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London, United Kingdom

St Bartholomew's Hospital, also known simply as Barts and later more formally as The Royal Hospital of St Bartholomew, is a hospital located at Smithfield in London. It is the oldest hospital in Europe, having been founded in 1123, thus being the oldest in the United Kingdom still occupying its original site Wikipedia.

Kokka F.,St. Bartholomews Hospital
Cochrane database of systematic reviews (Online) | Year: 2010

Endometrial cancer is a cancer of the lining of the womb and worldwide is the seventh most common cancer in women. Treatment with hormones is thought to be beneficial in patients with endometrial cancer. To assess the indications, effectiveness and safety of hormone therapy for advanced or recurrent epithelial endometrial cancer. We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE up to May 2009 and and CENTRAL (Issue 2, 2009). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies, and contacted experts in the field. Randomised controlled trials (RCTs) that studied hormonal therapy in adult women diagnosed with advanced or recurrent endometrial cancer. Two review authors independently abstracted data and assessed risk of bias. Comparisons were restricted to single-trial analyses so we did not synthesise data in meta-analyses. We found six trials (542 participants) that met our inclusion criteria. These trials assessed the effectiveness of hormonal therapy in women with advanced or recurrent endometrial cancer as a single agent, as part of combination therapy and as low versus high dose. All comparisons were restricted to single-trial analyses, where we found no evidence that hormonal therapy as a single agent or as a combination treatment prolonged overall or five-year disease-free survival of women with advanced or recurrent endometrial cancer. However, low-dose hormonal therapy may have had a benefit in terms of overall and progression-free survival (PFS) compared to high-dose hormonal therapy (HR 1.31, 95% CI 1.04 to 1.66 and HR 1.35, 95% CI 1.07 to 1.71 for overall and PFS, respectively). We found insufficient evidence that hormonal treatment in any form, dose or as part of combination therapy improves the survival of patients with advanced or recurrent endometrial cancer. However, a large number of patients would be needed to demonstrate an effect on survival and none of the included RCTs had a sufficient number of patients to demonstrate a significant difference. In the absence of a proven survival advantage and the heterogeneity of patient populations, the decision to use any type of hormonal therapy should be individualised and with the intent to palliate the disease. It is debatable whether outcomes such as quality of life, treatment response or palliative measures such as relieving symptoms should take preference over overall and PFS as the major objectives of future trials. Source

Swords R.,University of Miami | Freeman C.,St. Bartholomews Hospital | Giles F.,National University of Ireland
Leukemia | Year: 2012

Acute myeloid leukemia (AML) is a highly heterogenous disease with multiple signaling pathways contributing to its pathogenesis. A key driver of AML is the FMS-like tyrosine kinase receptor-3 (FLT3). Activating mutations in FLT3, primarily the FLT3-internal tandem duplication (FLT3-ITD), are associated with decreased progression-free and overall survival. Identification of the importance of FLT3-ITD and the FLT3 pathway in the prognosis of patients with AML has stimulated efforts to develop therapeutic inhibitors of FLT3. Although these inhibitors have shown promising antileukemic activity, they have had limited efficacy to date as single agents and may require use in combination with cytotoxic chemotherapies. Here, we review clinical and preclinical results for the clinically mature FLT3 inhibitors currently in development. We conclude that multitargeted FLT3 inhibitors may have more utility earlier in the course of disease, when in vitro evidence suggests that AML cells are less dependent on FLT3 signaling, perhaps because of upregulation of multiple other signaling pathways. More potent agents may have greater utility in relapsed and heavily pretreated patients, in whom high levels of circulating FLT3 ligand may necessitate use of an agent with a very favorable pharmacokinetic/ pharmacodynamic profile. Novel combination regimens are also discussed. © 2012 Macmillan Publishers Limited. Source

Botting R.M.,St. Bartholomews Hospital
Pharmacological Reports | Year: 2010

Aspirin exerts its analgesic, antipyretic and anti-inflammatory actions by inhibiting the enzyme cyclooxygenase and thus preventing the formation and release of prostaglandins. The elucidation by John Vane of the mechanism of action of aspirin in 1971 was followed twenty years later by the discovery of a second cyclooxygenase enzyme, COX-2 and the rapid development of selective inhibitors of this enzyme. The COX-2 inhibitors are potent anti-inflammatory drugs without the damaging side effects on the stomach mucosa of the non-selective aspirin-like inhibitors. More recently, two enzymes have been identified inhibition of which may explain the mechanism of action of paracetamol. These are a putative cyclooxygenase-3 which is a variant of cyclooxygenase-1 and derives from the same gene, anda COX-2 variant, induced with diclofenac, which may be involved inthe resolutionof inflammation. © by Institute of Pharmacy Polish Acadamy of Sciences. Source

Cohen V.M.L.,St. Bartholomews Hospital
Eye (Basingstoke) | Year: 2013

The eye is a rare site for disseminated malignancy because of the absence of a lymphatic system. Metastases to the ocular structures occur by haematogenous spread and therefore the parts of the eye with the best vascular supply are most likely to be affected. Many patients with Stage 4 carcinomatosis (distal metastatic spread) already have a history of a previous primary cancer. However, this is not always the case for lung cancer as this can metastasise early to the uveal tract and therefore the ophthalmologist may be the first to discover the presence of terminal metastatic disease. Broadly speaking, treatment options are focused on improving the patients' quality of life if visual acuity is threatened. Long-term side effects of treatment need to be considered as systemic cancer treatments and therefore patient life expectancy is improving. In this manuscript, presented at the Cambridge symposium 2012, the diagnosis and challenges involved in the management of ocular metastases are presented. © 2013 Macmillan Publishers Limited All rights reserved. Source

Lobo M.D.,St. Bartholomews Hospital
Journal of the American College of Cardiology | Year: 2016

There is no escaping the fact that SPRINT and PATHWAY-2 provide us with substantial and key data to inform hypertension management of the future. However, randomized clinical trials of this nature represent an idealized form of drug and patient evaluation: the inevitable selection bias ensures recruitment of a subset of patients whose subsequent altered behaviors in an environment of peerless medical surveillance cannot realistically be sustained (and not at appreciable scale) in the clinical realm. To better serve our patients, much greater emphasis in hypertension management needs to be placed on the fundamentals and, in particular, meticulous input into all aspects of lifestyle modification. Furthermore, hypertension specialists need to devote far more attention to determining the reasons why patients do not adhere to their medications and focus on preventing failure of persistence with drug regimens. The increasing trend for use of serum/urine assays of drugs or their metabolites to prove nonadherence is not the answer here-there is no point closing the stable door after the horse has bolted. © 2016 American College of Cardiology Foundation. Source

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