St Vincent's University Hospital Research Articles

Changes in TB contact tracing during the COVID-19 pandemic. An Irish single centre experience

Abstract Contact tracing following the diagnosis of tuberculosis (TB) is a crucial process in the identification and treatment of both secondary TB cases and also infected contacts who may require treatment for latent TB infection. During the COVID-19 pandemic, Public Health and Respiratory teams in the St Vincent’s University Hospital (SVUH) TB clinic in Dublin, Ireland, noted anecdotally that there appeared to be fewer contacts screened by public health services per index active TB case identified. To investigate this, we performed a retrospective review of the TB contact tracing service in SVUH, examining and comparing contact tracing of active TB cases in the 3 years prior to the pandemic (2017-2019) and four years thereafter (2020-2023). Results from 2017-2019 calendar years, prior to the COVID-19 pandemic noted an average of 4.77 contacts per index TB case (total 107 index cases and 510 contacts). In comparison, our data from 2020-2022 noted an average of 3.03 contacts per index TB case (total 59 index cases and 179 contacts). As pandemic restrictions were lifted again, we found our 2023 data to be more comparable to that of pre-pandemic times, noting 4.54 contacts per index case (total 22 index cases and 100 contacts). The reduction in TB contacts per index cases noted during the COVID-19 pandemic may reflect work and lifestyle changes over that time, particularly an increase in remote work but also social distancing. It is interesting that as the population emerged from the isolation measures of the pandemic, contact numbers returned quickly to pre-pandemic levels. In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services. Key messages • Our Irish centre experienced a notable but temporary reduction in contacts requiring screening by public health services, per index active TB case, during the COVID-19 pandemic. • In line with global concerns, our data highlights the ongoing workload of TB contact tracing locally and the importance of resource allocation for these services.

Gender Difference in sidE eFfects of ImmuNotherapy: a possible clue to optimize cancEr tReatment (G-DEFINER): study protocol of an observational prospective multicenter study.

Immune checkpoint inhibitors (ICIs) have significantly improved outcomes in various cancers. ICI treatment is associated with the incidence of immune-related adverse events (irAEs) which can affect any organ. Data on irAEs occurrence in relation to sex- differentiation and their association with gender-specific factors are limited. The primary objective of the G-DEFINER study is to compare the irAEs incidence in female and male patients who undergo ICI treatment. Secondary objectives are: to compare the irAEs incidence in pre- and postmenopausal female patients; to compare the irAEs incidence in female and male patients according to different clinical and gender-related factors (lifestyle, psychosocial, and behavioral factors). Exploratory objectives of the study are to compare and contrast hormonal, gene-expression, SNPs, cytokines, and gut microbiota profiles in relation to irAEs incidence in female and male patients. The patients are recruited from Fondazione IRCCS Istituto Nazionale dei Tumori, Italy, St Vincent's University Hospital, Ireland, Oslo University Hospital, Norway, and Karolinska Insitutet/Karolinska University Hospital, Sweden. The inclusion of patients was delayed due to the Covid pandemic, leading to a total of 250 patients recruited versus a planned number of 400 patients. Clinical and translational data will be analyzed. The expected outcomes are to improve the management of cancer patients treated with ICIs, leading to more personalized clinical approaches that consider potential toxicity profiles. The real world nature of the trial makes it highly applicable for timely irAEs diagnosis.

Impact of antidepressant use on post-operative weight loss following bariatric surgery.

Antidepressant medication can be associated with weight gain. Consideration should be given to the specific agent prescribed to optimize bariatric surgery outcomes. The aim of this study is to investigate if patients treated with antidepressants stratified by risk of weight gain are associated with less weight loss at 1year postbariatric surgery. Asingle centre, retrospective analysis of all patients who underwent bariatric surgery between July 2018 and 2021 within St Vincent's University Hospital group. The exposure was antidepressant use, stratified for risk of weight gain, and the control group was patients who underwent surgery but no antidepressant use. The primary outcome was % TWL (total weight loss) at 6weeks, 6months and 12months post-surgery. Multivariate linear regression analysis was used to estimate the impact of antidepressant treatment on post-surgery weight loss at 12months using the variables of age, gender and pre-operative BMI. Of the total cohort (n = 315), 70 patients (22.2%) were taking antidepressants. At 12months, post-operatively patients taking medium risk for weight gain antidepressants had significantly less mean %TWL compared to those not taking antidepressants (p = 0.015). Overall, taking any antidepressant was not found to be a significant predictor of %TWL at 12months after surgery (β = - 2.590, p = 0.0836). Many patients undergoing bariatric surgery have concurrent psychiatric conditions. Given the complex relationship between bariatric surgery and mental health, psychotropic medications may be best managed by a specialist in the field such as a bariatric psychiatrist in order to optimize patient outcomes.

