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Rerko MA, Pan X, Donaldson C, Jones GL, Bishop JY. Comparison of various imaging techniques to quantify glenoid bone loss in shoulder instability. J Shoulder Elbow Surg 2013; 22:528-34. [PMID: 22748926 DOI: 10.1016/j.jse.2012.05.034] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the most accurate imaging modality to quantify glenoid bone loss in recurrent anterior shoulder instability. This will allow the best preoperative prediction for patients needing a bone graft. MATERIALS AND METHODS Seven fresh frozen shoulder cadavers were imaged with radiographs, magnetic resonance imaging (MRI), computed tomography (CT), and 3-dimensional CT (3-D CT). Native shoulders were imaged, and 3 sequential anterior-inferior glenoid defects were created, measured, and reimaged. Defect sizes were <12.5%, 12.5% to 27%, and >27%. Four blinded evaluators (2 musculoskeletal radiologists, 2 shoulder fellowship-trained surgeons) reviewed the 112 image sets and estimated the percentage of glenoid bone loss. Images were scrambled and re-reviewed by the same observers 2 months later to determine intraobserver reliability. RESULTS Pearson correlation coefficients between predicted vs true bone loss across all 4 raters were 0.875 (3-D CT), 0.831 (CT), 0.693 (MRI), and 0.457 (x-ray imaging). Prediction errors (PE) were (mean ± SD in percentages) 3-D CT (-3.3 ± -6.6), CT (-3.7 ± -8.0), MRI (-2.75 ± -10.6), and x-ray images (-6.9 ± -13.1). Mean PE values were not significantly different among 3-D CT, CT, and MRI; however, the PE SDs were similar among the 4 evaluators for 3-D CT and lower than all other imaging techniques. Prediction based on x-ray images had the largest PE and SD. Covariance parameters revealed large variances for shoulders for MRI and x-ray imaging. The intraobserver intraclass correlation coefficients were 0.947 (3-D CT), 0.927 (CT), 0.837 (MRI), and 0.726 (x-ray image). CONCLUSIONS The most accurate imaging modality in predicting glenoid bone loss among the 4 blinded independent evaluators was 3-D CT.
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Affiliation(s)
- Michael A Rerko
- Sports Medicine Center, Department of Orthopaedics, The Ohio State University, Columbus, OH 43221, USA
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Bishop JY, Jones GL, Rerko MA, Donaldson C. 3-D CT is the most reliable imaging modality when quantifying glenoid bone loss. Clin Orthop Relat Res 2013; 471:1251-6. [PMID: 22996361 PMCID: PMC3585993 DOI: 10.1007/s11999-012-2607-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 09/07/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posttraumatic anterior shoulder instability is associated with anterior glenoid bone loss, contributing to recurrence. Accurate preoperative quantification of bone loss is paramount to avoid failure of a soft tissue stabilization procedure as bone reconstruction is recommended for glenoid defects greater than 20% to 27%. QUESTIONS/PURPOSES We determined whether radiography, MRI, or CT was most reliable to quantify glenoid bone loss in recurrent anterior shoulder instability. METHODS Seven intact fresh-frozen human cadaveric shoulders were imaged with radiography, MRI, CT, and three-dimensional (3-D) CT. Three sequential anterior glenoid defects then were created, measured, and the shoulders reimaged after each defect. Defect sizes were less than 12%, 12% to 25%, and 25% to 40%. The gold standard measurement was determined by comparing measurements taken on the cadaver by two surgeons using digital calipers with the measurements determined by using electronic digital calipers on the 3-D CT. This measurement was used for comparison of all estimations by the evaluators. Twelve independent blinded evaluators reviewed the 112 image sets and estimated the percent of glenoid bone loss. Images were scrambled and rereviewed by the same observers 2 months later to determine intraobserver reliability. We determined reliability with kappa values. RESULTS Kappa values between predicted bone loss versus true loss (determined by our gold standard measurements) across all 12 raters for each modality were: 3-D CT, 0.50; CT, 0.40; MRI, 0.27; and radiographs, 0.15. Interobserver agreement (kappa) values were: 3-D CT, 0.54; CT, 0.47; MRI, 0.31; and radiographs, 0.15. The intraobserver agreement (kappa) values were: 3-D CT, 0.59; CT, 0.64; MRI, 0.51; and radiographs, 0.45. CONCLUSIONS Three-dimensional CT was the most reliable imaging modality for predicting glenoid bone loss. Regular CT was the second most reliable and reproducible modality.
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Affiliation(s)
- Julie Y. Bishop
- Department of Orthopaedics, The Ohio State University Medical Center, The Ohio State University, 2050 Kenny Road, Suite 3300, Columbus, OH 43221 USA
| | - Grant L. Jones
- Department of Orthopaedics, The Ohio State University Medical Center, The Ohio State University, 2050 Kenny Road, Suite 3300, Columbus, OH 43221 USA
| | - Michael A. Rerko
- Department of Orthopaedics, The Ohio State University Medical Center, The Ohio State University, 2050 Kenny Road, Suite 3300, Columbus, OH 43221 USA
| | - Chris Donaldson
- Department of Orthopaedics, The Ohio State University Medical Center, The Ohio State University, 2050 Kenny Road, Suite 3300, Columbus, OH 43221 USA
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Bishop JY, Roesch M, Lewis B, Jones GL, Litsky AS. A biomechanical comparison of distal clavicle fracture reconstructive techniques. Am J Orthop (Belle Mead NJ) 2013; 42:114-118. [PMID: 23527327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Unstable fractures of the distal clavicle are often encountered in high-demand, young athletes. We evaluated biomechanical performance and mode of failure in 4 treatment methods. A Neer Type IIB distal clavicle fracture was created in fresh-frozen human cadaveric shoulders. Four fixation techniques were utilized, 5 times each on 5 different cadavers: suture fixation with a cerclage suture and coracoclavicular suture, distal clavicle locking plate, distal clavicle locking plates with suture augmentation, and distal clavicle hook plate. No significant difference in ultimate load to failure was found among groups in the treatment of the unstable distal clavicle fractures.
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Affiliation(s)
- Julie Y Bishop
- Sports Medicine Center, The Ohio State University, 2050 Kenny Rd, Columbus, OH 43221, USA.
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Abstract
Arthroscopic rotator cuff repair is a reliable option for symptomatic patients who have failed conservative treatments. Limited evidence exists regarding early rehabilitation time points (less than 1 year) and the influence of tear size. The authors sought to determine whether a difference exists in pre- and postoperative range of motion among small, medium, and large isolated rotator cuff tears treated arthroscopically. Patient- and tear-specific demographics were analyzed in a retrospective series of patients who had undergone arthroscopic rotator cuff repair. Two hundred seventy-four patients (153 [56%] men and 121 [44%] women; mean age, 53 years) were analyzed. Small tears (n=158 [58%]) were more common than medium (n=70 [25%]) and large (n=46 [17%]) tears. Shoulder range of motion was measured preoperatively and at 2 and 6 weeks, 3 and 6 months, and 1 year postoperatively. At nearly all time points pre- and postoperatively, large tears were significantly stiffer than small tears in external rotation and forward elevation (P<.05). It takes 1 year to fully regain external rotation after small and medium tears, whereas mild residual stiffness remains after large tears. Full forward elevation is restored by 3 months for small tears vs 6 months for medium and large tears. Significant tear size-dependent differences exist in shoulder range of motion after arthroscopic repair of isolated rotator cuff tears. These data can be used to manage patients' expectations for range of motion after arthroscopic rotator cuff repair to improve patient satisfaction.
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Affiliation(s)
- Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Siston RA, Geier D, Bishop JY, Jones GL, Kaeding CC, Granger JF, Skaife T, May M, Flanigan DC. The high variability in sizing knee cartilage defects. J Bone Joint Surg Am 2013; 95:70-5. [PMID: 23283375 DOI: 10.2106/jbjs.k.01406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Articular cartilage defects of the knee are commonly encountered during arthroscopic examination and are believed to be a precursor to osteoarthritis. While a variety of surgical treatments exist, the defect size, specifically the cross-sectional area, has historically been used as a critical element in choosing one procedure over another. The purpose of this study was to characterize the variability associated with arthroscopic techniques that are used to determine the cross-sectional area of distal femoral articular cartilage defects. METHODS Six orthopaedic surgeons used four measurement techniques to estimate the area of cartilage defects in ten cadaveric knees. The areas of the defects determined by the surgeons were compared against the known areas of the defects that were determined from plastic molds. RESULTS Averaged across all approaches, the four measurement techniques yielded highly variable results that underestimated the size of the defects (mean and standard deviation, -0.31 ± 1.22 cm²). There was no difference in the estimated sizes of the defects on the medial or lateral femoral condyles (p = 0.96), but defects on the trochlea (mean, -0.53 ± 1.00 cm²) were less accurately sized than defects on either of the condyles (p < 0.01). The areas of defects that were <2 cm² were overestimated (mean, 0.21 ± 0.65 cm²) compared with other sizes of defects (p < 0.001), and the areas of defects that were >4 cm² were underestimated (mean, -0.87 ± 1.83 cm²) compared with other defects (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE Our current treatment algorithms rely heavily on the size of a cartilage defect, but only 57% of the measurements in this study would have accurately led to the appropriate surgical procedure. There is a need to evaluate and quantify the size of a lesion more appropriately than current standards allow and potentially revise existing treatment algorithms.
