Anthony James P Clover

• B MedSci BM BS MD FRCS(Plast)
• Consultant at University College Cork

Simple Summary Electrochemotherapy has proven to be an efficient treatment for cutaneous metastases of various cancers including breast cancer (BC). The large number of patients collected within the INSPECT database provides the possibility of a differentiated analysis on BC with different receptor statuses (estrogen receptor and HER2 receptor). Pa...

Background: Skin metastases are an important co-morbidity in melanoma. Despite broad adoption, electrochemotherapy implementation is hindered by a lack of treatment indications, uncertainty regarding procedural aspects, and the absence of quality indicators. An expert consensus may harmonize the approach among centres and facilitate comparison wit...

This prospective registry-based study aims to describe electrochemotherapy (ECT) modalities in basal cell carcinoma (BCC) patients and evaluate its efficacy, safety, and predictive factors. The International Network for Sharing Practices of Electrochemotherapy (InspECT) multicentre database was queried for BCC cases treated with bleomycin-ECT betwe...

Electrochemotherapy (ECT) is an effective locoregional therapy for cutaneous melanoma metastases and has been safely combined with immune checkpoint inhibitors in preliminary experiences. Since ECT is known to induce immunogenic cell death, its combination with immune checkpoint inhibitors might be beneficial. In this study, we aimed to investigate...

Background: Pruritus assessment is difficult due to the varying subjective nature of the experience. There have been several validated tools described to quantify the severity of itch, however these tools fail to provide a comprehensive assessment or are too cumbersome and therefore lack usability. Our novel burn assessment tool, "The Pruritus Sev...

Aim Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns, and decrease the need for surgical intervention. Several studies outside of Ireland demonstrate inadequate parental knowledge of bu...

Background With extending life expectancy, more people are diagnosed with cutaneous malignancies at advanced ages and are offered nonsurgical treatment. We assessed outcomes of the oldest-old adults after electrochemotherapy (ECT). Methods The International Network for Sharing Practices of ECT (InspECT) registry was queried for adults aged ≥90 yea...

Background Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. Methods Twenty-eight centres across Europe prospectively uploaded data over an 11-year period....

Introduction: Mucosal melanoma (MM) is a rare condition with a poor prognosis. Surgery is the corner stone of treatment, however, radiotherapy has been commonly employed as a treatment strategy and recent studies suggesting that survival outcomes may be improving are emerging. Methods: A systematic review and meta-analysis comparing risk ratios of...

The density and phenotype of tumour-associated macrophages have been linked with prognosis in a range of solid tumours. While there is strong preclinical evidence that tumour-associated macrophages promote aspects of tumour progression, it can be challenging to infer clinical activity from surface markers and ex vivo behaviour. We investigated the...

Purpose: Head and neck injuries are common in major trauma patients, but the prevalence is poorly documented in the literature. This study aims to investigate this further, particularly in the context of increasing development of Irish and European trauma systems. Aims: To determine the prevalence of, and patterns behind head and neck injury in...

Mesenchymal stromal cells (MSC) have immunomodulatory effects impacting macrophages, promoting polarisation towards a reparative phenotype. CCL2 is a potent cytokine involved in the recruitment of macrophages. We hypothesised that MSC derived CCL2 may be involved in the MSC therapeutic effect by facilitating macrophage repolarisation. To further de...

Background and study aims Electrochemotherapy is an anticancer treatment that uses electric pulses to facilitate uptake of chemotherapeutic drugs in tumor cells and has proven to have a high local cytotoxic effect with minimal adverse events. Electrochemotherapy has mostly been used in treatment of cutaneous metastases but development of a new endo...

Basal cell carcinoma (BCC) are the commonest cutaneous malignancy and incidence continues to increase. There is a need to expand the therapeutic toolbox to increase options for patients that are unsuitable for or unwilling to undergo the current therapies. Electrochemotherapy (ECT) is a technique where cells are temporarily permeabilized after expo...

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Coated microneedles have significant potential for use in transdermal delivery applications. In this paper, we describe the fabrication of microneedle master templates using microstereolithography techniques and subsequently use a commercial injection moulding process to replicate these microneedles in biocompatible cyclic olefin polymer (COP) mate...

Introduction: Stem cell therapy application is at the vanguard of regenerative medicine across all medical disciplines. Stem cells are of special interest in burn wounds, as they have multiple potential indications for application; including - accelerating wound healing, improving skin regeneration to incorporate skin appendages, reducing fibrosis...

