Publications by Joseph Shalhoub
Micro-ribonucleic acids (miRNAs) are a class of endogenous non-coding ribonucleic acids that regu... more Micro-ribonucleic acids (miRNAs) are a class of endogenous non-coding ribonucleic acids that regulate gene expression. MiRNAs have been shown to act as key regulators in the vascular system, with wide-ranging physio-pathological effects. Atherosclerotic disease is a leading cause of morbidity and mortality worldwide. This review presents current knowledge on miRNAs implicated in atherosclerosis susceptibility, development and progression. They are involved in cell phenotype switching, response to shear stress, cell senescence, adhesion molecule expression, macrophage response to oxidised low-density lipoprotein, Toll-like receptor 4 expression, neointimal lesion formation, plaque angiogenesis and cellular cholesterol homeostasis. Clinically, early work has demonstrated the utility of miRNAs for differentiating patients with arterial disease from controls and predicting future cardiac events; this highlights potential diagnostic and prognostic roles. MiRNA involvement in the crucial stages of atherosclerosis promises new hope in treating arterial disease. However, issues regarding multiple miRNA targets, stability and delivery continue to present challenges
Systemic Vasculitis, 2012
Contrast enhanced ultrasound (CE-US) was initially used to facilitate unenhanced duplex for as pa... more Contrast enhanced ultrasound (CE-US) was initially used to facilitate unenhanced duplex for as part of the structural vascular examination. CE-US is emerging as having utility for assessing the adventitial and plaque vasa vasorum, and reflecting vascular and plaque inflammation. Such functional imaging may help with risk stratification of carotid atherosclerosis and in monitoring the response to plaque stabilising and risk modifying cardiovascular therapeutics. Research is ongoing in the refinement and standardisation of ...
International Journal of …, 2011
removal, poor pain control (11.3%vs4.8%) and early post-operative complications (42.9%vs16.2%) (p... more removal, poor pain control (11.3%vs4.8%) and early post-operative complications (42.9%vs16.2%) (p<0.01). Conclusions: This study reveals 8 key factors associated with failed daycase discharge, 7 of which are preventable. We have outlined a targeted approach to minimize these to achieve higher day-case rates, significant cost savings and better patient care.
… Journal of Surgery, 2010
International Journal of Surgery, Volume 8, Issue 7, Pages 550, 2010, Authors:Bhaskar Thakur; Jos... more International Journal of Surgery, Volume 8, Issue 7, Pages 550, 2010, Authors:Bhaskar Thakur; Joseph Shalhoub; Adam M. Hill; Manjit S. Gohel; Alun H. Davies.
Atherosclerosis, 2010
Rationale: Plasma concentration of high-density lipoprotein (HDL) is inversely proportional to th... more Rationale: Plasma concentration of high-density lipoprotein (HDL) is inversely proportional to the incidence of coronary artery
… Journal of Surgery, 2011
Aims: The Royal College SAC requires endoscopy accreditation for gastrointestinal surgeons. Train... more Aims: The Royal College SAC requires endoscopy accreditation for gastrointestinal surgeons. Trainee work pattern changes make attendance at training lists difficult. This study evaluates the use of endoscopy training lists before and after the introduction of an electronic booking system. Methods: Training lists were audited for 24 months in 2007/08 and for 4 months in 2010 after the introduction of the e-booking system. Utilisation was calculated as the number of 'points' used by trainees divided by the total points available for the lists. (Training lists have up to 16 points, whilst service lists up to 24. Gastroscopy, sigmoidoscopy, colonscopy, upper GI EUS, and ERCP confer 2, 4, 5 and 6 points respectively). Results: In 2007/08, 12 trainees performed 677 procedures (1858 points). 47.0% was on training lists. Training lists were 17.7% utilised (95% CI 16.6%-18.8%). In 2010, 10 trainees performed 276 procedures (766 points). 65.0% were on training lists. The lists were 61.0% utilised in 2010 (95% CI 57.6%-64.4%). The most significant improvements were in upper GI and medical training lists. Conclusions: Significant improvement in training list utilisation was evident after implementation of the e-booking system. Such systems may aid surgical training within modern work patterns.