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Affiliation(s)
- Robert A Siston
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH 43210, USA.
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Munir A, Leech N, Windebank KP, McLelland J, Jones GL, Mitra D, Jenkins A, Quinton R. Langerhans cell histiocytosis: a multisystem disorder. J R Coll Physicians Edinb 2012; 42:311-3. [PMID: 23240116 DOI: 10.4997/jrcpe.2012.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Langerhans cell histiocytosis can involve single or multiple organ/tissue systems and may go undiagnosed for years until it enters the clinician's differential diagnosis framework. We report on a young patient who initially presented with diabetes insipidus and subsequently with pyrexia of unknown origin. She progressed from single system Langerhans cell histiocytosis to multisystem involvement and remains in long-term remission following chemotherapy.
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Affiliation(s)
- A Munir
- Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Trinh TQ, Harris JD, Kolovich GP, Griesser MJ, Schickendantz MS, Jones GL. Operative management of capitellar fractures: a systematic review. J Shoulder Elbow Surg 2012; 21:1613-22. [PMID: 22694882 DOI: 10.1016/j.jse.2012.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 02/01/2023]
Abstract
PURPOSE This study was conducted to evaluate reports of clinical outcomes of isolated capitellar fractures. MATERIALS AND METHODS We conducted a systematic review of medical databases reporting clinical outcomes of patients undergoing nonoperative and operative management of isolated capitellar fractures. RESULTS We identified 28 studies for inclusion comprising 174 patients. All included studies were level IV evidence. Capitellar fractures were more common among women than men and were more likely to involve the nondominant arm. Type I fractures (84%) were more common than type II (14%) and III fractures (2%). Operative and nonoperative management both led to satisfactory clinical outcomes. No significant difference in outcomes was observed in those undergoing operative management compared with those undergoing closed reduction and immobilization. CONCLUSIONS Nonoperative and operative management of isolated capitellar fractures leads to satisfactory clinical outcomes as determined by postoperative range of motion, improvement in pain, and a return to previous levels of function. No statistical difference in outcomes was observed between those undergoing operative management compared with those treated with closed reduction and immobilization.
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Affiliation(s)
- Thai Q Trinh
- Department of Orthopaedics, Division of Sports Medicine, The Ohio State University Sports Medicine Center, Columbus, OH 43221, USA
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Tsai LCL, Chan GCK, Nangle SN, Shimizu-Albergine M, Jones GL, Storm DR, Beavo JA, Zweifel LS. Inactivation of Pde8b enhances memory, motor performance, and protects against age-induced motor coordination decay. Genes Brain Behav 2012; 11:837-47. [PMID: 22925203 DOI: 10.1111/j.1601-183x.2012.00836.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/10/2012] [Accepted: 08/09/2012] [Indexed: 01/02/2023]
Abstract
Phosphodiesterases (PDEs) are critical regulatory enzymes in cyclic nucleotide signaling. PDEs have diverse expression patterns within the central nervous system (CNS), show differing affinities for cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), and regulate a vast array of behaviors. Here, we investigated the expression profile of the PDE8 gene family members Pde8a and Pde8b in the mouse brain. We find that Pde8a expression is largely absent in the CNS; by contrast, Pde8b is expressed in select regions of the hippocampus, ventral striatum, and cerebellum. Behavioral analysis of mice with Pde8b gene inactivation (PDE8B KO) demonstrate an enhancement in contextual fear, spatial memory, performance in an appetitive instrumental conditioning task, motor-coordination, and have an attenuation of age-induced motor coordination decline. In addition to improvements observed in select behaviors, we find basal anxiety levels to be increased in PDE8B KO mice. These findings indicate that selective antagonism of PDE8B may be an attractive target for enhancement of cognitive and motor functions; however, possible alterations in affective state will need to be weighed against potential therapeutic value.
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Affiliation(s)
- L-C L Tsai
- Department of Pharmacology, University of Washington, Seattle, WA 98195-7280, USA
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Khazzam M, Kuhn JE, Mulligan E, Abboud JA, Baumgarten KM, Brophy RH, Jones GL, Miller B, Smith M, Wright RW. Magnetic resonance imaging identification of rotator cuff retears after repair: interobserver and intraobserver agreement. Am J Sports Med 2012; 40:1722-7. [PMID: 22707747 DOI: 10.1177/0363546512449424] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the most commonly used imaging modality to assess the rotator cuff. Currently, there are a limited number of studies assessing the interobserver and intraobserver reliability of MRI after rotator cuff repair. HYPOTHESIS Fellowship-trained orthopaedic shoulder surgeons will have good inter- and intraobserver agreement with regard to features of the repaired rotator cuff (repair integrity, fat content, muscle volume, number of tendons involved, tear size, and retract) on MRI. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Seven fellowship-trained orthopaedic shoulder surgeons reviewed 31 MRI scans from 31 shoulders from patients who had previous rotator cuff repair. The scans were evaluated for the following characteristics: rotator cuff repair status (full-thickness retear vs intact repair), tear location, tendon thickness, fatty infiltration, atrophy, number of tendons involved in retear, tendon retraction, status of the long head of the biceps tendon, and bone marrow edema in the humeral head. Surgeons were asked to review images at 2 separate time points approximately 9 months apart and complete an evaluation form for each scan at each time point. Multirater kappa (κ) statistics were used to assess inter- and intraobserver reliability. RESULTS The interobserver agreement was highest (80%, κ = 0.60) for identifying full-thickness retears, tendon retear retraction (64%, κ = 0.45), and cysts in the greater tuberosity (72%, κ = 0.43). All other variables were found to have fair to poor agreement. The worst interobserver agreement was associated with identifying rotator cuff footprint coverage (47%, κ = -0.21) and tendon signal intensity (29%, κ = -0.01). The mean intraobserver reproducibility was also highest (77%-90%, κ = 0.71) for full-thickness retears, quality of the supraspinatus (47%-83%, κ = 0.52), tears of the long head of the biceps tendon (58%-94%, κ = 0.49), presence of bone marrow edema in the humeral head (63%-87%, κ = 0.48), cysts in the greater tuberosity (70%-83%, κ = 0.47), signal in the long head of the biceps tendon (60%-80%, κ = 0.43), and quality of the infraspinatus (37-90%, κ = 0.43). The worst intraobserver reproducibility was found in identification of the location of bone marrow edema (22%-83%, κ = -0.03). CONCLUSION The results of this study indicate that there is substantial variability when evaluating MRI scans after rotator cuff repair. Intact rotator cuff repairs or full-thickness retears can be identified with moderate reliability. These findings indicate that additional imaging modalities may be needed for accurate assessment of the repaired rotator cuff.
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Affiliation(s)
- Michael Khazzam
- UT Southwestern Medical Center at Dallas, 1801 Inwood Rd, Dallas, TX 75390-8883.
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Li W, Newell-Price J, Jones GL, Ledger WL, Li TC. Relationship between psychological stress and recurrent miscarriage. Reprod Biomed Online 2012; 25:180-9. [PMID: 22687324 DOI: 10.1016/j.rbmo.2012.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 03/17/2012] [Accepted: 03/20/2012] [Indexed: 01/20/2023]
Abstract
Stress arousal may compromise the feedback regulation of the hypothalamo-pituitary-adrenal axis, releasing stress-related biomarkers and thereby affecting establishment of pregnancy. This study examined the relationship between stress and recurrent miscarriage (RM) and the impact of stress on establishment of pregnancy. The stress status of 45 patients with unexplained RM and 40 fertile women was investigated with the Fertility Problem Inventory (FPI), Perceived Stress Scale (PSS), Positive and Negative Affect Schedule, peripheral natural killer (NK) cells and cortisol. Patients with unexplained RM had significantly higher scores on the FPI (P<0.05, adjusted OR 1.02), PSS (P<0.05, adjusted OR 1.13) and Negative Affect scale (P<0.05, adjusted OR 1.12) and lower scores on the Positive Affect scale (P<0.05, adjusted OR 0.89) than fertile controls. Patients who had live births (n=20) during the study period had significantly lower scores in the Positive Affect scale (P<0.05, adjusted OR 1.17) than those who miscarried (n=10). There was a little association between psychological stress measurements and biochemical stress measurements. These results suggest that stress is a risk factor of RM. Within women with RM, moderate stress appears to be associated with improved pregnancy outcome.
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Affiliation(s)
- W Li
- Academic Unit of Reproductive and Developmental Medicine, Dept Human Metabolism, University of Sheffield, Sheffield, S102SF, UK.
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Harris JD, Pedroza A, Jones GL. Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med 2012; 40:359-66. [PMID: 22095706 PMCID: PMC3632074 DOI: 10.1177/0363546511426003] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined. PURPOSE To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores. RESULTS A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P < .001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant. CONCLUSION Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore, physical therapy for patients with symptomatic rotator cuff tears should target these modifiable factors associated with pain and loss of function.
