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Introduction
Current institution
Publications
Publications (90)
Abdominal aortic aneurysm (AAA) is an inflammatory vascular disease with high mortality and limited treatment options. How blood lipids regulate AAA development is unknown. Here lipidomics and genetic models demonstrate a central role for procoagulant enzymatically oxidized phospholipids (eoxPL) in regulating AAA. Specifically, through activating c...
Introduction:
Excimer laser coronary atherectomy (ELCA) is a recognized adjunctive therapy utilized in the percutaneous management of complex coronary lesions. Studies examining its safety and utility have been limited by small sample sizes. Our study examines the determinants and outcomes of ELCA.
Methods:
Using the British Cardiac Intervention...
Objectives
The authors used the BCIS (British Cardiovascular Intervention Society) database to define the factors associated with percutaneous coronary intervention (PCI) procedural complexity.
Background
Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly defined.
Methods
The BCIS (Brit...
Phospholipids (PLs) are found in all cell types and are required for structural support and cell activation signalling pathways. In resting cells, PLs are asymmetrically distributed throughout the plasma membrane with native procoagulant aminophospholipids (aPLs) being actively maintained in the inner leaflet of the membrane. Upon platelet activati...
Aminophospholipids (aPL) such as phosphatidylserine are essential for supporting the activity of coagulation factors, circulating platelets, and blood cells. Phosphatidylthreonine (PT) is an aminophospholipid previously reported in eukaryotic parasites and animal cell cultures, but not yet in human tissues. Here, we evaluated whether PT is present...
12/15-lipoxygenase (12/15-LOX, Alox15) generates bioactive oxygenated lipids during inflammation, however its homeostatic role(s) in normal healing are unclear. Here, the role of 12/15-LOX in resolving skin wounds was elucidated, focusing on how its lipids act together in physiologically relevant amounts. In mice, wounding caused acute appearance o...
Background:
Rheumatoid arthritis (RA) is associated with significantly higher thrombotic risk, which is not yet mechanistically understood. Here, the role of pro-coagulant membranes of platelets and blood cells in driving thrombosis, and their regulation by inflammation was determined using human cohorts and genetically-modified mice.
Methods:
Anti...
Background
Training in complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) has frequently been reserved for established operators (consultants/attending) with trainees (fellows-in-training or FIT) being often discouraged from carrying out such procedures as a primary operator due to their high-risk nature. Whether the outcomes...
Background
Transcatheter aortic valve implantation (TAVI) procedures to treat severe aortic stenosis are rising, in line with aging populations and advancements in healthcare access. Economic development correlates with AS mortality rates. Socio-economic status (SES), defined by social and economic factors such as median household income, significa...
There are four basic ethical principles in clinical practice: non-maleficence; beneficence; autonomy and justice. Evidence upon which each of these is judged comes from appropriate research, but there are also personal opinions and claims-many of which are supported by little, if any, research evidence. The evaluation of evidence is likely to be as...
Enzymatically oxygenated phospholipids (eoxPL) from lipoxygenases (LOX) or cyclooxygenase (COX) are prothrombotic. Their generation in arterial disease, and their modulation by cardiovascular therapies is unknown. Furthermore, the Lands cycle acyl-transferases that catalyze their formation are unidentified. eoxPL were measured in platelets and leuk...
Oxidized phospholipids (oxPLs) are generated during innate immunity and inflammation, where they play a variety of biological roles, including regulation of autoimmunity and coagulation. Some are generated by enzymatic reactions, leading to stereo- and regiospecificity, while many others can be formed through nonenzymatic oxidation and truncation a...
Background
Although data suggests ad hoc percutaneous coronary intervention (PCI) results in similar patient outcomes compared to planned PCI in nonselected patients, data for ad hoc unprotected left main stem PCI (uLMS‐PCI) are lacking.
Aim
To determine if in‐hospital outcomes of uLMS‐PCI vary by ad hoc versus planned basis.
Methods
Data were an...
BACKGROUND
Clotting, leading to thrombosis, requires interactions of coagulation factors with the membrane aminophospholipids (aPLs) phosphatidylserine and phosphatidylethanolamine. Atherosclerotic cardiovascular disease (ASCVD) is associated with elevated thrombotic risk, which is not fully preventable using current therapies. Currently, the contr...
Aspirin as a possible treatment of cancer has been of increasing interest for over 50 years, but the balance of the risks and benefits remains a point of contention. We summarise the valid published evidence ‘for’ and ‘against’ the use of aspirin as a cancer treatment and we present what we believe are relevant ethical implications. Reasons for asp...