Evidence from a Smoking Management Service in a University Teaching Hospital in Dublin, Ireland monitored by repeat surveys, 1997–2022

St Vincent’s University Hospital (SVUH) has a comprehensive smoking management programme and since 1997 has conducted periodic surveys of inpatients, outpatients, staff and visitors to establish prevalence of smoking and associated attitudes towards the hospital’s smoke-free campus policy pioneered in 2009. We report trends and describe also the online community stop smoking course (SSC) developed more recently in response to COVID-19. A questionnaire examining attitudes and smoking status was administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors in the time period of 1997–2018. Chi square test for trend was used. Smoking rates declined in all groups but significantly so in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs. 9.5%; p < 0.0001) and staff (30.0% vs. 10.8%; p < 0.0001). Use of E-Cigarettes was low in all cohorts. Rates of smoking were borderline higher in inpatients eligible by income for state-funded General Medical Services (33.2% vs 26.8%, p = 0.099). Support for and awareness of the ban increased over time. Demographic and quit data was compared between participants of in-person or online SSC. The online courses were successful with a maintenance of quit rates (End of Course: 54.7% vs. 55.0%, 1 Month: 50.4% vs. 54.0%, 3 Month: 19.8% vs. 22.5%). While the hospital community’s smoking prevalence has decreased over time and attitudes to the smoking ban have been increasingly positive, the campus is not without difficulties in keeping it smoke-free. We continue to advocate for hospital staff support in enacting this flagship initiative.

Editorial introductions.

Editorial introductions.

The association of centromere amplification and response to trastuzumab in HER2+ metastatic breast cancer.

1016 Background: Chromosomal instability and copy number aberration (CNA) burden can be associated with patients' survival in some cancers. Centromeres, chromosomal regions crucial for genomic stability, can be found altered by CNA in tumours but remain largely unexplored due to sequencing technologies. Using whole-genome sequencing (WGS) data from cases of long term, never relapsed HER2+ metastatic breast cancer (MBC) patients, also referred as exceptional responders (ExRs), we aim to better characterise the CNA profiles and underlying long-term survival of this “exceptional” cohort and investigate the centromeric and pericentromeric association with prognosis and treatment response. Methods: Two hundred and forty-three HER2+ MBC patients were enrolled in the HER2 Patients Project Database from St Vincent University Hospital, Dublin, Ireland. Eighty-five HER2+ MBC patients were identified as exceptional survivors (ExS) with an OS &gt; 60 months (range 60-248 months), of which 28 never-relapsed and responded exceptionally (ExR) to trastuzumab. Patients with an OS &lt; 60 months (N=158, range 0.2-59 months) were identified as non responders (NR). WGS was performed on 13 ExR tumours (primary or metastases) and matching control at a mean depth of 60X and 30X, respectively. Control-FREEC and CNVkit were used to characterise the CNA profiles and estimate the CNA burden. Samples from 10 NR patients were used for comparison with the ExR. Results: WGS analysis revealed that ExR samples are more impacted by gain rather than loss of copy overall, with a median fraction altered by gain of 0.24. No significant difference was observed between the ExR and NR in terms of CNA burden. However, a large fragment on chromosome 9 was amplified in 92% of ExR (12/13) which corresponded to the centromere (chr9q11) and a large heterochromatic block (chr9q12). A higher copy number status of this centromeric region was detected in the ExR, with a gain of at least 1 additional copy compared to the NR tumoral samples (P&lt;0.001). The dichotomisation into high versus low copy number of the centromeric region of chromosome 9 was also observed in centromeres of chromosome 17 (P=0.009) and chromosome 19 (P&lt;0.001). No case of polysomy was detected in our cohort and genes located near the centromeres, such as ERBB2 (amplified in both ExR and NR), were independent of the centromeres copy-number status. Conclusions: The identification of the genomic aberrations of these metastatic patients, treated with trastuzumab who never relapsed, increases our understanding of the mechanisms involved in MBC progression. Our results suggest that the centromere co-amplification of chr9q11-q12, chr17p11.1-q11.1 and chr19p11-q11 stratifies patients according to their OS. CNA status of the centromeric regions of chromosomes 9, 17 and 19 may therefore represent a novel prognostic predictor to trastuzumab response and new outcomes for patients.