Background: Electrochemotherapy (ECT) has evolved considerably over the past decade, but its application is yet to be standardized. In fact, a lack of agreement exists on eligible patients, timing of treatment, combination strategies and outcomes. Therefore, our aim was to establish a consensus on treatment indications (TI), procedural modalities (...

Basal Cell Carcinoma and Electrochemotherapy: the InspECT experience Giulia Bertino1,, Silvia Di Felice1, Francesca de Terlizzi2, Tobian Muir3, Pietro Curatolo4, Ales Groselj5, Erika Kis6, Julie Gehl7,8,9, A. James P. Clover10.11, Luca G. Campana12,13, Graeme Moir14, Joy Odili15, See Hwang Liew16, Pietro Quaglino17, Christian Kunte18,19, Antonio Or...

There have been truly incredible strides in the standard of burn care. The mortality from burn injuries has more than halved since the 1950s, making it hugely unique among major diseases of the developed world. There can be no doubt technology and technological advances have driven this process, dramatically improved every aspect of burn care, from...

Electrochemotherapy is now in routine clinical use to treat cutaneous metastases of any histology, and is listed in national and international guidelines for cutaneous metastases and primary skin cancer. Electrochemotherapy is used by dermatologists, surgeons, and oncologists, and for different degrees and manifestations of metastases to skin and p...

Background Cutaneous recurrence from breast cancer can pose a clinical challenge. It might be the only disease site, or could be part of disseminated disease, and often profoundly impacts quality of life. Electrochemotherapy is a palliative treatment using electric pulses to locally permeabilise tumour cells and thereby increase bleomycin cytotoxic...

Context Delivery of slow-release local anesthesia has considerable potential for postoperative analgesia. Fibrin gel has shown huge potential for drug delivery, but has not been fully investigated for the delivery of local anesthetics nor has whether incorporation of anesthetic drugs into fibrin alters its mechanical properties. Aims This study ai...

In this chapter we will present the International Network for Sharing Practices on Electrochemotherapy group, founded to answer the need of discussing issues and share experience on the use of the procedure, its history, and the objective for what it was established. Furthermore, on 2008 the online InspECT database was created as a tool for the Net...

Basal Cell Carcinoma (BCC) represents an evolving clinical challenge. It is the most common form of skin cancer and is increasing in prevalence due to aging populations and greater recreational sun exposure. As a result, it is responsible for a growing burden on healthcare services and requires a range of treatment options. The current gold standar...

There is an identified need within the field of pain management to optimise the delivery of local anaesthetic agents as slow release formulations. Fibrin gel has shown huge potential for the local delivery of drugs including antibiotics, vasodilators, and chemotherapeutic agents however its potential for the delivery of local anaesthetic drugs has...

Burns are devastating to the individual and society, representing a huge biomedical burden. Improved education in burns has however ignited a revolution in high-income countries—burn mortality is reducing. Education in burns is far-reaching. For the purpose of this concise review, we focus on four categories: education of both (1) emergency and (2)...

Coated microneedles have shown immense promise for use in transdermal delivery and diagnostics, due to their ability to painlessly breach the skin's outermost stratum corneum layer and interact with the epidermal layers immediately beneath. In this work, we use an off-the-shelf piezoelectric dispensing system to demonstrate the feasibility of depos...

Aesthetic plastic surgery is a consumer-driven industry, subject to influence by financial forces. A changing economic environment may thus impact on the demand for surgery. The aim of this study was to explore trends in demand for bilateral breast augmentation (BBA) in consecutively presenting patients over an 11-year period and to examine if a co...

Background: A prolonged inflammatory phase is seen in aberrant wound healing and in chronic wounds. Macrophages are central to wound healing. Distinct macrophage subtypes have differing roles both in initial inflammation and in later tissue repair. Broadly, these cells can be divided into M1 and M2 macrophages. M2 macrophage proliferation and diff...

Purpose: Electrochemotherapy (ECT) is the application of electric pulses to tumour tissue to render the cell membranes permeable to usually impermeant hydrophilic anti-cancer drugs, thereby enhancing cytotoxic effects. We sought to ascertain whether ECT can be an effective palliative treatment for cutaneous metastases of breast cancer. Methods:...

The benefits of high-quality postoperative analgesia are well documented and include earlier mobilization, fewer respiratory and cardiovascular complications, and shorter hospital stay. Local anesthesia–based acute pain regimens are at worst equal to and at best superior to opiate-based regimens from the perspective of analgesia. A multimodal appro...

Patients recovering from hand surgery frequently ask when it is safe to drive and it is unclear where the responsibility lies; the surgeon, the patient or the insurance company. An eight-question survey looking at various aspects of clinical practice was circulated to consultant and trainee plastic and orthopaedic surgeons in Ireland and the UK. Of...