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Affiliation(s)
| | | | - Grant L. Jones
- Address correspondence to Grant L. Jones, MD, The Ohio State University Medical Center, Department of Orthopaedics, 2050 Kenny Rd, Suite 3100, Columbus, OH 43221 ()
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Wolf BR, Britton CL, Vasconcellos DA, Spencer EE, Bishop JY, Brophy RH, Carey JL, Dunn WR, Jones GL, Kuhn JE, Ma CB, Marx RG, McCarty EC, Vidal AF, Wright RW. Agreement in the classification and treatment of the superior labrum. Am J Sports Med 2011; 39:2588-94. [PMID: 21946567 DOI: 10.1177/0363546511422869] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Snyder classification scheme is the most commonly used system for classifying superior labral injuries. Although this scheme is intended to be used for arthroscopic visual classification only, it is thought that other nonarthroscopic historical variables also influence the classification. PURPOSE This study was conducted to evaluate the intrasurgeon and intersurgeon agreement in classifying variable presentations of the superior labrum and to evaluate the influence of clinical variables on the classification and treatment choices of surgeons. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A group of arthroscopic shoulder surgeons were asked to rank in order of importance clinical variables considered in diagnosing and treating the superior labrum. The surgeons then watched 50 arthroscopic videos of the superior labrum, ranging from normal to pathologic, on 3 different occasions. The first and third viewings were accompanied by no clinical information. The second viewing was accompanied by a detailed clinical vignette for each video. The surgeons selected a classification and treatment for each video. RESULTS A patient's job/sport, age, and physical examination findings were considered the most important clinical variables surgeons consider during management of the superior labrum. Comparing the 2 viewings without clinical information, surgeons selected a different classification 28.5% of the time from the first to the second time. A different classification was chosen 71.5% of the time when the surgeon was supplied a clinical vignette at the subsequent viewing. Similarly, the treatment selected changed in 36% and 69.1% of cases when viewed again without vignettes and with vignettes, respectively. Intersurgeon agreement was moderate without clinical vignettes and fair with vignettes. Historical, physical examination, and surgical observations were found to influence the odds of change of classification. CONCLUSION There is significant intrasurgeon and intersurgeon variability in classification and treatment of the superior labrum. Clinical historical, examination, and surgical findings influence classification and treatment choices.
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Affiliation(s)
- Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, USA.
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Abstract
Sodium hyaluronate injection into the glenohumeral joint is a treatment option in the management of adhesive capsulitis of the shoulder. We hypothesized that a systematic review would demonstrate that intra-articular sodium hyaluronate injections would result in significant improvements in passive range-of-motion, shoulder and general clinical outcome measures, and pain scales at short- and mid-term follow-up. Multiple medical databases were searched for levels I–IV evidence with a priori defined specific inclusion and exclusion study criteria. Clinical outcome measures used included Constant score, VAS pain scores, Cho functional scores, JOA scores, and range-of-motion measurements. Seven studies were included (four Level I and three Level IV; 292 subjects, 297 shoulders). Mean subject age was 59.1 years and mean pre-treatment duration of symptoms was 7.3 months. 140 subjects underwent one or multiple hyaluronate injections (120 glenohumeral joint; 20 subacromial bursa). Clinical follow-up was mean 9.0 weeks. Sodium hyaluronate injection into the glenohumeral joint has significantly improved shoulder range-of-motion, constant scores, and pain at short-term follow-up following treatment of adhesive capsulitis. Isolated intra-articular hyaluronate injection has significantly better constant scores than control. Isolated intra-articular hyaluronate injection has equivalent clinical outcomes and range-of-motion compared to intra-articular corticosteroid injection. Intra-articular hyaluronate injection was safe, with no reported complications within the studies in this review. Sodium hyaluronate injection into the glenohumeral joint is a safe, effective treatment in the management of adhesive capsulitis of the shoulder. Short-term evidence indicates that clinical outcomes are better than control and equivalent to intra-articular corticosteroid injection.
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Affiliation(s)
- Joshua D Harris
- Department of Orthopaedics, The Ohio State University Sports Medicine Center, OH, Columbus
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Abstract
Background: Biologic augmentation with allograft has shown equivalent healing rates to autograft in several nonunion models. No literature exists clearly demonstrating this in the clavicle. The purpose of this study was to evaluate the healing and complication rates of clavicle nonunions treated solely with open reduction and internal fixation (ORIF) and allograft. Materials and Methods: Nineteen clavicle nonunions treated with ORIF and allograft were evaluated retrospectively to assess healing rates and complications based on clinical symptoms and radiographic findings. Results: For the 19 patients included and treated with ORIF and allograft, clinical follow-up averaged 15 months. Seven patients were smokers. Although complete radiographic healing was achieved in only 68% of patients, clinical success occurred in 16 (84%) patients who demonstrated full range of motion and strength without pain. The three patients who did not demonstrate full radiographic healing were completely pain free. Five patients experienced complications (26%). Two underwent hardware removal due to persistent irritation after union. Three had a persistent painful nonunion. Each of these three patients was a smoker (P=0.08). Two proceeded to union after revision fixation. The other had hardware failure, which was removed, with a persistent nonunion and did not wish any further treatment. Conclusion: ORIF with allograft bone substitute is an acceptable treatment alternative to iliac crest bone graft for clavicle nonunions. However, we did not demonstrate equivalent healing rates to published results utilizing autograft. Smokers were identified to have a trend toward higher failure rates with ORIF augmented with allograft and therefore these patients may be better served by augmenting fixation with autograft. Level of Evidence: IV; retrospective comparative study.
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Abstract
OBJECTIVE To use a cadaver model to evaluate an all-inside meniscal repair device (MaxFire). METHODS Six fresh-frozen cadaveric knees (ages 30-84 years) without evidence of prior surgery were used for this study. The knees were rigidly mounted and arthroscopy performed using standard anteromedial and anterolateral portals. Four MaxFire devices were placed into the medial and lateral meniscus according to the technique provided by the manufacturer. The devices were placed in a vertical or horizontal mattress fashion systematically from posterior to anterior. Implants were placed from either the ipsilateral- or contralateral-portal at the discretion of each surgeon. Placement into the medial meniscus was performed with the knee in approximately 10° of flexion and into the lateral meniscus in 45° of flexion. RESULTS In all, 54 MaxFire devices were placed. Twenty-six devices were used medially, and 28 laterally. Forty-five (83%) were placed successfully. Of those, 3 (7%) were placed in a "top hat" fashion. The nine failures (17%) were related to final device tensioning. Three of the sutures broke, one suture would not reduce, and three implants pulled out of the meniscus. The devices were successfully removed arthroscopically with a grasper or oscillating shaver. Pulling of implants out of menisci occurred in degenerative knees with degenerative meniscal tissue and did not occur with healthy appearing menisci. CONCLUSION The MaxFire device is easy to use, has a low risk of complications, and can be inserted expeditiously by arthroscopy.
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Affiliation(s)
- Rickland L Likes
- Sports Medicine Center, Department of Orthopaedics, Ohio State University, Columbus, Ohio 43221-3502, USA
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66
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Griesser MJ, Harris JD, Jones GL. Intramuscular synovial cyst of the shoulder. Am J Orthop (Belle Mead NJ) 2011; 40:E198-E201. [PMID: 22263202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, we report a case of intramuscular synovial cyst of the rotator cuff musculature with associated supraspinatus and infraspinatus tears. The patient was treated arthroscopically with cyst decompression and inside-out rotator cuff repair. We also present a review of the current literature on intramuscular synovial cysts of the rotator cuff.
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Affiliation(s)
- Michael J Griesser
- Department of Orthopaedics, Ohio State University Medical Center, Columbus, USA.
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67
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Baumgarten KM, Carey JL, Abboud JA, Jones GL, Kuhn JE, Wolf BR, Brophy RH, Cox CL, Wright RW, Vidal AF, Ma CB, McCarty EC, Holloway GB, Spencer EE, Dunn WR. Reliability of determining and measuring acromial enthesophytes. HSS J 2011; 7:218-22. [PMID: 23024617 PMCID: PMC3192897 DOI: 10.1007/s11420-011-9209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 05/04/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the reliability of determining acromial morphology has been examined, to date, there has not been an analysis of interobserver and intraobserver reliability on determining the presence and measuring the size of an acromial enthesophyte. QUESTIONS/PURPOSES The hypothesis of this study was that there will be poor intraobserver and interobserver reliability in the (1) determination of the presence of an acromial enthesophyte, (2) determination of the size of an acromial enthesophyte, and (3) determination of acromial morphology. PATIENTS AND METHODS Fifteen fellowship-trained orthopedic shoulder surgeons reviewed the radiographs of 15 patients at two different intervals. Measurement of acromial enthesophytes was performed using two techniques: (1) enthesophyte length and (2) enthesophyte-humeral distance. Acromial morphology was also determined. Interobserver and intraobserver agreement was determined using intraclass correlation and kappa statistical methods. RESULTS The interobserver reliability was fair to moderate and the intraobserver reliability moderate for determining the presence of an acromial enthesophyte. The measurement of the enthesophyte length showed poor interobserver and intraobserver reliability. The measurement of the enthesophyte-humeral distance showed poor interobserver reliability and moderate intraobserver reliability. The interobserver and intraobserver reliability in determining acromial morphology was found to be moderate and good, respectively. CONCLUSIONS There is fair to moderate reliability among fellowship-trained shoulder surgeons in determining the presence of an acromial enthesophyte. However, there is poor reliability among observers in measuring the size of the enthesophyte. This study suggests that the enthesophyte-humeral distance may be more reliable than the enthesophyte length when measuring the size of the enthesophyte.
