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Study to assess the neurological and cognitive effects of using Hypofractionated Stereotactic Radiotherapy used to treat multiple (3-10) brain metastases.
The purpose of this study is to investigate whether improved radiation planning technology that conforms to the shape and size of the cancer, can be used to treat multiple sites of cancer within the brain, and at the same time protect and preserve brain (memory and cognitive) function. This study is for patients who are are aged 18 years or above and have been diagnosed with 3-10 cerebral metastases, i.e. the cancer has spread to three or more spots on the brain. All participants in this study will receive a new treatment called Hypofractionated Stereotactic Radiotherapy. This is highly focused radiation given in one to five treatments. Robotic targeting is used to avoid important parts of the normal brain. Whereas previous treatment for multiple sites of cancer within the brain has involved giving radiation to the whole brain, this treatment will allow for targeted treatment of just the affected areas. In this way, the dose of radiation delivered to key areas of the brain involved with memory function can be minimised. All participants will be monitored throughout treatment for safety. At the beginning of the study, and then at 3 and 6 months following treatment, patients will be asked to undergo MRI scans to assess disease control, have assessments of neurocognitive function by a trained neuropsychologist, and complete quality of life questionnaires. We estimate that this study will contribute further to the research into using radiotherapy to control cancers that have spread to the brain, while minimising the effects on brain function.
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A randomized, placebo-controlled study of the safety and tolerability of PTG-100 in healthy volunteers
The study is to assess the safety and tolerability of PTG-100 to normal healthy volunteers. This includes vital signs, safety labs and physical examinations The drug will be given in single ascending then multiple ascending doses. The study will also evaluate the PK of the drug after dose administration. Participants will be entered into standard study cohorts
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Effect of the remote ischemic preconditioning on primary graft failure after heart transplantation: A Randomized Controlled Trial
Objectives of this study are to assess the effects of the remote ischemic preconditioning (RIPC) on the primary graft failure (PGF), heart function and multi-organ protection after heart transplantation. This is a prospective, multi-centre, double-blind randomized controlled clinical trial (RCT). The outcome of the study is expected to determine if significant protection by the RIPC previously achieved in animal study can be translated into clinical heart transplantation. Study Duration: Three years. Intervention is the RIPC stimulus (also referred to as ‘protocol’) which consists of four five-minute cycles of arm ischemia with intervening five minutes of reperfusion following induction of standard anaesthesia in the operating room, prior to heart transplantation (HT). Inflating a standard blood pressure cuff to a pressure exceeding systolic by 20 mmHg will interrupt blood flow. The cuff would be deflated during reperfusion. Control patients will have sham placement of cuff without inflation. Participants will be monitored after HT and an analysis of blood samples (involving an examination of markers of myocardial damage, i.e., troponin I) collected as a part of standard care will be used to determine if there are protective effects due to the RIPC protocol used. Number of Subjects: 50. Population: Adults and children aged >15 years undergoing heart transplantation for the first time.
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Low dose Colchicine after Acute Myocardial Infarction: LoDoCo-MI
This randomised placebo-controlled trial will recruit 210 patients following an acute myocardial infarction (MI). They will be randomised to colchicine 0.5mg once daily or matching placebo for 30-days. Patients, health-care providers, data collectors and outcome adjudicators will be blinded to treatment allocation. Randomisation will occur within 7 days of the index MI and will be stratified by study centre. Baseline clinical data, including concomitant medications, serum biochemistry, full blood count and creatine kinase will be recorded. These blood tests will be repeated at 30 days. Levels of C-reactive protein (CRP) will also be measured at baseline and at 30-days. Patients with a type 1 MI (using the 3rd universal definition) will be eligible for inclusion unless they have a know contraindication to, intolerance of or clear indication for treatment with colchicine. The primary aims of this study are to provide data regarding the feasibility, tolerability and safety of low-dose colchicine after acute MI. The secondary end-points relate to the ability of colchicine to reduce CRP. Data from this trial will be used to inform the design of a larger outcome trial.
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Fertility Understanding Through Registry and Evaluation (FUTuRE Fertility): exploring the fertility-related quality of life and psychological distress in young people with cancer, their parents and aged matched controls.
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Effect of a physical activity promotion and fall prevention plan on physical activity and falls in community-dwelling people aged 60+.
We will conduct a cluster randomised trial (60 groups of older people) to evaluate two healthy ageing strategies among community-dwelling people who attend established community-based groups. The primary objective is to measure the effectiveness of: a) a physical activity and fall prevention intervention including telephone-based health coaching and written information on physical activity and falls over a 12 month period, and b) a nutrition intervention including telephone-based health coaching and written information on eating habits over 12 months. The trial also aims to establish the impact of the interventions on physical activity guideline adherence, eating habits, body mass index, goal attainment, mobility confidence, quality of life, fear of falling, risk taking behaviour, wellbeing and mood.