Aim: Bifurcation-PCI is performed frequently, although without extensive evidence to back up a definitive solution for its complexity. We set out to identify factors associated with 1- and 12-month mortality after bifurcation-PCI between 2017 and 2021 in our tertiary centre in Wales, UK. Results: Of 732 bifurcation PCI cases (mean age 69; 25% femal...
Introduction:
Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifesting as intracoronary stent restenosis (ISR). Even with advances of stent technology and medical therapy this complication is reported to affect around 10%...
Introduction
Bifurcation percutaneous coronary intervention (PCI) is a complex procedure that is performed in the presence of coronary disease in a significant side branch of the stented main vessel. Despite the description of a number of bifurcation techniques and ongoing trials to test their performance, there is limited ‘real world’ data on hard...
Background: Acute coronary syndrome (ACS) is caused by arterial thrombosis and is associated with sustained activation of coagulation. Clotting requires interactions of coagulation factors with aminophospholipids (aPL): phosphatidylserine (PS) and phosphatidylethanolamine (PE) on membrane surfaces. The aPL composition of circulating membranes in co...
Background
Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain.
Methods
Using the United Kingdom national PCI database, we studied all patients...
Enzymatically oxygenated phospholipids (eoxPL) formed by lipoxygenases (LOX) and cyclooxygenase (COX) in platelets and leukocytes are pro-coagulant in multiple model systems. However, their generation in arterial thrombotic disease, and how their levels are modulated by common therapies is unknown. Here, eoxPL were first characterized in isolated p...
Evidence on aspirin and cancer comes from two main sources: (1) the effect of aspirin upon biological mechanisms in cancer, and (2) clinical studies of patients with cancer, some of whom take aspirin. A series of systematic literature searches identified published reports relevant to these two sources. The effects of aspirin upon biological mechani...
Introduction:
Left main stem percutaneous coronary intervention (LMS-PCI) is a complex high-risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn-down patients or where there is equipoise in percutaneous versus surgical strategies. Current guidelines suggest that PCI is an appropr...
The lipid envelope of SARS-CoV-2 is an essential component of the virus; however, its molecular composition is undetermined. Addressing this knowledge gap could support the design of anti-viral agents, as well as further our understanding of viral-host protein interactions, infectivity, pathogenicity, and innate immune system clearance. Using lipid...
Purpose of the study
In 2010, the National Institute for Health and Care Excellence (NICE) recommended the use of anticoagulants rather than aspirin as pharmacological thromboprophylaxis after hip fracture. We examine the impact of implementing this change in guidance on the clinical incidence of deep vein thrombosis (DVT).
Study design
Demographi...
Purpose of the study:
In 2010, the National Institute for Health and Care Excellence (NICE) recommended the use of anticoagulants rather than aspirin as pharmacological thromboprophylaxis after hip fracture. We examine the impact of implementing this change in guidance on the clinical incidence of deep vein thrombosis (DVT).
Study design:
Demogr...
Introduction:
There is increasing evidence supporting the use of intracoronary imaging to optimize the outcomes of percutaneous coronary intervention (PCI). However, there are no studies examining the impact of imaging on PCI outcomes in cases utilising rotational atherectomy (RA-PCI). Our study examines the determinants and outcomes of using intr...
The lipid envelope of SARS-CoV2 is an essential component of the virus, however its molecular composition is unknown. Addressing this knowledge gap could support the design of anti-viral agents, and further understanding of viral interaction with extracellular host proteins, infectivity, pathogenicity, and innate immune system clearance. Lipidomics...
Background:
Despite the accumulation of research papers on aspirin and cancer, there is doubt as to whether or not aspirin is an acceptable and effective adjunct treatment of cancer. The results of several randomised trials are awaited, and these should give clear evidence on three common cancers: colon, breast and prostate. The biological effects...
Objectives
The aims of this study were to use a national percutaneous coronary intervention (PCI) registry to study temporal changes in procedure volumes of PCI using rotational atherectomy (ROTA-PCI), the patient and procedural factors associated with differing quartiles of operator ROTA-PCI volume, and the relationship between operator ROTA-PCI v...
Background:
The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS popula...
Background
Coronary stent avulsion is a rare, infrequently reported complication of percutaneous coronary intervention (PCI) with no consensus on management options.
Case summary
This case series presents three descriptions of iatrogenic coronary stent avulsions, and three different bailout management strategies. All patients presented with acute...
Purpose of study
This study examines the associations between dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) and gastrointestinal bleeding (GIB), to explore possible predictors of outcomes.
Study design
Retrospective analysis of 3342 patients who underwent PCI between 1 August 2011 and 31 December 2018 in a single...
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review,...
Introduction
To compare the impact of an e-learning package with theoretical teaching on the ability of both graduate and undergraduate medical students to learn the management of supraventricular tachycardia.