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Affiliation(s)
- Keith M. Baumgarten
- Sports Medicine and Shoulder Surgery Section, Orthopedic Institute, 810 E 23rd Street, Sioux Falls, SD 57117 USA
| | - James L. Carey
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN USA
| | - Joseph A. Abboud
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA USA
| | - Grant L. Jones
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH USA
| | - John E. Kuhn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN USA
| | - Brian R. Wolf
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Charles L. Cox
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN USA
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Armando F. Vidal
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - Eric C. McCarty
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO USA
| | - G. Brian Holloway
- Shoulder and Elbow Institute, Knoxville Orthopaedic Clinic, Knoxville, TN USA
| | - Edwin E. Spencer
- Shoulder and Elbow Institute, Knoxville Orthopaedic Clinic, Knoxville, TN USA
| | - Warren R. Dunn
- Department of Orthopaedics & Rehabilitation, Health Sciences Research Center, Vanderbilt University Medical Center, Nashville, TN USA
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68
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Griesser MJ, Harris JD, Campbell JE, Jones GL. Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg Am 2011; 93:1727-33. [PMID: 21938377 DOI: 10.2106/jbjs.j.01275] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael J Griesser
- Department of Orthopaedics, The Ohio State University Medical Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221, USA
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69
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Mumm HP, Chupp TE, Cooper RL, Coulter KP, Freedman SJ, Fujikawa BK, García A, Jones GL, Nico JS, Thompson AK, Trull CA, Wilkerson JF, Wietfeldt FE. New limit on time-reversal violation in beta decay. Phys Rev Lett 2011; 107:102301. [PMID: 21981496 DOI: 10.1103/physrevlett.107.102301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 05/31/2023]
Abstract
We report the results of an improved determination of the triple correlation DP·(p(e)×p(v)) that can be used to limit possible time-reversal invariance in the beta decay of polarized neutrons and constrain extensions to the standard model. Our result is D=[-0.96±1.89(stat)±1.01(sys)]×10(-4). The corresponding phase between gA and gV is ϕAV=180.013°±0.028° (68% confidence level). This result represents the most sensitive measurement of D in nuclear β decay.
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Affiliation(s)
- H P Mumm
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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70
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Abstract
The optimal surgical treatment for symptomatic os acromiale that has failed nonoperative management is unclear in the literature. We conducted a systematic review of multiple medical databases for level I–IV evidence. Both radiographic and clinical outcomes were analyzed. Nine studies met the inclusion criteria (118 subjects, 125 shoulders). One hundred and fifteen subjects were treated surgically (122 shoulders). The mean age of the subjects was 49±11 years. The mean preoperative duration of symptoms was 12±8.6 months. Mesoacromiale was the most common type treated (94%). Internal fixation was the most common surgical technique used (60%), followed by excision (27%) and acromioplasty (13%). Rotator cuff repair was the most common concurrent surgical technique (performed in 59% of the surgically treated shoulders), followed by distal clavicle excision (25%). All surgical techniques resulted in improvement in clinical outcomes. Surgical management of symptomatic os acromiale that has failed nonoperative measures may predictably lead to improved outcomes.
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Affiliation(s)
- Joshua D Harris
- Department of Orthopaedics, The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
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71
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72
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Griesser MJ, Harris JD, Likes RL, Jones GL. Synovial chondromatosis of the elbow causing a mechanical block to range of motion: a case report and review of the literature. Am J Orthop (Belle Mead NJ) 2011; 40:253-256. [PMID: 21734934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a unique case of elbow synovial chondromatosis with sudden onset of severe loss of elbow extension and flexion range of motion caused by mechanical block from deposition of chondral fragments in the olecranon and coronoid fossae, respectively. We performed successful arthroscopic surgical treatment of synovial chondromatosis of the elbow. Arthroscopy examination revealed an acutely evolving synovial chondromatosis. Three-year follow-up indicated that arthroscopic removal of loose bodies and partial synovectomy can yield lasting improvement in motion without disease recurrence.
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74
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Lee WT, Tong X, Pierce J, Fleenor M, Ismaili A, Robertson JL, Chen WC, Gentile TR, Hailemariam A, Goyette R, Parizzi A, Lauter V, Klose F, Kaiser H, Lavelle C, Baxter DV, Jones GL, Wexler J, McCollum L. In-situ Polarized3He-Based Neutron Polarization Analyzer for SNS Magnetism Reflectometer. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/251/1/012086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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75
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Lindley K, Jones GL. Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead NJ) 2010; 39:592-600. [PMID: 21720577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Full-thickness rotator cuff tears are common. When symptomatic, they can affect quality of life. Surgical repair might improve patients' overall health. We systematically reviewed postoperative outcomes in 10 studies comparing mini-open repair and all-arthroscopic repair techniques. Data regarding patient demographics, rotator cuff pathology, postoperative rehabilitation protocols, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, pain scores, and incidence of recurrent defects were extracted. There were no statistically significant differences between groups within each study in terms of these data points. One study found decreased pain 6 months after surgery in the all-arthroscopic group versus the miniopen repair group. This systematic literature review indicates there is no statistically significant difference in postoperative ASES, UCLA, or pain scores or incidence of recurrent rotator cuff tears in rotator cuffs repaired all-arthroscopically versus using the mini-open technique. However, there might be decreased short-term pain in patients who undergo arthroscopic repairs.
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Affiliation(s)
- Kenneth Lindley
- Department of Orthopaedic Surgery and Sports Medicine, University of South Carolina, Columbia, USA
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76
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Waylen AL, Jones GL, Ledger WL. Effect of cigarette smoking upon reproductive hormones in women of reproductive age: a retrospective analysis. Reprod Biomed Online 2010; 20:861-5. [PMID: 20378408 DOI: 10.1016/j.rbmo.2010.02.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/02/2009] [Accepted: 01/25/2010] [Indexed: 11/24/2022]
Abstract
There is continuing debate concerning the relationship between cigarette smoking and premature ovarian failure. The aim of this retrospective data analysis was to investigate whether smoking has a measurable effect on early follicular serum concentrations of inhibin B hormone, FSH and anti-Müllerian hormone (AMH) in women of reproductive age. A database containing data on age, smoking status and serum concentrations of inhibin B, FSH and AMH was analysed. Pearson's correlation coefficient was calculated to determine the correlation between hormone concentrations and age. One-way analysis of variance was used to determine any significant difference in age between smoking categories and a univariate general linear model was used to compare geometric means and geometric mean ratios of hormone concentrations in relation to smoking status. Serum concentrations of inhibin B were significantly lower in women who had ever smoked cigarettes: F(2,332) = 3.371, P = 0.036. There was no statistically significant difference in FSH or AMH concentrations although a trend towards lower AMH concentrations in smokers was observed. This analysis provides evidence of an advancement of ovarian ageing in women who smoke cigarettes and is relevant to women of childbearing age who wish to avoid premature decline in fertility.
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Affiliation(s)
- A L Waylen
- University of Sheffield School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S102RX, UK.
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Proctor SJ, Lennard AL, Jackson GH, Jones GL, Lewis J, Wilkinson J, White J, Sieniawski M, McKay P, Culligan D, Lucraft HH. The role of an all-oral chemotherapy containing lomustine (CCNU) in advanced,fs progressive Hodgkin lymphoma: a patient-friendly palliative option which can result in long-term disease control. Ann Oncol 2009; 21:426-428. [PMID: 19901016 DOI: 10.1093/annonc/mdp527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S J Proctor
- Northern Institute of Cancer Research, Academic Haematology, Medical School, Newcastle University.
| | | | | | | | - J Lewis
- Northern Centre for Cancer Treatment, Newcastle NHS Hospital Foundation Trust
| | - J Wilkinson
- Institute of Health and Society, Newcastle University
| | - J White
- Scotland and Newcastle Lymphoma Group, Academic Haematology, Medical School, Newcastle University, Newcastle upon Tyne
| | - M Sieniawski
- Northern Institute of Cancer Research, Academic Haematology, Medical School, Newcastle University
| | - P McKay
- Department of Haematology, Gartnavel General Hospital, Glasgow
| | - D Culligan
- Department of Haematology, Ward 16, Anchor Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - H H Lucraft
- Northern Centre for Cancer Treatment, Newcastle NHS Hospital Foundation Trust
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78
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Scott AD, Musa O, Al-Hassani F, Jones GL, Hobson MB, Miller JG. Is the Patient Outcomes Of Surgery (POS)-Hand/Arm questionnaire a reliable, valid and responsive measurement of patient-based outcomes in hand and upper limb surgery? J Hand Surg Eur Vol 2009; 34:530-6. [PMID: 19587081 DOI: 10.1177/1753193409102458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of our study was to evaluate a new region-specific outcome measure in hand and upper limb surgery: the Patient Outcomes of Surgery (POS)-Hand/Arm questionnaire using the generic Short Form Health Survey (SF)-36 questionnaire as a 'gold standard' comparative measure. The POS-Hand/Arm preop questionnaire and the SF-36 questionnaire were completed by 214 patients on the day of their hand or upper limb surgery; and a postop POS-Hand/Arm and the SF-36 questionnaire were completed by patients 3 months after their initial surgery. The POS-Hand/Arm questionnaire responses were psychometrically evaluated and it was shown to have high internal consistency; high total-item correlations; signification scale correlations with the SF-36; and a low proportion of missing data. The POS-Hand/Arm questionnaire is a psychometrically sound instrument that can be used pre- and post-surgery to evaluate patient-based outcomes for a wide range of conditions in hand and upper limb surgery.