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Breaking Up Sitting Time after Stroke (BUST-Stroke)
People who have had a stroke and are living at home spend 75% of their waking hours sitting down, which is much higher than people of a similar age without stroke. Spending long periods of time sitting down each day increases the risk of cardiovascular disease, including stroke, putting this population at particularly high risk. About a third of people who have had one stroke will have a second or third stroke, so it is important that we look for ways to reduce this risk. In studies of people without stroke, breaking up prolonged sitting time with regular activity breaks (walking or simple strengthening exercises) leads to significant reductions in cardiovascular disease risk factors such as glucose metabolism and blood pressure. The effects of breaking up sitting time in people with stroke, and the optimal type of activity break for this group is not known. Not getting enough physical activity is the second highest risk factor for stroke, but achieving the recommended amount of daily physical activity, particularly for those people who find it difficult to walk, is near impossible for many stroke survivors. Therefore, reducing sitting time is a promising, innovative, low cost intervention to reduce the risk of having another stroke. We will conduct a study that will help us to understand the impact of prolonged sitting time on stroke risk factors, and will assess the effectiveness of two ways of regularly breaking up sitting time in people with stroke. We will recruit 19 stroke survivors who have difficulty walking. Each survivor will complete all 3 experimental conditions in a random order, under the direct supervision of research staff at HMRI. The 3 conditions will be (1) prolonged sitting without breaks (control), (2) breaking up sitting time by walking at a comfortable speed overground (ie not on a treadmill) for 3 minutes every 30 minutes, and (3) breaking up sitting time with 3 minutes of simple exercises in standing every 30 minutes. Participating stroke survivors will have blood samples taken at regular intervals throughout the duration of the study, and will have their blood pressure continually monitored. Our study outcome measures will include glucose and insulin measures (primary), blood pressure, plasma fibrinogen (secondary) as well as safety and feasibility indicators. This study will be first to assess the effects of breaking up prolonged sitting time in people with stroke. We aim to build on this work in the future by testing different types of activity breaks (eg standing only, seated exercises) at varying frequencies and durations in different sub-groups of stroke survivors (eg people who walk well, and those that cannot walk at all). BUST-Stroke will also inform future research to assess the effect of reducing daily sitting time in people both early (in hospital) and later after stroke.
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Modulation of Plasmalogens in Human Males using Alkylglycerol
In previous studies, we and others have observed that the levels of plasmalogens (a class of phospholipid (blood fat)) are lower in obese people and people with type 2 diabetes and cardiovascular (heart) disease. In one of our studies we have shown that dietary supplementation of alkylglycerol (fats found in the liver of most animals and fish) can increase levels of plasmalogens. This increase is associated with a reduction of athersosclerosis (artery blockage) in mice. In separate experiments, after treating mice on a high fat diet with alkylglycerols, we observed a reduction in the inflammation caused by obesity. In this project we will observe the effect of alkylglycerol (Alkyrol) supplementation (in the form of a capsule) on overweight/obese males. The study will involve a cross-over design, where participants will take a supplement of Alkyrol (shark liver oil capsule) or placebo (dummy capsule) for three weeks, a wash out (no supplementation) period of three weeks and cross over to Alkyrol or placebo for three weeks. Over this time blood will be collected at certain points and then analysed to observe the effect of alkylglycerol on plasmalogens and the effect of inflammation. We will recruit 10 overweight/obese men (Body Mass Index (BMI – a measure of body fat based in relation to your height) of 28-35kg/m2), not being treated for hypertension (high blood pressure), diabetes or cardiovascular (heart) disease or taking any fish oil supplements. This study represents the first proof of concept (demonstration) human trial that alkylglycerols can modify circulating plasmalogen levels and influence inflammation. If positive, this randomised clinical trial will support therapeutic approaches targeting plasmalogen modification for the prevention of type 2 diabetes and cardiovascular disease.
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Randomised trial of division vs no division of the short gastric blood vessels during laparoscopic Nissen fundoplication for gastro-oesophageal reflux
Patients undergoing laparoscopic Nissen fundoplication were randomly assigned to undergo division or no division of the short gastric blood vessels. The study sought to determine whether or not dysphagia was the same in each group
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Laparoscopic Nissen fundoplication with anterior vs posterior hiatal repair to assess dysphagia in patients undergoing surgery for gastro-oesophageal reflux
During Nissen fundoplication, hiatal repair undertaken either in front or behind the oesophagus