with a non-significant reduction in MACE, consistent with the effect estimate in the main trial.
Primary endometrial carcinomas with somatically derived yolk sac tumor (YST) components are rare. We analyzed 23 such cases using detailed clinicopathologic, immunohistochemical, and molecular methods. The median patient age was 68 years. Elevated serum alpha-fetoprotein (AFP) was detected in 76.9% (10/13) of tested cases. International Federation of Gynecology and Obstetrics (FIGO) 2009 stages were I (n = 12, 55%), II (n = 1, 5%), III (n = 5, 23%), IV (n = 4, 18%), and unknown in one. Histologic YST patterns included glandular (87%), papillary (52%), solid (48%), endodermal sinus (17%), hepatoid (17%), and reticular (13%) architectures. The associated Müllerian-type neoplasms were endometrioid carcinoma (n = 17), carcinosarcoma (n = 3), serous carcinoma (n = 2), and clear cell carcinoma (n = 1). Immunohistochemically, 17 cases (74%) exhibited mutation-type p53 staining, and 2 (9%) were mismatch repair-deficient (MMRd). YST components uniformly expressed glypican-3 and spalt-like transcription factor 4 (SALL4), whereas 17 (74%) also expressed AFP. HER2 positivity was seen in 13 of 21 tested (62%; four 3+, three 2+, and six 1+). Molecular analysis revealed TP53 variants in 16 of 22 cases (73%) without POLE hotspot mutations. According to The Cancer Genome Atlas molecular classification, 17 tumors were p53-abnormal (74%), 2 (9%) MMRd, 4 (17%) were no specific molecular profile, and none was POLE-ultramutated. Recurrent copy number gains involved CCNE1 (9/22, 41%), 1q44 (12/14, 86%), and 3q26.32 (8/14, 57%). Features reminiscent of germ cell tumors included amplifications at 7p21.2 (8/14, 57%) and 9p21.3 (11/14, 79%), polysomy or amplification of chromosome 12p (6/22, 27%), deletion at 11q24.3 (8/14, 57%), and a high frequency of T>C nucleotide substitutions. Follow-up showed 15 patients (75%) had died of disease or were alive with disease; 12 of these 15 cases were p53-abnormal. Overall survival was significantly poorer than in other molecular subtypes of endometrial carcinoma. These tumors should therefore be regarded as high grade (grade 3) by definition. In summary, endometrial carcinomas with a somatically derived YST component are highly aggressive, predominantly p53-abnormal, with smaller subsets classified as MMRd or no specific molecular profile. Recognition of the YST component is crucial, and biomarker profiling may reveal therapeutic targets.
Expression of the β-adrenergic receptors' family has been associated with survival outcomes in multiple different cancer types, showing their potential to act as prognostic factors. No previous work has evaluated these receptors in relation to survival in oesophageal adenocarcinoma. We sought to analyse the expression of β1 and β2 adrenergic receptors in oesophageal adenocarcinoma and their association with survival outcomes. The expression of β1 and β2 adrenergic receptors was evaluated in a cohort of oesophageal adenocarcinoma patients treated with neo-adjuvant chemotherapy prior to surgical resection at the Northern Ireland Cancer Centre between 2004 and 2012. Immunohistochemical staining for was assessed using a Tissue Microarray with triplicate tumour cores. Cox proportional hazards regression was used to investigate the association of β1 and β2 adrenergic receptor expression with survival outcomes, including adjustment for clinical factors. In total, 115 and 122 patients were assessed for β1 and β2 adrenergic receptor expression, respectively. In adjusted analysis, high β2 adrenergic receptor expression was associated with improved recurrence-free [hazard ratio [HR] 0.57, 95% CI 0.33-0.97] and overall survival (HR 0.53, 95% CI 0.30-0.94) with restriction to gastro-oesophageal junction tumours showing a stronger association with improved overall survival (HR 0.27, 95% CI 0.13-0.59). No significant association was observed for β1 adrenergic receptor expression and any survival outcome. In summary, we found that higher expression of the β2 adrenergic receptor was associated with a significant improvement in survival in oesophageal adenocarcinoma patients, and gastro-oesophageal junction tumours in particular, treated with neoadjuvant chemotherapy followed by surgical resection.
Progression to late AMD phenotypes was different for HRF and SDD. HRF increased risk of progression to FoA with or without nAMD, whereas SDD to FoA only, suggesting distinct biological pathways driving divergent disease outcomes.