Methods
We conducted a randomised, controlled, study at two Welsh medical schools. Participants were graduate-entry and undergraduate medic...
Introduction
Combining rotational (RA) and excimer laser coronary atherectomy (ELCA)—RASER atherectomy—is technique utilized in the percutaneous management of calcific coronary disease. The evidence base examining its safety and utility is sparse and limited to small case‐series. This study examines the patterns and outcomes of RASER atherectomy us...
Behaviors which are associated with the preservation of health include nonsmoking, regular exercise, a low body weight, a healthy diet, and a low alcohol intake. Together, as a healthy lifestyle, these have been shown to be associated with marked protection against a wide range of diseases: diabetes, vascular disease, cancer, and dementia. On the o...
Background
Rotational atherectomy (RA) during PCI is linked to a higher likelihood coronary perforations (CP). However, the evidence base on incidence, predictors and outcomes of this complication in RA-PCI remains limited.
Methods
Using the British Cardiac Intervention Society database, data were analysed on all RA-PCI procedures in UK 2007–2014....
Background
Percutaneous coronary intervention (PCI) is increasingly utilized for treatment of coronary disease involving the unprotected left main stem (ULMS). However, no studies to date have examined the outcomes of such interventions when complicated by coronary perforation (CP).
Methods
Using the British Cardiovascular Intervention society (BC...
WW domain binding protein 1‐like (WBP1L), also known as outcome predictor of acute leukaemia 1 (OPAL1), is a transmembrane adaptor protein, expression of which correlates with ETV6‐RUNX1 (t(12;21)(p13;q22)) translocation and favourable prognosis in childhood leukaemia. It has a broad expression pattern in haematopoietic and in non‐haematopoietic ce...
Objectives
We sought to evaluate whether socioeconomic status influences outcome after first-time transcatheter aortic valve implantation (TAVI).
Method
This is a single-centre study carried out in Swansea, South West Wales, UK between 5 November 2009 and 10 June 2018. Data included age, gender, domiciliary postal code, comorbidities, complication...
Solitary cardiac metastasis remains an uncommon diagnosis. Herein, the authors report describes a rare case of a 53-year-old woman with cardiac metastasis of a peripheral de-differentiated myxofibrosarcoma. This case demonstrates the complexity of pairing multimodality imaging and invasive techniques to achieve tissue characterization and diagnosis...
Background
Phospholipids on the surface of platelets play a key role in supporting coagulation in both health and disease. Alterations to phospholipid composition in platelets can contribute to thrombotic and bleeding disorders. We recently identified pro-coagulant enzymatically oxidized phospholipids (eoxPL) generated by platelets in response to t...
Introduction
To compare the impact of e-learning package and theoretical teaching on the ability of both graduate and undergraduate medical students to learn the management of supraventricular tachycardia (SVT).
Methods
We conducted a randomized controlled blinded study at two medical schools in Wales, UK. Participants included graduate-entry medi...
The prescribing patterns of antiplatelet medicines in primary care in Wales have significantly changed in the last decade. In the 10 years to the end of Q1 2018, the use of aspirin (as measured by the defined daily dose per 1000 prescribing units [DDD per 1000PUs]) has declined in absolute terms by 45% and the use of clopidogrel has more than doubl...
Aim:
Antiplatelets have been used for decades to prevent atherothrombotic disease, but there is limited 'real-life' prescribing data. We hereby report the prescribing patterns for oral antiplatelets in Wales, UK.
Methods/results:
Retrospective analysis of anonymized data in Wales from 2005 to 2016 revealed differences in prescribing patterns of...
Background
Application to cardiology specialty training is competitive with uncertainty among candidates as to what the secret recipe for a successful appointment is. We aimed to investigate objective variables, which were demonstrated by successful appointees to cardiology training schemes in the UK.
Methods
Data from successful cardiology applic...
Introduction
Diabetes mellitus (DM) is a recognised risk factor for the development of non-alcoholic fatty liver disease (NAFLD). Both entities are increasingly recognised to be different manifestations of a wide spectrum of metabolic syndrome phenotypes. Our study aims to determine whether incidental abnormal liver function tests (LFT) precede the...
Background and aim
Cardiovascular disease is the biggest killer in Wales, with non-ST-elevation acute coronary syndrome (NSTEACS) forming the commonest diagnosis. NSTEACS patients are at risk of death, reinfarction and ischaemia, a risk that increases as cardiovascular risk (GRACE) increases. Standard initial medical therapy followed by the conside...
Objectives
Following non-ST-elevation acute coronary syndrome (NSTEACS), patients are treated with medication and considered for invasive therapy and revascularization. Mortality for this whole population is high in the first year with multiple studies suggesting anything from 4% to 10%. However, the risk of death after the first year has a wide di...