Reducing the treatment burden of keratinocyte cancers requiring referral to plastic surgery: Lessons from lockdown

AbstractBackgroundKeratinocyte cancers are increasing in incidence in Ireland and are more common in older age, necessitating multidisciplinary specialist input and treatment often is a greater burden for patients. The coronavirus disease 2019 (COVID‐19) allowed us to restructure our interspecialty treatment pathways to reduce healthcare contact for patients.ObjectivesThe aim of this study was to establish whether a revised interspecialty pathway reduced the time‐to‐treatment completion (days) and treatment burden (defined as total healthcare encounter days).MethodsPatients with keratinocyte cancer under the care of dermatology and plastic surgery at St Vincent's University Hospital Dublin from July to December 2020 inclusive were identified in the Hospital‐Inpatient Enquiry database. Treatment burden was captured as the number of total days with a healthcare encounter and time‐to‐treatment completion was captured as the time from initial dermatology review to complete excision by plastic surgery.ResultsForty patients with 49 keratinocyte cancers were referred by dermatology to plastic surgery from July to December 2020. Thirty‐nine patients with 48 keratinocyte cancers were included in the analysis. The new referral pathway reduced the time‐to‐treatment completion from a mean of 164 to 75 days (p = 0.04). Treatment burden reduced from a mean of 5.4 to 3.5 (p = 0.002) total healthcare encounter days.ConclusionsMultidisciplinary input to establish a more efficient referral pathway for patients with keratinocyte cancer has successfully reduced the time‐to‐treatment completion and the treatment burden for our patients. This approach reduced the risk of exposure to COVID‐19 for patients and frees up valuable healthcare resources to treat these increasingly frequent malignancies.

HIV and co-morbidities - an evolving, global view.

aCentre for Experimental Pathogen Host Research, School of Medicine, University College Dublin bDepartment of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland Correspondence to Patrick W.G. Mallon, MBBS, PhD, University College Dublin, National University of Ireland, Dublin D4, Ireland. E-mail: [email protected]

Editorial introductions.

Editorial introductions.

Development of a coordinated acute diabetic foot pathway for management of acute diabetic foot infection and ulceration.

Diabetic foot ulceration (DFU) has become an increasingly common emergency presentation. These patients are presenting at a younger age and with increasingly complex co-morbidities. They require frequent hospitalisation for management of DFU which has significant consequences for management of health resources but also for quality of life in the diabetic patient population. The aim of this study was to evaluate the impact of the development of a coordinated, streamlined acute diabetic foot pathway for management of in-patients presenting as emergencies with DFU on length of stay, re-admission to hospital and minor and major amputations. A dedicated acute diabetic foot pathway was introduced to St. Vincent's University Hospital (SVUH) in April 2016. Management of patients admitted urgently to the emergency department or out-patient clinics of St. Vincent's University Hospital during the 3-year period before April 2016 was compared to that of patients admitted in the 3years after April 2016 following introduction of the acute diabetic foot pathway. Demographic data hospital length of stay, need for re-admission, major and minor amputations performed and cost of hospital stay were compared before and after introduction of the pathway. There were 931 admissions with acute diabetic foot ulceration or infection between January 2012 and December 2019; 419 were admitted between January 2012 and March 2016 and 512 between April 2016 and December 2019. There was no difference in demographic data between the two time periods. Length of stay decreased from 13 +/- 4.24 to 3 +/- 1.41days between the two time periods (p < 0.001). Re-admission rates within 30days decreased from 21.7 to 10.1% (p < 0.05). The number of major lower limb amputations decreased over the two time periods from 8.8 to 7.2% with a concomitant increase in minor amputations from 16.7 to 25.3%. Risk of major lower limb amputation was significantly higher in those patients living more than 20km from the hospital. Costs associated with in-patient stay for management of DFU decreased from €9,247,700 to €8,988,100 despite an 18% increase in the number of patients treated and a 9.9% increase in hospital admissions. Introduction of a dedicated, streamlined pathway involving multi-disciplinary input resulted in a significant improvement in patient management as assessed by length of hospital stay and need for re-admission. While the number of major lower limb amputations has decreased there has been a significant increase in the number of minor amputations.