Circulation: …, 2011
by modifying GCH1 may regulate excessive NO production and therefore represent a novel therapeuti... more by modifying GCH1 may regulate excessive NO production and therefore represent a novel therapeutic target for the treatment of refractory hypotension in septic shock patients.
British journal of hospital medicine (London, England : 2005), 2009
Never before have medical trainees been asked to select a specialty at such an early stage in the... more Never before have medical trainees been asked to select a specialty at such an early stage in their careers. It has therefore become imperative that both medical students and junior doctors are wise to the competition they will face. They should aim to develop a medical portfolio that will provide the evidence required to excel, both at the application form and interview stages of the selection process.
Vascular
The benefit of exercise in the management of intermittent claudication has been explored through ... more The benefit of exercise in the management of intermittent claudication has been explored through extensive research in the preceding decades. Within the clinical setting, there is often little differentiation between home-based and supervised exercise regimens. We examined the history and qualification of supervised exercise as a distinct treatment modality from nonsupervised exercise in intermittent claudication. A Medline, Embase, Ovid, Cochrane Database, and Google Scholar search was performed on all studies published until December 31, 2007, investigating the use of supervised exercise in peripheral arterial disease. Supervised exercise is well grounded in evidence to support its superiority over nonsupervised exercise in the management of intermittent claudication, conveying marked improvement in symptomatology, function, and quality of life. Further research is required to determine the nature of the advantage that supervision affords.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
We herein report a laparoscopically performed re-do operation on a patient who had previously und... more We herein report a laparoscopically performed re-do operation on a patient who had previously undergone a laparoscopic parastomal hernia repair. We describe the case of a 71-year-old patient who presented within 3 months of her primary laparoscopic parastomal hernia repair with recurrence. On relaparoscopy, dense adhesions to the mesh were found, and the mesh had migrated into the hernia sac. This had allowed loops of small bowel to herniate into the sac. The initial part of the procedure involved the lysis of adhesions. A piece of Gore-Tex DualMesh with a central keyhole and a radial slit was cut so that it could provide at least 3 cm to 5 cm of overlap of the fascial defect. The tails of the mesh were wrapped around the bowel, and the mesh was secured to the margins of the hernia with circumferential metal tacking and 4 transfascial sutures. The patient remains in satisfactory condition and no recurrence or any surgery-related problem has been observed during 8 months of follow-up. Revisional laparoscopic repair of parastomal hernias seems feasible and has been shown to be safe and effective in this case. The success of this approach depends on longer follow-up reports and standardization of the technical elements.
Annals of the Royal College of Surgeons of England, 2010
Medical teacher, 2010
UK PubMed Central (UKPMC) is an archive of life sciences journal literature.
Current vascular pharmacology, 2011
Hypoxia-inducible factor-1 (HIF-1) is a nuclear transcription factor that is upregulated in hypox... more Hypoxia-inducible factor-1 (HIF-1) is a nuclear transcription factor that is upregulated in hypoxia and co-ordinates the adaptive response to hypoxia by driving the expression of over 100 genes. In facilitating tissues to adapt to hypoxia, HIF-1 may have a role in reducing the cellular damage induced by ischaemia, such as that seen in peripheral arterial disease (PAD), or following acute ischaemic insults such as stroke and myocardial infarction. This therefore raises the possibility of HIF-1 modulation in such contexts to reduce the consequences of ischaemic injury. HIF1 has further been implicated in the pathogenesis of atherosclerosis, abdominal aortic aneurysm (AAA) formation, pulmonary hypertension and systemic hypertension associated with obstructive sleep apnoea. Through a better understanding of the role of HIF-1 in these disease processes, novel treatments which target HIF-1 pathway may be considered. This review summarises the role of HIF-1 in arterial disease, specifically its role in atherosclerosis, ischaemic heart disease, in-stent restenosis following coronary revascularisation, stroke, PAD, AAA formation, pulmonary artery hypertension and systemic hypertension. The potential for exploiting the HIF-1 signalling pathway in developing therapeutics for these conditions is discussed, including progress made so far, with attention given to studies looking into the use of prolyl-hydroxylase inhibitors.