BACKGROUND Malignant mixed tumour is an exceedingly rare cutaneous adnexal carcinoma with a propensity for aggressive growth, recurrence and metastasis. More common in men (x2), it can affect all age groups (range 15 months to 50 years. ) Malignant mixed tumour usually presents as a firm, circumscribed, asymmetrical cutaneous or subcutaneous large...
Introduction
Neonatal jaundice is a common condition with 60% of newborns being clinically affected in the first days of life. Severe hyperbilirubinemia makes infants at considerable risk of potentially dangerous bilirubin encephalopathy with subsequent kernicterus.
Aim of study
To evaluate importance of clinical and laboratory factors affecting oc...
Aim:
Statins have a proven role for the secondary prevention of cardiovascular disease. Despite this, typical patient use in real life is variable. Our aim was to investigate the typical clinical use, including adherence, for statins in a sample population in South Wales (UK).
Methods:
We identified 2248 patients admitted to hospitals in South W...
What is known and objective:
Oral anticoagulants (OACs) have been used for decades for the long-term prevention of arterial and venous thromboembolic disease. These include warfarin and the newer direct-acting OACs (DOACs). Data on 'real-life' prescribing patterns for DOACs are limited. In this commentary, we report the prescribing patterns for OA...
Background:
Friday the 13th is described as an "unlucky" day that brings misfortune. There are few studies on the question, and none on its effect in cardiovascular patients. The recently misreported "weekend effect" has led to changes in the junior doctor contract in England, providing greater staffing levels on weekends. Should we make similar p...
Objectives: Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed w...
Objectives Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed wi...
Background Coronary artery disease (CAD) is a major public and economic health problem. Coronary angiography is a gold standard for diagnosing CAD and is indicated in patients with 61–90% pre-test probability of the disease when the diagnosis cannot be made on clinical grounds alone and when revascularisation is being considered. The natural histor...
Severe Symptomatic Aortic Stenosis:
Historical medical treatment vs Transcatheter Aortic Valve Implantation.
A Real World Analysis of Admission profiles, Cost, and Mortality using the Secure Anonymised Information Linkage (SAIL) databank.
Majd B Protty †, Phillip M Freeman †*, Omar Aldalati §, Arron Lacey §, William King *, Richard A Anderson †, Da...
Objectives To determine the association between the side of the hip fracture and the subsequent occurrence of symptomatic lower limb DVT.
Setting Single tertiary trauma centre, Wales.
Participants All 3657 patients presenting with hip fracture between 2007 and 2013 were identified from our unit's National Hip Fracture Database. We excluded 404 pati...
Background. Near-peer teaching is becoming increasingly popular as a learning methodology. We report the development of a novel near-peer biological sciences revision course and its acceptability and impact on student confidence and exam performance. Methods. A cross-sectional analysis of tutee-completed evaluation forms before and after each sessi...
The GMC has emphasized the importance of teaching skills for doctors and recommended that training for these skills is introduced early on in the medical education curriculum. One way to achieve this is in the form of near-peer assisted learning, where junior medical students are taught by senior ones. We here report the development of an extensive...
The risk of increased IOP was significantly raised with higher serum PAI-1, with adjusted odds ratios (95% confidence intervals) for second and third tertiles of 1.31 (0.81-2.12) and 1.81 (1.15-2.83), respectively. Haematocrit, glycosylated haemoglobin (HbA1c), heart rate, and high-density lipoprotein (HDL-C) were the only vascular risk factors pos...
We investigated the cause of mild mucocutaneous bleeding in a 14-year-old male patient (P1). Platelet aggregation and ATP secretion induced by arachidonic acid and the thromboxane A(2) receptor (TxA(2)R) agonist U46619 were reduced in P1 compared with controls, whereas the responses to other platelet agonists were retained. P1 was heterozygous for...
Background
Increasing evidence suggests that individual isoforms of protein kinase C (PKC) play distinct roles in regulating platelet activation.Methodology/Principal FindingsIn this study, we focus on the role of two novel PKC isoforms, PKCδ and PKCε, in both mouse and human platelets. PKCδ is robustly expressed in human platelets and undergoes tr...
Platelets are essential for wound healing and inflammatory processes, but can also play a deleterious role by causing heart attack and stroke. Normal platelet activation is dependent on tetraspanins, a superfamily of glycoproteins that function as 'organisers' of cell membranes by recruiting other receptors and signalling proteins into tetraspanin-...
During thrombopoiesis, maturing megakaryocytes (MKs) migrate within the complex bone marrow stromal microenvironment from the proliferative osteoblastic niche to the capillary-rich vascular niche where proplatelet formation and platelet release occurs. This physiologic process involves proliferation, differentiation, migration, and maturation of MK...