1080 An Audit on Compliance with Recommended Duration of Surgical Antimicrobial Prophylaxis in St. Vincent’s University Hospital, Dublin, Ireland

Abstract Aim Surgical site infection (SSI) is a common healthcare-associated infection, and a frequent cause of post-operative morbidity. SSI comprises any infection of the operative incision, cavity or involved organ, that occurs within the 30-day post-operative period. Antimicrobial prophylaxis is critical in reducing SSIs. Our aim was to assess adherence to the recommended surgical antimicrobial prophylaxis guidelines in St. Vincent’s University Hospital (SVUH), as part of the hospital antimicrobial stewardship programme. Compliance of surgical services was measured against the recommended regimens described in the SVUH Antimicrobial Guidelines. Method Data on duration and choice of prophylaxis were prospectively gathered on inpatients undergoing elective surgery during a three-week period between August-September 2020. Patients undergoing transplant procedures, inpatients in the intensive care unit, and patients who moved off-site postoperatively were excluded. Results Eighty-one patients were included. Sixty-four (79%) were compliant with prophylaxis duration, while seventeen (21%) were not. Reasons for extended prophylaxis included three (18%) cases where there were intra-operative complications and five (29%) cases of routine prescribing of an additional 24-hour coverage. Nine (53%) did not document the reason for extended cover. Conclusions Compliance with recommended duration of prophylaxis improved in comparison to prior audits. Among patients receiving extended prophylaxis, documentation of the indication was poor. Patients with evidence of post-operative infection may be better served with targeted antimicrobial therapy rather than extended prophylaxis. One reason for extended prophylaxis may be due to difficulty accessing guidelines on recommended prophylaxis duration, hence a targeted smartphone application was introduced to improve accessibility.

Prevalence and Impact of Atrial Fibrillation in a Cohort of Patients with Hypertrophic Cardiomyopathy in Ireland.

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), and is associated with deterioration in clinical status and outcome. To date, no data have been published pertaining to AF in an Irish HCM population. 159 patients with HCM attending St Vincent's University Hospital and Blackrock Clinic, Dublin, were identified. Detailed review of medical notes, Holter monitor, echocardiogram, cardiac MRI (CMR) and implantable cardioverter-defibrillator (ICD) records was performed.Prevalence of AF was 38.4%. HCM patients with AF (HCM-AF) were older (60.6±14.8 v 54.9±17.3 years, P=0.016) and more symptomatic (NYHA II: 29.7% v 16.9%, NYHA III: 4.3% v 1.2%) than HCM patients without AF. History of stroke was recorded in 16.4% of HCM-AF patients, compared with 1% in those without AF.HCM-AF patients had lower left ventricular ejection fraction (echo: 59.5±11.8v68±8, P<0.001; CMR: 62.3%v70.5%, P<0.01) and higher left atrial diameter (echo: 49.8±9.5v40.9±7.4, p<0.001; CMR 62.3±11.3v70.4±9, p<0.001), compared with those without AF. Myocardial fibrosis was detected on CMR in 74% of HCM-AF patients and 62% of those without AF.34% of patients had an ICD in situ, of whom 61% had AF. 24% of these HCM-AF patients received inappropriate shocks, all triggered by AF. AF is common in the Irish HCM population. It is associated with increased risk of stroke, deterioration in symptom status and is a common trigger for inappropriate ICD discharge. We have shown, in-keeping with previous studies, that AF is associated with reduced EF, increased LA diameter and mitral regurgitation in this HCM population.

Lockdown logistics in consultation-liaison psychiatry.

We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation-Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent's University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.