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Affiliation(s)
- A D Scott
- Department of Plastic Surgery, Northern General Hospital, Sheffield, UK.
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79
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Waylen AL, Metwally M, Jones GL, Wilkinson AJ, Ledger WL. Effects of cigarette smoking upon clinical outcomes of assisted reproduction: a meta-analysis. Hum Reprod Update 2008; 15:31-44. [PMID: 18927070 DOI: 10.1093/humupd/dmn046] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis was to investigate whether any difference exists in success rate of clinical outcomes of assisted reproductive technologies (ART) between women who actively smoke cigarettes at the time of treatment and those who do not. METHODS An intensive computerized search was conducted on published literature from eight databases, using search terms related to smoking, assisted reproduction and outcome measures. Eligible studies compared outcomes of ART between cigarette smoking patients and a control group of non-smoking patients and reported on live birth rate per cycle, clinical pregnancy rate per cycle, ectopic pregnancy rate per pregnancy or spontaneous miscarriage rate per pregnancy, and 21 studies were included in the meta-analyses. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for the data, and statistical heterogeneity was tested for using chi(2) and I(2) values. A systematic review examined the effect of smoking upon fertilization rates across 17 studies. RESULTS Smoking patients demonstrated significantly lower odds of live birth per cycle (OR 0.54, 95% CI 0.30-0.99), significantly lower odds of clinical pregnancy per cycle (OR 0.56, 95% CI 0.43-0.73), significantly higher odds of spontaneous miscarriage (OR 2.65, 95% CI 1.33-5.30) and significantly higher odds of ectopic pregnancy (OR 15.69, 95% CI 2.87-85.76). A systematic literature review revealed that fertilization rates were not significantly different between smoking and non-smoking groups in most studies. CONCLUSIONS This meta-analysis provides compelling evidence for a significant negative effect of cigarette smoking upon clinical outcomes of ART and should be presented to infertility patients who smoke cigarettes in order to optimize success rates.
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Affiliation(s)
- A L Waylen
- University of Sheffield School of Medicine and Biomedical Sciences, Sheffield, UK.
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80
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Jones GL, Ledger W, Mitchell C. [Suspected premature menopause]. Praxis (Bern 1994) 2008; 97:1089-1090. [PMID: 18850527 DOI: 10.1024/1661-8157.97.20.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- G L Jones
- Health Services Research Section, School of Health and Related Research, University of Sheffield, UK.
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81
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Abstract
The aim of this review was to identify the ways in which obesity affects the health-related quality of life (HRQoL) of postmenopausal women. This was considered important because a growing body of literature has identified obesity as a significant predictor for a poor psychological wellbeing and negative HRQoL, particularly in women, and because during the transition through the menopause women tend to accumulate more body weight. After searching eight electronic databases, only nine papers appeared meaningful. Although a meta-analysis was not possible, we found that a body mass index (BMI) >30 kg/m2 was associated with a poor HRQoL in postmenopausal women; particularly in the areas associated with physical functioning, energy and vitality, and health perceptions. Thus, clinical management of obese postmenopausal women should focus on weight reduction and exercise in an attempt to improve wellbeing in these areas. However, the paucity of research, the different instruments chosen to measure HRQoL and the methodological limitations of the studies identified, prevented firm conclusions being made about whether the relationship between BMI and HRQoL is linear in postmenopausal women. Further research is needed to explore this relationship; particularly in comparison with underweight postmenopausal women and obese premenopausal women, where a few papers have identified these women as having a worse HRQoL than their obese postmenopausal counterparts. Other measures of central adiposity, including waist circumference and waist-hip ratio are recommended as useful supplemental measures to BMI in future studies.
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Affiliation(s)
- G L Jones
- Health Services Research Section; ScHARR, Sheffield, UK
| | - A Sutton
- Information Resources, ScHARR, Sheffield, UK
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Jones GL, Hall JM, Balen AH, Ledger WL. Health-related quality of life measurement in women with polycystic ovary syndrome: a systematic review. Hum Reprod Update 2008; 14:15-25. [PMID: 17905857 DOI: 10.1093/humupd/dmm030] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The symptoms typically associated with polycystic ovary syndrome (PCOS) such as acne, hirsutism, irregular menses, amenorrhoea, obesity and subfertility are a major source of psychological morbidity and can negatively affect quality of life (QoL). We systematically searched the literature to identify the impact of symptoms and treatments for PCOS on health-related QoL (HRQoL) and to report on the types and psychometric properties of the instruments used. Papers were retrieved by systematically searching four electronic databases and hand searching relevant reference lists and bibliographies. Nineteen papers used a standardized questionnaire to measure health status; of these 12 (63.2%) used generic tools and 8 (42%) used the disease-specific PCOS questionnaire. Although a meta-analysis was not possible, it appears that weight concerns have a particular negative impact upon HRQoL, although the role of body mass index in affecting HRQoL scores is inconclusive from the available evidence. Acne is the area least reported upon in terms of its impact upon HRQoL. With the exception of three studies, most of the research has focused upon adult women with PCOS. Despite the benefits of HRQoL measures in research, few are being used to evaluate the outcomes of treatment for PCOS upon the subjective health status of women with the condition.
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Affiliation(s)
- G L Jones
- Health Services Research Section, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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83
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Abstract
BACKGROUND The 1-incision and 2-incision techniques are commonly used methods to repair a distal biceps rupture, and they differ in the location of reinsertion of tendon into bone. HYPOTHESIS The native distal biceps brachii tendon inserts on the posterior-ulnar aspect of the bicipital tuberosity, which functions as a cam, increasing the tendon's moment arm during its principal action of forearm supination. Repair of the distal biceps tendon to the anterior aspect of the tuberosity compromises forearm supination due to absence of the bicipital tuberosity's cam effect. STUDY DESIGN Controlled laboratory study. METHODS Eleven matched pairs of fresh-frozen cadaveric upper extremities were prepared for repair of the distal biceps tendon using either anterior or posterior reattachment with transosseous suture fixation. Specimens were tested on a materials testing machine with intact distal biceps insertion and after repair. A load cell at the distal radial-ulnar joint measured resultant elbow flexion and forearm supination torque produced by 100-N force applied to the proximal aspect of the tendon. RESULTS Although there was a trend (P= .104) toward loss of supination torque with the anterior reconstruction method, no significant differences in torque (0.80 vs 0.89 N.m) or flexion force (11.87 vs 12.07 N) were found between the anterior and posterior reconstruction techniques. CONCLUSION There is no statistically significant difference in flexion force or supination torque between the anterior and posterior reconstruction techniques. CLINICAL RELEVANCE This study supports existing limited clinical data suggesting no functional differences exist between 2 common repair methods. Further biomechanical and clinical investigations directly comparing the results of distal biceps tendon repairs made to the anterior aspect versus the posterior aspect of the tuberosity are necessary to definitely determine if differences exist in resultant elbow flexion and forearm supination functions.
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Affiliation(s)
- Jon Henry
- Aurora Healthcare Orthopedic Surgery, Manitowoc, Wisconsin, USA
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Worrillow LJ, Smith AG, Scott K, Andersson M, Ashcroft AJ, Dores GM, Glimelius B, Holowaty E, Jackson GH, Jones GL, Lynch CF, Morgan G, Pukkala E, Scott D, Storm HH, Taylor PR, Vyberg M, Willett E, Travis LB, Allan JM. Polymorphic MLH1 and risk of cancer after methylating chemotherapy for Hodgkin lymphoma. J Med Genet 2007; 45:142-6. [PMID: 17959715 DOI: 10.1136/jmg.2007.053850] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Methylating agents are effective chemotherapy agents for Hodgkin lymphoma, but are associated with the development of second primary cancers. Cytotoxicity of methylating agents is mediated primarily by the DNA mismatch repair (MMR) system. Loss of MLH1, a major component of DNA MMR, results in tolerance to the cytotoxic effects of methylating agents and persistence of mutagenised cells at high risk of malignant transformation. We hypothesised that a common substitution in the basal promoter of MLH1 (position -93, rs1800734) modifies the risk of cancer after methylating chemotherapy. METHODS 133 patients who developed cancer following chemotherapy and/or radiotherapy (n = 133), 420 patients diagnosed with de novo myeloid leukaemia, 242 patients diagnosed with primary Hodgkin lymphoma, and 1177 healthy controls were genotyped for the MLH1 -93 polymorphism by allelic discrimination polymerase chain reaction (PCR) and restriction fragment length polymorphism assay. Odds ratios and 95% confidence intervals for cancer risk by MLH1 -93 polymorphism status, and stratified by previous exposure to methylating chemotherapy, were calculated using unconditional logistic regression. RESULTS Carrier frequency of the MLH1 -93 variant was higher in patients who developed therapy related acute myeloid leukaemia (t-AML) (75.0%, n = 12) or breast cancer (53.3%. n = 15) after methylating chemotherapy for Hodgkin lymphoma compared to patients without previous methylating exposure (t-AML, 30.4%, n = 69; breast cancer patients, 27.2%, n = 22). The MLH1 -93 variant allele was also over-represented in t-AML cases when compared to de novo AML cases (36.9%, n = 420) and healthy controls (36.3%, n = 952), and was associated with a significantly increased risk of developing t-AML (odds ratio 5.31, 95% confidence interval 1.40 to 20.15), but only in patients previously treated with a methylating agent. CONCLUSIONS These data support the hypothesis that the common polymorphism at position -93 in the core promoter of MLH1 defines a risk allele for the development of cancer after methylating chemotherapy for Hodgkin lymphoma. However, replication of this finding in larger studies is suggested.