Basal Cell Carcinoma (BCC) represents an evolving clinical challenge. It is the most common form of skin cancer and is increasing in prevalence due to aging populations and greater recreational sun exposure. As a result, it is responsible for a growing burden on healthcare services and requires a range of treatment options. The current gold standar...

Wearable ‘smart patches’ of the future will incorporate microneedle technologies that painlessly interact with the body, using closed-loop theranostic systems to continuously monitor the physiological status of the body and deliver appropriate therapeutic agents when needed. Among other components, these Micro Transdermal Interface Platforms (Micro...

Background and study aims: Targeted delivery of specific chemotherapeutic drugs into tumors can be achieved by delivering electrical pulses directly to the tumor tissue. This causes a transient formation of pores in the cell membrane that enables passive diffusion of normally impermeant drugs. A novel device has been developed to enable the endosc...

Background Electrochemotherapy is becoming a well-established treatment for malignancies of skin and non-skin origin and its use is widening across Europe. The technique was developed and optimized from solid experimental and clinical evidence. A consensus document is now warranted to formalize reporting results, which should strengthen evidence-ba...

Disorders affecting smooth muscle structure/function may require technologies that can generate large scale, differentiated and contractile smooth muscle cells (SMC) suitable for cell therapy. To date no clonal precursor population that provides large numbers of differentiated SMC in culture has been identified in a rodent. Identification of such c...

In this chapter we will present the International Network for Sharing Practices on Electrochemotherapy group, founded to answer the need of discussing issues and share experience on the use of the procedure, its history, and the objective for what it was established. Furthermore, on 2008 the online InspECT database was created as a tool for the Net...

Procedures involving complex surgical techniques in rats, such as placement of abdominal aortic graft require extended duration of surgical anesthesia, which often can be achieved by repeated administrations of xylazine-ketamine combination. However such repeated anesthetic administration, in addition to being technically challenging, may be associ...

Human skin is a remarkable organ that sustains insult and injury throughout life. The ability of skin to expeditiously repair wounds is paramount to survival. With an aging global population, coupled with a rise in the prevalence of conditions such as diabetes, chronic wounds represent a significant biomedical burden. Mesenchymal stem cells (MSC),...

Aesthetic surgery is a rapidly expanding industry and patient safety is a fundamental issue. The need for regulation has been outlined by the Professional Standards for Cosmetic Practice Report, published by the Royal College of Surgeons in January 2013 which highlighted standards of patient care. The aim of this study was to review institutional c...

Fibrin is formed in the body upon initiation of the clotting cascade and is produced commercially for use as a tissue sealant and hemostasis device during surgical procedures. Experimentally fibrin is being increasingly used as a vector to deliver growth factors, cells, drugs and genes in tissue engineering applications mimicking aspects of the ext...

The relationship between cancer and the immune system is a complex one. The immune system can prevent tumour growth by eliminating cancer cells but this editing process ultimately results in poorly immunogenic cells remaining allowing for unchallenged tumour growth. In light of this, the focus of cancer treatment should be to maximise cancer elimin...

The use of cell therapy to improve burn wound healing is limited as a validated cell source is not rapidly available after injury. Progenitor cells have shown potential to drive the intrinsic wound regeneration. Two sources of cells, allogeneic mesenchymal stem cells (MSC) and autologous culture modified monocytes (CMM), were assessed for their abi...

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. To suggest a topic for this series, please email us at [email protected] /* */

Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is importa...

The aim of this study was to characterise a recently identified adult smooth muscle stem-like/progenitor cell (SMSPC) and exploit the ability to differentiate contractile smooth muscle cells (SMC) from SMSPCs facilitating tissue engineering of small to medium arteries, an approach which is hampered by inadequate sources of, and scale up methodologi...

Basal Cell Carcinoma (BCC) affecting the ocular region is potentially problematic due to its ability to infiltrate aesthetic and functional structures. Due to the paucity of local tissue, resection frequently requires reconstruction with skin grafts or local flaps. Surgical treatment may not be suitable for patients with multiple co-morbidities. El...

A 63 year old woman sustained an extravasation of vasopressor during a successful in hospital cardiopulmonary resuscitation resulting in an acutely ischaemic hand. This was treated with multiple washouts of the hand due to incipient recurrence of the ischaemia. Extravasation of vasopressor is exceedingly rare and potentially devastating. This case...