Abstract 1678: Establishment and characterization by expression microarrays of a patient-derived xenograft biobank for human pancreatic adenocarcinoma

Abstract Pancreatic cancer survival rate is poor, with a 5-year survival rate of 7% in the Republic of Ireland. Over the last 40 years, pancreatic cancer is one of the only solid tumor types to have minimal improvement in patient outcome. In Ireland, pancreatic cancer surgical resection is limited to two hospitals: Cork University Hospital and St Vincent's University Hospital (SVUH) in Dublin. In collaboration with SVUH, we have established Ireland's only pancreatic cancer patient-derived xenograft (PDX) biobank program. Tumor material from candidate patients following surgical resection was cold transferred and implanted subcutaneously into CB17/Icr-Prkdcscid mice. At time of implant and continuation of generations, snap frozen material was collected. Using miRNA and mRNA microarray technology, matched adjacent normal tissue, original tumor material and first generation (F1) PDX tumor material was interrogated. Differential expression analysis was carried out on all samples with comparisons of normal, tumor and F1 generation. Across all comparisons there were approximately 4000 genes and miRNAs found to be differential expressed. In focusing on genes that were upregulated in tumor samples compared to normal and further upregulated in the PDX F1 samples compared to the tumor samples, we identified 88 genes of interest. Biological processes such as cell division, mitotic cell cycle processes and cell cycle processes characterized a significant number of these genes. Two of the key genes of interest in this analysis were TSPAN1 and TPX2. TSPAN1 was upregulated 9.5-fold in tumor-normal comparison and upregulated a further 2.3-fold in the PDX F1 compared to the patient tumor. TPX2 was upregulated 4.4-fold in the tumor-normal comparison and a further 3.9-fold increase in the PDX tumor compared to patient tumor. TSPAN1 has previously been shown to increase the metastatic and invasive potential of pancreatic ductal adenocarcinoma cell lines. TPX2, a microtubule-associated protein, has been shown to reduce tumor growth in vivo when silenced. The pancreatic PDX biobank represents a versatile, expandable patient cohort for preclinical investigation. Analysis of gene expression profiles of normal vs tumor and tumor Vs PDX showed genes with associated tumor proliferation and aggressiveness. Citation Format: Sandra Roche, Fiona O'Neill, Niall Swan, Ninfa L. Straubinger, Neil T. Conlon, Jean Murphy, Kevin Conlon, Ray McDermott, Justine Meiller, Justin Geoghegan, Michael Moriarty, Robert M. Straubinger, Martin Clynes. Establishment and characterization by expression microarrays of a patient-derived xenograft biobank for human pancreatic adenocarcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1678.

Editorial introductions

Editorial introductions

Physiotherapist-Led Triage at a Rheumatology-Based Musculoskeletal Assessment Clinic: an 18-Month Service Evaluation of Activity and Outcomes.

ObjectivePhysiotherapist‐led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist‐led triage in hospital‐based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist‐led rheumatology‐based Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).MethodsA retrospective service evaluation was undertaken of all patients who attended the Rheumatology MAC at St Vincent's University Hospital, Dublin (SVUH) between August 2012 and February 2014. The Clinical Audit Department of SVUH approved the study. Data were analyzed using descriptive statistics.ResultsFive hundred and eight patients attended the MAC: 76% were female and the mean age was 55 years and ranged between 18‐91. Seventy‐five percent of patients were independently managed by the CSP without needing to see a consultant rheumatologist, whereas 17% were referred to the rheumatology team. Eighty‐seven percent of patients referred to the rheumatology team had rheumatological intervention (eg, injection, medical management, or multidisciplinary rehabilitation). A substantially higher proportion of patients with regional musculoskeletal pain and degenerative conditions were independently managed by the CSP compared with those who had rheumatological/inflammatory conditions.ConclusionThe majority of patients who attended the MAC were independently managed by the physiotherapists, suggesting that physiotherapist‐led triage may be a useful and efficient means of managing a proportion of patients referred for a specialist rheumatological consultation.