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Affiliation(s)
- L J Worrillow
- Department of Biology, University of York, Heslington, York, UK
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Abstract
BACKGROUND Children's palliative care services have recently been awarded fixed-term grants, aimed at improving the provision of care for children with life-limiting conditions in the community. We report findings of a qualitative study to investigate the experience of a cohort of community children's nurses from teams involved in setting up or extending community-based children's palliative care services. The purpose of the study was to identify factors that affect service delivery, from the staff perspective, and to suggest ways of promoting their sustainable development. METHODS Semi-structured telephone interviews were conducted with 21 nurses from 12 different teams providing palliative care for children at home and in hospices. Participants were questioned about the services they provided and their own roles in that provision. NVIVO qualitative data analysis software was used to explore themes arising from the transcribed recorded interviews. FINDINGS Key findings were the importance of physical location in facilitating multidisciplinary communication, the importance of defining role boundaries between existing and new providers of children's palliative care, and the potentially detrimental impact of insecure funding on referral patterns and recruitment to posts. Staff named the opportunity to offer direct 'hands-on' care to families, access to work-based support and networking opportunities as important factors in helping them cope with the stresses involved in managing finite resources and the emotional challenges of their work. CONCLUSIONS The maintenance of a mixed caseload with a significant proportion of direct care, provision of ongoing support and clearly defined roles are recommended as means of bolstering the ability of staff to develop their services. The deliberate locating of services to enhance communication between staff and guidance on the preparation of funding applications may further contribute to the sustainability of these services.
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Affiliation(s)
- A J Beringer
- University of the West of England Bristol, Bristol, UK.
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86
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Jones GL, Taylor PRA, Windebank KP, Hoye NA, Lucraft H, Wood K, Angus B, Proctor SJ. Outcome of a risk-related therapeutic strategy used prospectively in a population-based study of Hodgkin's lymphoma in adolescents. Br J Cancer 2007; 97:29-36. [PMID: 17533403 PMCID: PMC2359673 DOI: 10.1038/sj.bjc.6603809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim was to assess outcome in a population-based cohort of adolescents with Hodgkin's lymphoma (HL) diagnosed in the UK's northern region over a 10-year period. Among a population of 3.09 million, 55 of 676 patients (8%) diagnosed with HL were aged 13–19. Seven had nodular lymphocyte-predominant HL, 48 classical HL (cHL). Of the latter, 36 were ⩾16 years. Application of the Scottish and Newcastle Lymphoma Group (SNLG) prognostic index meant 21 patients were considered high risk (index ⩾0.5). They received PVACEBOP multi-agent chemotherapy as primary therapy. Standard risk patients (SNLG index <0.5) were treated with standard ChlVPP or ABVD chemotherapy±radiotherapy. Scottish and Newcastle Lymphoma Group indexing is not valid for patients under 16. Twelve patients therefore received UKCCSG protocols (n=8), ABVD plus radiotherapy (n=2), or PVACEBOP (n=2). Forty-six patients with cHL (96%) achieved complete remission. Seven patients relapsed but all entered complete remission after salvage therapy. Five patients died: three of HL, one in an accident and one of disseminated varicella complicating cystic fibrosis. Five- and 10-year overall survival was 93 and 86%, respectively; disease-specific survival was 95 and 92%. The data suggest that older adolescents with high-risk HL require intensive protocols as primary therapy to secure optimal outcome.
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Affiliation(s)
- G L Jones
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - P R A Taylor
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - K P Windebank
- Paediatric Oncology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - N A Hoye
- Northumbria Healthcare NHS Trust, North Shields Tyne & Wear NE29 8NH, UK
| | - H Lucraft
- Northern Centre for Cancer Treatment, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 6BE, UK
| | - K Wood
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - B Angus
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - S J Proctor
- Academic Haematology, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- E-mail:
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87
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Abstract
Superior labral anterior posterior (SLAP) lesions of the glenoid have proven difficult to diagnose clinically. SLAP-lesion-specific physical examination tests have been developed to improve clinical acumen. Initial reported performance of these tests has not been reproduced by independent investigation. We hypothesized SLAP-specific physical examination tests could not provide a definitive diagnosis of a SLAP lesion. We further intended to elucidate factors responsible for the variable performance of SLAP-specific tests. A review of the literature through Medline and Embase database searches was conducted. All studies with level of evidence of III or better involved in the reporting of diagnostic accuracy of SLAP-specific physical examination tests were included and reviewed. Each instance of independent evaluation of a SLAP-specific examination showed poorer examination performance than in the originating study. Considerable variability existed between independent evaluations of a given SLAP-specific examination as well. We concluded SLAP-specific physical examination results cannot be used as the sole basis of a diagnosis of a SLAP lesion. Differences in patient populations between studies and the accompanying differences in SLAP lesion prevalence and comorbid conditions played the greatest role in test result variance.
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Affiliation(s)
- Grant L Jones
- Ohio State University, Division of Sports Medicine, Department of Orthopaedics, Columbus, OH 43220, USA
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88
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Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ. Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG 2006; 113:231-8. [PMID: 16412003 DOI: 10.1111/j.1471-0528.2005.00820.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop and evaluate a Web-based, electronic pelvic floor symptoms assessment questionnaire (e-PAQ)1 for women. DESIGN A cross-sectional study in primary and secondary care. SETTING Two general practices, two community health clinics and a secondary care urogynaecology clinic. SAMPLE A total of 432 women (204 in primary care and 228 in secondary care) were recruited between June 2003 and January 2004. METHODS The e-PAQ was located on a workstation (computer, touchscreen and printer). Women completed the e-PAQ prior to their appointment. Untreated women in primary care were asked to return seven days later to complete the e-PAQ a second time (test-retest). MAIN OUTCOME MEASURES Factor analysis, reliability, validity, patient satisfaction, completion times and system costs. RESULTS In secondary care, factor analysis identified 14 domains within the four dimensions (urinary, bowel, vaginal and sexual symptoms) with internal consistency (Cronbach's alpha)>or=0.7 in 11 of these. In primary care, alpha values were all>or=0.7 and test-retest analysis found acceptable intraclass correlations of 0.50-0.95 (P<0.001) for all domains. A measure of face validity and utility was gained using a nine-item questionnaire, which yielded strongly positive patient views on relevance and acceptability. CONCLUSIONS The e-PAQ offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation and may enhance the clinical episode as well as the quality of care for women with pelvic floor disorders.
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Affiliation(s)
- S C Radley
- Department of Obstetrics and Gynaecology, Royal Hallamshire Hospital, Sheffield, and Statistical Sciences Department, Leicester University, UK
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89
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Abstract
We present the case of a previously healthy 59-year-old man who was under treatment for scleritis and episcleritis when he developed a parotid-gland swelling and pus-producing sinus. On surgical exploration, the features were those of a parotid abscess, but the lesion not only failed to heal post-operatively but increased in size very significantly. There was also severe necrotizing keratitis of the eyes. Due to clinical suspicion and a positive antineutrophil cytoplasmic antibodies test, Wegener’s granulomatosis was diagnosed and the patient successfully treated with cyclophosphamide and steroids. Previously, a number of cases of Wegener’s granulomatosis causing salivary-gland swelling have been reported in the literature; this is the first case in which the disease has masqueraded as a parotid abscess.
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Affiliation(s)
- G L Jones
- Department of Otorhinolaryngology, Royal Gwent Hospital, Newport, Wales.
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90
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Jones GL, Juszczak MT, Hughes SJ, Powis SH, Press M. An Improved Method of Fluorescent Dual Insulin and Endothelial Staining Allows Visualisation of the Revascularisation of Intraportally Transplanted Islets. Transplant Proc 2005; 37:3509-11. [PMID: 16298644 DOI: 10.1016/j.transproceed.2005.09.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intraportally transplanted islets are avascular at the time of transplantation and take up to 14 days to fully revascularize, during which time up to 60% of islet mass may be lost. To investigate and improve islet revascularization, a robust method for the visualization and quantification of this process is required. METHODS Islets isolated from Lewis rats were transplanted intraportally into the liver of diabetic syngeneic Lewis recipients. The animals were humanely killed either on the day of transplant or at 3, 5, 7, or 14 days posttransplant. The harvested livers were sectioned and stained with Bandeiraea simplicifolia lectin (for endothelial cells) and anti-insulin antibody and counterstained with DAPI. The slides were visualized with a fluorescent microscope. RESULTS Islets were visualized over the whole time course. Insulin and endothelial staining was clearly visualized on the day of transplantation, but by day 3 endothelial staining was scarce within the islet. By day 5, early vessel formation could be seen within the islet, but insulin staining was patchy and associated with apoptotic nuclei. By day 7, vessels could be seen throughout the islet and insulin staining had returned. Day 14 sections showed a fully revascularized islet. CONCLUSIONS The staining provided good delineation of islet endothelium and beta-cell location, with clear observation of the revascularization process. This technique also suggests that days 3 through 5 may be a critical period for islet survival and provides a good model for studying the effects of manipulating the revascularization process.