Porous scaffolds are limited in volume due to diffusion constraint and delay of vascular network formation. Channels have the potential to speed up cellular penetration. Their effectiveness in improving angiogenic cell penetration was assessed in vitro and in vivo in 3-D collagen scaffolds. In vitro, channelled and non-channelled scaffolds were see...

Background: Conventional collar incision closure in thyroid and parathyroid surgery involves the insertion of an epidermal layer of subcutaneous absorbable sutures that are reinforced by a deep layer of sutures. Adhesive strips offer an alternative method to close the epidermal layer. The aim of this study was to compare adhesive strip closure wit...

Hurling is an Irish national game of stick and ball known for its ferocity, played by 190 000 players. Facial injuries were common but have been significantly reduced by legislation enforcing compulsory helmet wearing. Current standard helmets worn by hurlers do not offer protection to the external ear. Here we describe an emerging pattern of ear i...

The first trials using progenitor cells to improve burn wound healing are beginning. However, there remains a paucity of data on patients' opinions of the source of stem cells. In this study, 279 patients attending plastic surgery/burns outpatient and medical outpatient clinics were questioned to assess willingness to accept a tissue-engineered ski...

The development of a good blood supply is a key step in burn wound healing and appears to be regulated in part by myeloid cells. CX3CR1 positive cells have recently been identified as myeloid cells with a potential role in angiogenesis. The role of functional CX3CR1 system in burn wound healing is not previously investigated. A 2% contact burn was...

Trauma is a significant part of the workload in plastic surgery. There are currently wide variations in the available resource for dealing with these patients. Delays to treatment currently exist and may result in poorer clinical outcomes. Data was collected prospectively in 4 centres (Cork University Hospital, John Radcliffe Hospital, Stoke Mandev...

After the devastating earthquake in Haiti on January 12, 2010, a British orthoplastic limb salvage team was mobilized. The team operated in a suburb of Port-au-Prince from January 20, 2010. This analysis gives an overview of the caseload and early outcomes. A retrospective analysis of operative data from the log book was performed from the opening...

Despite advances in burn care some injuries remain non survivable. Good end of life care for these patients is arguably as important as life prolonging care. The Liverpool Care Pathway is a useful tool for providing good quality end of life care. It has previously been modified for the acute setting. We modified it further specifically for use in b...

Biological scaffolds used in tissue engineering are incorporated in vivo by a process of cellular in-growth, followed by host-mediated degradation and replacement of these scaffolds, in which phagocytic cells from the monocyte/macrophage cell lineage play a key role. The chemical degradation of scaffolds with collagenases is well established, but t...

Clinical images are invaluable in medical teaching and research publications. In the past efforts to conceal patient identity, if any, were limited to a black bar concealing the eyes. However, there is no consensus on this among major journals and publishing houses. This research analyses the effectiveness of blacking out the eyes in facial photogr...

Atypical fibroxanthoma (AFX) is a cutaneous neoplasm of mesenchymal origin. The mainstay of treatment is complete surgical excision. Recurrence is estimated at between 2 and 20% and metastasis has previously been reported. This series presents a retrospective audit over 10years, identifying 39 lesions in 28 patients. Complete excision was achieved...

We report a rare case of rectal cancer presenting with necrotising fasciitis of the posterior thigh. Perforation of a rectal cancer adjacent to the piriformis muscle provided a route for bowel contents to travel into, and contaminate, the posterior compartment of the thigh. This case highlights the need for prompt diagnosis, urgent aggressive surgi...

Pyogenic granuloma is a common, acquired, benign vascular lesion of skin and mucous membranes which may occasionally present intravascularly or subcutaneously. Pyogenic granuloma occur in all age groups and although they may eventually regress, removal of unsightly, bleeding or uncomfortably positioned lesions is usually sought before this takes pl...

A 41-year-old man presented with an occult median nerve injury. This report highlights the importance of adequate wound exploration and reinforces the significance of adequate history and examination in patients with signs of nerve injury.

A 4 1-year-old man presented with an occult median nerve injury. This report highlights the importance of adequate wound exploration and reinforces the significance of adequate history and examination in patients with signs of nerve injury.

Therapeutic angiogenesis has great potential for the treatment of ischemic diseases. One possible route for noninvasive induction of microvessels has recently been suggested by the finding that subcontractile electrical stimulation induces increased vascularization in animals. The present study tests the ability of such stimulation to augment micro...

Introduction: The provision of a blood supply is essential in producing large volume tissue engineering. In reconstructive surgery, there is a need to develop scaffolds that are rapidly incorporated in vivo allowing for restoration of the integrity of the skin. Hence, there is a strong need for promoting rapid angiogenesis in 3D collagen scaffolds...