Vascular and endovascular surgery, 2010
Annals of the Royal College of Surgeons of England, 2010
The national abdominal aortic aneurysm (AAA) screening programme measures internal wall diameter;... more The national abdominal aortic aneurysm (AAA) screening programme measures internal wall diameter; however, current UK intervention criteria use external wall diameter. Our aim was to determine the clinical significance of the difference between these two measurements.
Clinical medicine (London, England), 2009
British journal of hospital medicine (London, England : 2005), 2009
Peripheral arterial disease is commonly caused by atherosclerosis, and symptoms depend on the loc... more Peripheral arterial disease is commonly caused by atherosclerosis, and symptoms depend on the location and size of the affected artery, metabolic demands on the tissue, and the presence or absence of a collateral circulation. This article reviews the current evidence for the diagnosis and management of peripheral arterial disease.
International angiology : a journal of the International Union of Angiology, 2009
Cilostazol is a phosphodiesterase III inhibitor with a firm evidence base for use in intermittent... more Cilostazol is a phosphodiesterase III inhibitor with a firm evidence base for use in intermittent claudication. We aimed to assess outcomes using cilostazol in critical limb ischemia (CLI). Prospective consecutive observational study of local practice. Twenty-three patients (26 lower limbs) with CLI defined by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease. None were considered suitable for radiological or surgical revascularisation. Oral cilostazol starting at 100 mg twice daily was used in combination with best medical therapy (BMT). Mean follow-up time was 13.7 months (median 11.8 months). One patient died (5% of patients). There was one major amputation (4% of limbs). Six limbs (26%) improved, 5 reverting to a diagnosis of intermittent claudication and 1 becoming asymptomatic. The remaining 15 limbs remained ischemic, with some clinical improvement and without major amputation. In this study, there was one major amputation and one death in a mean period of a year following a diagnosis of non-reconstructible limb ischemia. The use of cilostazol was associated with marked improvement in 26%, and may have at least deferred major amputation in those with ongoing ischaemia. Further study using cilostazol in this context is recommended.
International journal of surgery (London, England), 2010
The perioperative mortality for people with ruptured abdominal aortic aneurysms (RAAA) has not ch... more The perioperative mortality for people with ruptured abdominal aortic aneurysms (RAAA) has not changed for two decades. Of patients who survive long enough to undergo open repair for ruptured aneurysms, half die (48%; 95% confidence interval [CI] 46 to 50). Randomized trials have shown that endovascular aneurysm repair (EVAR) for nonruptured abdominal aortic aneurysms decreases perioperative mortality compared with open repair. EVAR may similarly benefit patients with RAAA. We aimed to summarize studies of patients undergoing EVAR for ruptured aneurysms. Methods: Two reviewers searched Medline and EMBASE databases from 1994 to July 2006, Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effectiveness, the Cochrane Central Register of Controlled Trials, Best Evidence 1994 to 2006, reference lists, clinical trial registries, and conference proceedings; we also contacted authors. All published and unpublished studies in which a group of people with ruptured aneurysms, assessed objectively by imaging, was treated with EVAR (REVAR) were eligible. We used the generic inverse variance function of the REVMAN software to pool results for death in hospital. Sensitivity analyses, using prespecified subgroups, explored heterogeneity between studies. Results: Pooled mortality in 18 observational studies describing 436 people who underwent REVAR was 21% (95% CI 13 to 29); however, 90% of the heterogeneity between studies was not explained by chance alone. Surgical volume explained substantial heterogeneity. According to study-specific criteria, 47% (95% CI 39 to 55) of people with ruptured aneurysms were potentially eligible for REVAR.
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Publications by Joseph Shalhoub