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Affiliation(s)
- G L Jones
- Centre for Nephrology and Department of Endocrinology, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, United Kingdom.
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91
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Wilburn WS, Bowman JD, Mitchell GS, O'Donnell JM, Penttila SI, Seo PN, Calarco JR, Hersmann FW, Chupp TE, Cianciolo TV, Rykaczewski KP, Young GR, De Souza RT, Snow WM, Desai D, Greene GL, Grzywacz RK, Frlez E, Pocanic D, Gentile TR, Gudkov V, Jones GL. Measurement of Neutron Decay Parameters-The abBA Experiment. J Res Natl Inst Stand Technol 2005; 110:389-393. [PMID: 27308155 PMCID: PMC4852843 DOI: 10.6028/jres.110.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/11/2004] [Indexed: 06/06/2023]
Abstract
We are developing an experiment to measure the correlations a, A, and B, and the Fierz interference term b in neutron decay, with a precision of approximately 10(-4). The experiment uses an electromagnetic spectrometer in combination with two large-area segmented silicon detectors to detect the proton and electron from the decay in coincidence, with 4π acceptance for both particles. For the neutron-polarization-dependent observables A and B, precision neutron polarimetry is achieved through the combination of a pulsed neutron beam, under construction at the SNS, and a polarized (3)He neutron polarizer. Measuring a and A in the same apparatus provides a redundant determination of λ = gA/gV . Uncertainty in λ dominates the uncertainty of CKM unitarity tests.
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Affiliation(s)
- W S Wilburn
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - J D Bowman
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - G S Mitchell
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - J M O'Donnell
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - S I Penttila
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - P-N Seo
- Los Alamos National Laboratory, Los Alamos, NM 87544
| | - J R Calarco
- University of New Hampshire, Durham, NH 03824
| | | | - T E Chupp
- University of Michigan, Ann Arbor, MI 48109
| | | | | | - G R Young
- Oak Ridge National Laboratory, Oak Ridge, TN 37831
| | | | - W M Snow
- Indiana University, Bloomington, IN 47408
| | - D Desai
- University of Tennessee, Knoxville, TN 37996
| | - G L Greene
- University of Tennessee, Knoxville, TN 37996
| | | | - E Frlez
- University of Virginia, Charlottesville, VA 22904
| | - D Pocanic
- University of Virginia, Charlottesville, VA 22904
| | - T R Gentile
- National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - V Gudkov
- University of South Carolina, Columbia, SC 29208
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92
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Gentile TR, Chen WC, Jones GL, Babcock E, Walker TG. Polarized (3) He Spin Filters for Slow Neutron Physics. J Res Natl Inst Stand Technol 2005; 110:299-304. [PMID: 27308140 PMCID: PMC4849589 DOI: 10.6028/jres.110.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2004] [Indexed: 05/09/2023]
Abstract
Polarized (3)He spin filters are needed for a variety of experiments with slow neutrons. Their demonstrated utility for highly accurate determination of neutron polarization are critical to the next generation of betadecay correlation coefficient measurements. In addition, they are broadband devices that can polarize large area and high divergence neutron beams with little gamma-ray background, and allow for an additional spin-flip for systematic tests. These attributes are relevant to all neutron sources, but are particularly well-matched to time of flight analysis at spallation sources. There are several issues in the practical use of (3)He spin filters for slow neutron physics. Besides the essential goal of maximizing the (3)He polarization, we also seek to decrease the constraints on cell lifetimes and magnetic field homogeneity. In addition, cells with highly uniform gas thickness are required to produce the spatially uniform neutron polarization needed for beta-decay correlation coefficient experiments. We are currently employing spin-exchange (SE) and metastability-exchange (ME) optical pumping to polarize (3)He, but will focus on SE. We will discuss the recent demonstration of 75 % (3)He polarization, temperature-dependent relaxation mechanism of unknown origin, cell development, spectrally narrowed lasers, and hybrid spin-exchange optical pumping.
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Affiliation(s)
- T R Gentile
- National Institute of Standards and Technology, Gaithersburg, MD 20899-0001
| | - W C Chen
- National Institute of Standards and Technology, Gaithersburg, MD 20899-0001
| | | | - E Babcock
- University of Wisconsin at Madison, Madison, Wisconsin
| | - T G Walker
- University of Wisconsin at Madison, Madison, Wisconsin
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93
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Page SA, Bowman JD, Carlini RD, Case T, Chupp TE, Coulter KP, Dabaghyan M, Desai D, Freedman SJ, Gentile TR, Gericke MT, Gillis RC, Greene GL, Hersman FW, Ino T, Ishimoto S, Jones GL, Lauss B, Leuschner MB, Losowski B, Mahurin R, Masuda Y, Mitchell GS, Nann H, Penttila SI, Ramsay WD, Santra S, Seo PN, Sharapov EI, Smith TB, Snow WM, Wilburn WS, Yuan V, Zhu H. Measurement of Parity Violation in np Capture: the NPDGamma Experiment. J Res Natl Inst Stand Technol 2005; 110:195-203. [PMID: 27308121 PMCID: PMC4849605 DOI: 10.6028/jres.110.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2004] [Indexed: 05/30/2023]
Abstract
The NPDGamma experiment will measure the parity-violating directional gamma ray asymmetry A γ in the reaction [Formula: see text]. Ultimately, this will constitute the first measurement in the neutron-proton system that is sensitive enough to challenge modern theories of nuclear parity violation, providing a theoretically clean determination of the weak pion-nucleon coupling. A new beam-line at the Los Alamos Neutron Science Center (LANSCE) delivers pulsed cold neutrons to the apparatus, where they are polarized by transmission through a large volume polarized (3)He spin filter and captured in a liquid para-hydrogen target. The 2.2 MeV gamma rays from the capture reaction are detected in an array of CsI(Tl) scintillators read out by vacuum photodiodes operated in current mode. We will complete commissioning of the apparatus and carry out a first measurement at LANSCE in 2004-05, which would provide a statistics-limited result for A γ accurate to a standard uncertainty of ±5 × 10(-8) level or better, improving on existing measurements in the neutron-proton system by a factor of 4. Plans to move the experiment to a reactor facility, where the greater flux would enable us to make a measurement with a standard uncertainty of ±1 × 10(-8), are actively being pursued for the longer term.
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Affiliation(s)
| | - J D Bowman
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - R D Carlini
- Thomas Jefferson National Accelerator Facility, Newport News VA 23606
| | - T Case
- University of California, Berkeley, CA 94720-7300
| | - T E Chupp
- University of Michigan, Ann Arbor, MI 48109-1120
| | - K P Coulter
- University of Michigan, Ann Arbor, MI 48109-1120
| | - M Dabaghyan
- University of New Hampshire, Durham, NH 03824
| | - D Desai
- University of Tennessee, Knoxville, TN 37996-1200
| | - S J Freedman
- University of California, Berkeley, CA 94720-7300
| | - T R Gentile
- National Institute of Standards and Technology, Gaithersburg, MD 20899-0001
| | - M T Gericke
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - R C Gillis
- University of Manitoba, Winnipeg, MB Canada R3T 2N2
| | - G L Greene
- University of Tennessee, Knoxville, TN 37996-1200
| | - F W Hersman
- University of New Hampshire, Durham, NH 03824
| | - T Ino
- KEK National Laboratory, Tsukuba, Ibaraki 305-0801 Japan
| | - S Ishimoto
- KEK National Laboratory, Tsukuba, Ibaraki 305-0801 Japan
| | | | - B Lauss
- University of California, Berkeley, CA 94720-7300
| | - M B Leuschner
- Indiana University Cyclotron Facility, Bloomington, IN 47408-1398
| | - B Losowski
- Indiana University Cyclotron Facility, Bloomington, IN 47408-1398
| | - R Mahurin
- University of Tennessee, Knoxville, TN 37996-1200
| | - Y Masuda
- KEK National Laboratory, Tsukuba, Ibaraki 305-0801 Japan
| | - G S Mitchell
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - H Nann
- Indiana University Cyclotron Facility, Bloomington, IN 47408-1398
| | - S I Penttila
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - W D Ramsay
- University of Manitoba, Winnipeg, MB Canada R3T 2N2
| | - S Santra
- Indiana University Cyclotron Facility, Bloomington, IN 47408-1398
| | - P-N Seo
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - E I Sharapov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - T B Smith
- University of Dayton, Dayton OH 45469-1679
| | - W M Snow
- Indiana University Cyclotron Facility, Bloomington, IN 47408-1398
| | - W S Wilburn
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - V Yuan
- Los Alamos National Laboratory, Los Alamos, NM 87545
| | - H Zhu
- University of New Hampshire, Durham, NH 03824
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94
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Gericke MT, Bowman JD, Carlini RD, Chupp TE, Coulter KP, Dabaghyan M, Desai D, Freedman SJ, Gentile TR, Gillis RC, Greene GL, Hersman FW, Ino T, Ishimoto S, Jones GL, Lauss B, Leuschner MB, Losowski B, Mahurin R, Masuda Y, Mitchell GS, Muto S, Nann H, Page SA, Penttila SI, Ramsay WD, Santra S, Seo PN, Sharapov EI, Smith TB, Snow WM, Wilburn WS, Yuan V, Zhu H. Commissioning of the NPDGamma Detector Array: Counting Statistics in Current Mode Operation and Parity Violation in the Capture of Cold Neutrons on B 4 C and (27) Al. J Res Natl Inst Stand Technol 2005; 110:215-219. [PMID: 27308124 PMCID: PMC4849590 DOI: 10.6028/jres.110.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/11/2004] [Indexed: 06/06/2023]
Abstract
The NPDGamma γ-ray detector has been built to measure, with high accuracy, the size of the small parity-violating asymmetry in the angular distribution of gamma rays from the capture of polarized cold neutrons by protons. The high cold neutron flux at the Los Alamos Neutron Scattering Center (LANSCE) spallation neutron source and control of systematic errors require the use of current mode detection with vacuum photodiodes and low-noise solid-state preamplifiers. We show that the detector array operates at counting statistics and that the asymmetries due to B4C and (27)Al are zero to with- in 2 × 10(-6) and 7 × 10(-7), respectively. Boron and aluminum are used throughout the experiment. The results presented here are preliminary.