Neoadjuvant Therapy for Borderline Resectable Pancreatic Ductal Adenocarcinoma (PDA) Involving a High Volume Pancreatic Centre in Ireland

Background: Neoadjuvant (NA) therapy for borderline resectable PDA patients (pts) appear to improve outcome.[1,2] There is limited data with the use of FOLFIRINOX (FX) and Gemcitabine/nab-paclitaxel (GP). Methods: St. Vincent’s University Hospital (SVUH) is a national referral centre for PDA in Ireland. Pts were identified from the pancreatic MDT discussions. Borderline resectability as defined by the NCCN criteria. Primary endpoints were resection rate and median survival (mOS). Results: 93 pts were identified between 1 Jan 2012 and 31 Dec 2015 with median follow-up of 11.40 mos (95% CI 11.51 – 15.10). 50 (53%) were female with a median age of 67 years (range: 43 -78). NA chemotherapy was administered in 76 pts. Majority were treated with FX (24, 32%) and GP (20, 26%). 53/76, 82% pts had sequential radiation; 58% were treated with long course- and 42% with short course-radiation. 34/53, 64% were planned for surgery. Resection rate was 40% (21/53); 53% (16/30) with FX/GP v 22% (5/23) with other regimens, p=0.02. R0 resection rate was 76% (16/21); 88% with FX/GP v 40% other reg, p=0.03. mOS improved with FX/GP 19.87 mos v other reg 13.36 mos, p<0.005; including in those who were resected, 40.86 mos with FX/GP v 22.31 mos with other reg, p=0.02. There is a trend in improved resection rate between those treated with NA FX/GP in SVUH v other centres; 50% v 23% respectively, p=0.06. Conclusion: NA FFX/GNP improve resection, R0 resection and mOS. Treatment in high-volume specialist centre may improve resection outcome.

Neoadjuvant therapy for borderline resectable pancreatic ductal adenocarcinoma (PDA) involving a high volume pancreatic centre in Ireland

Background: Neoadjuvant (NA) therapy for borderline resectable PDA patients (pts) appear to improve outcome [1, 2]. There is limited data with the use of FOLFIRINOX (FX) and Gemcitabine/nab-paclitaxel (GP). Methods: St. Vincent’s University Hospital (SVUH) is a national referral centre for PDA in Ireland. Pts were identified from the pancreatic MDT discussions. Borderline resectability as defined by the NCCN criteria. Primary endpoints were resection rate and median survival (mOS). Results: 93 pts were identified between 1 Jan 2012 and 31 Dec 2015 with median follow-up of 11.40 mos (95% CI 11.51 – 15.10). 50 (53%) were female with a median age of 67 years (range: 43 -78). NA chemotherapy was administered in 76 pts. Majority were treated with FX (24, 32%) and GP (20, 26%). 53/76, 82% pts had sequential radiation; 58% were treated with long course- and 42% with short course-radiation. 34/53, 64% were planned for surgery. Resection rate was 40% (21/53); 53% (16/30) with FX/GP v 22% (5/23) with other regimens, p=0.02. R0 resection rate was 76% (16/21); 88% with FX/GP v 40% other reg, p=0.03. mOS improved with FX/GP 19.87 mos v other reg 13.36 mos, p<0.005; including in those who were resected, 40.86 mos with FX/GP v 22.31 mos with other reg, p=0.02. There is a trend in improved resection rate between those treated with NA FX/GP in SVUH v other centres; 50% v 23% respectively, p=0.06. Conclusion: NA FFX/GNP improve resection, R0 resection and mOS. Treatment in high-volume specialist centre may improve resection outcome.

Apnea Recognition with Wavelet Neural Networks

Apnea is a Sleep Disorder Syndrome characterized by an interruption or reduction of air flow for at least 10 seconds. Polysomnography is a test used to apnea diagnosis. Several signals, including Electrocardiogram (ECG), Electroencephalogram (EEG) and Oxygen Saturation (SpO_2) are obtained in this diagnostic test. Since most tests for apnea are uncomfortable, there is an increase search for alternative methods to reduce cost and improve patient well-being.In this work, we use only SpO_2 data from 25 patients of the St Vincent's University Hospital, Dublin, to extract parameters connected to a Neural Network attempting to classify patients with apnea or non-apnea. Results confirm that our alternative method can be used as an auxiliary tool for diagnosis by using exclusively SpO_2 signal.

ERJ September Podcast: Challenges and perspectives in obstructive sleep apnoea.

As part of the September issue, the European Respiratory Journal presents the latest in its series of podcasts. Section Editor David Gozal interviews Walter McNicholas (St Vincent's University Hospital and University College Dublin, Ireland) about a report by an ad hoc working group of the Sleep Disordered Breathing Group of the European Respiratory Society and the European Sleep Research Society.