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Affiliation(s)
- M T Gericke
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J D Bowman
- Indiana University, Bloomington, Indiana 47405, USA
| | - R D Carlini
- Thomas Jefferson National Accelerator Facility, Newport News VA 23606, USA
| | - T E Chupp
- University of Michigan, Ann Arbor, MI 48104, USA
| | - K P Coulter
- University of Michigan, Ann Arbor, MI 48104, USA
| | - M Dabaghyan
- University of New Hampshire, Durham, NH 03824, USA
| | - D Desai
- University of Tennessee, Knoxville, TN 37996, USA
| | - S J Freedman
- University of California, Berkeley, CA 94720-7300, USA
| | - T R Gentile
- National Institute of Standards and Technology, Gaithersburg, MD 20899-0001, USA
| | - R C Gillis
- University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - G L Greene
- Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - F W Hersman
- University of New Hampshire, Durham, NH 03824, USA
| | - T Ino
- High Energy Accelerator Research Organization (KEK), Tukubash-shi, 305-0801, Japan
| | - S Ishimoto
- High Energy Accelerator Research Organization (KEK), Tukubash-shi, 305-0801, Japan
| | - G L Jones
- Hamilton College, Clinton, NY 13323, USA
| | - B Lauss
- University of California, Berkeley, CA 94720-7300, USA
| | | | - B Losowski
- Indiana University, Bloomington, Indiana 47405, USA
| | - R Mahurin
- University of Tennessee, Knoxville, TN 37996, USA
| | - Y Masuda
- High Energy Accelerator Research Organization (KEK), Tukubash-shi, 305-0801, Japan
| | - G S Mitchell
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Muto
- High Energy Accelerator Research Organization (KEK), Tukubash-shi, 305-0801, Japan
| | - H Nann
- Indiana University, Bloomington, Indiana 47405, USA
| | - S A Page
- University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada
| | - S I Penttila
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W D Ramsay
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - S Santra
- Indiana University, Bloomington, Indiana 47405, USA
| | - P-N Seo
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E I Sharapov
- Joint Institute for Nuclear Research, Dubna, Russia
| | - T B Smith
- University of Dayton, Dayton, OH 45469, USA
| | - W M Snow
- Indiana University, Bloomington, Indiana 47405, USA
| | - W S Wilburn
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - V Yuan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H Zhu
- University of New Hampshire, Durham, NH 03824, USA
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95
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Juszczak MT, Hughes SJ, Jones GL, Powis SH, Press M. Effect of donor treatment with heparinoids on graft function after intraportal transplantation of a marginal islet mass: An experimental study. Transplant Proc 2004; 36:3117-20. [PMID: 15686709 DOI: 10.1016/j.transproceed.2004.10.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Heparinoids interact with factors that are involved in ischemia-reperfusion injury and thus may prevent organ injury. We therefore studied the effects on subsequent intraportal islet transplantation of systemic administration of unfractionated and N-desulphated heparin to donors prior to pancreatectomy. Donor rats were given an intravenous injection of either heparin (1.3 mg/kg or 13.3 mg/kg; 200 U/kg or 2000 U/kg, respectively) or N-desulphated heparin (50 mg/kg; approximately 5 U/kg) at 5 to 10 minutes prior to pancreas procurement. Five hundred freshly isolated islets were injected intraportally into syngeneic male Lewis recipients that had developed streptozotocin-induced diabetes. Blood glucose and body weight were monitored for 5 weeks thereafter. Rats transplanted with islets from donors given high dose heparin showed a fall in blood glucose from 25.1 +/- 1.4 to 11.0 +/- 2.7 mmol/L (P <.01) with 60% of animals euglycemic within the first week. In contrast, the controls, did not show a fall in glucose levels at 1 week and none had become euglycaemic. Normalization of glycemia was slower in recipients of islets from animals treated with the lower dose of heparin. Results were intermediate with islets from donors given N-desulphated heparin. Nevertheless, all heparinoids used in this study caused more than a doubling of the number of animals achieving normoglycemia by 3 to 4 weeks. We hypothesize that pretreatment of the donor with heparin protects islet integrity during procurement and isolation and hence accelerates islet engraftment and remodelling. Since the effect was seen with N-desulphated heparin, which has negligible anticoagulant properties, we believe the mechanism to be independent of the anticoagulant activity.
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Affiliation(s)
- M T Juszczak
- Department of Endocrinology and Diabetes, Royal Free Campus, University College London, London, UK.
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96
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Affiliation(s)
- S C Radley
- Department of Obstetrics and Gynaecology, Royal Hallamshire Hospital, Sheffield, UK
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97
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Jones GL, Benes K, Clark TL, Denham R, Holder MG, Haynes TJ, Mulgrew NC, Shepherd KE, Wilkinson VH, Singh M, Balen A, Lashen H, Ledger WL. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ): a validation. Hum Reprod 2004; 19:371-7. [PMID: 14747184 DOI: 10.1093/humrep/deh048] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We wished to evaluate the psychometric properties of the Polycystic Ovary Syndrome Questionnaire (PCOSQ), a questionnaire developed to measure the health-related quality of life (HRQoL) of women with polycystic ovary syndrome. METHOD To assess reliability and validity, women recruited from an outpatient gynaecology clinic at the Jessop Wing, Royal Hallamshire Hospital, Sheffield completed two copies of the PCOSQ and the Short Form-36 (SF-36). Secondary factor analysis was carried out to verify the composition of the dimensions. Semi-structured interviews were conducted to assess face validity. RESULTS Of the 92 women who consented, 82 women (89%) returned questionnaires at time 1, and 69 women (75%) returned questionnaires at time 2. All five PCOSQ dimensions were internally reliable with Cronbach's alpha scores ranging from 0.70 to 0.97. Intra-class correlation coefficients to evaluate test-retest reliability were high (range 0.89-0.95, P < 0.001). Construct validity was demonstrated by high correlations for all comparisons of similar scales of the SF-36 and PCOSQ (0.49 and 0.54). Acne was identified as an important area of HRQoL missing from the questionnaire. CONCLUSIONS The PCOSQ is a reliable instrument for measuring the HRQoL in women with PCOS. However, the validity of the questionnaire needs to be improved by incorporating a dimension on acne into the instrument.
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Affiliation(s)
- G L Jones
- University of Sheffield Institute of General Practice and Primary Care, Community Sciences Building, Herries Rd, Northern General Hospital, Sheffield S5 7AU, UK.
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98
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Jones GL, Browning S, Phillipps J. The value of coagulation profiles in epistaxis management. Int J Clin Pract 2003; 57:577-8. [PMID: 14529056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
A prospective pilot study was conducted to investigate the role and relevance of clotting profiles in the management of epistaxis patients. Forty-eight per cent of the study patients had abnormal clotting profiles. Half of the abnormal clotting profiles could have been predicted from a routine history, but half could not. The coagulation screens on this group were repeated and 5% of the initial study group were found to have a persistent abnormality. The authors suggest that although coagulation screens will not predict the potential management problems associated with the epistaxis patient, they remain an important part of the clinical investigation. An epistaxis may be the only indication of an underlying coagulation disorder. The diagnosis of such a disorder following an epistaxis may lead to the treatment of an otherwise unknown condition and prevention of more serious sequelae.
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Affiliation(s)
- G L Jones
- ENT Department, Singleton Hospital, Swansea
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99
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Jones GL, Kingdon EJ, Burns AP. Anti-neutrophil cytoplasmic antibody and a pelvic mass. J R Soc Med 2003. [PMID: 12835453 PMCID: PMC539544 DOI: 10.1258/jrsm.96.7.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- G L Jones
- Centre for Nephrology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
| | - E J Kingdon
- Centre for Nephrology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - A P Burns
- Centre for Nephrology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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100
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Jones GL, Redfern RM, Jerwood DC. Deafness--a complication of nasopharyngeal airways. Anaesth Intensive Care 2002; 30:807-8. [PMID: 12500523 DOI: 10.1177/0310057x0203000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a patient who developed temporary deafness secondary to oedema of the uvula and soft palate following prolonged continuous positive airway pressure via a nasopharyngeal airway.
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Affiliation(s)
- G L Jones
- Department of Neurosurgery, Morriston Hospital, Swansea, Wales, United Kingdom
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