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Baez Hernandez N, Kirk R, Sutcliffe D, Davies R, Jaquiss R, Gao A, Zhang S, Butts RJ. Utilization and outcomes in biventricular assist device support in pediatrics. J Thorac Cardiovasc Surg 2019; 160:1301-1308.e2. [PMID: 31948738 DOI: 10.1016/j.jtcvs.2019.11.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with biventricular assist devices (BiVADs) have worse outcomes than those with left ventricular assist devices (LVADs). It is unclear whether these outcomes are due to device selection or patient factors. We used propensity score matching to reduce patient heterogeneity and compare outcomes in pediatric patients supported with BiVADs with a similar LVAD cohort. METHODS The Pedimacs registry was queried for patients who were supported with BiVAD or LVAD. Patients were analyzed by BiVAD or LVAD at primary implant and the 2 groups were compared before and after using propensity score matching. RESULTS Of 363 patients who met inclusion criteria, 63 (17%) underwent primary BiVAD support. After propensity score matching, differences between cohorts were reduced. Six months after implant, in the BiVAD cohort (LVAD cohort) 52.5% (42.5%) had been transplanted; 32.5% (40%) were alive with device, and 15% (10%) had died. Survival was similar between cohorts (P = .31, log-rank), but patients with BiVADs were more likely to experience a major adverse event in the form of bleeding (P = .04, log-rank). At 1 week and 1 and 3 months' postimplant, the percentage of patients on mechanical ventilation, on dialysis, or with elevated bilirubin was similar between the 2 groups. CONCLUSIONS When propensity scores were used to reduce differences in patient characteristics, there were no differences in survival but more major adverse events in the patients with BiVADs, particularly bleeding. Differences in unmatched patient outcomes between LVAD and BiVAD cohorts likely represent differences in severity of illness rather than mode of support.
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Abou Zahr R, Gooty V, Tandon A, Greil G, Pirolli T, Davies R, Jaquiss R, Ramaciotti C, Hussain T. Feasibility of real-time cine cardiac magnetic resonance imaging to predict the presence of significant retrosternal adhesions prior to redo-sternotomy. J Cardiovasc Magn Reson 2019; 21:67. [PMID: 31672164 PMCID: PMC6824134 DOI: 10.1186/s12968-019-0576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/21/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Injury to vital structures posterior to the sternum is a complication associated with redo sternotomy in congenital cardiac surgery. The goal of our study was a novel evaluation of real-time cine cardiovascular magnetic resonance (CMR) to predict the presence of significant retrosternal adhesions of cardiac and vascular structures prior to redo sternotomy in patients with congenital heart disease. METHODS Twenty-three patients who had prior congenital heart surgery via median sternotomy had comprehensive CMR studies prior to redo sternotomy. The real time cine (RTC) sequence that was used is an ungated balanced steady-state free precession (bSSFP) sequence using SENSitivity Encoding for acceleration with real-time reconstruction. Spontaneously breathing patients were instructed to take deep breaths during the acquisition whilst increased tidal volumes were delivered to mechanically ventilated patients. All patients underwent redo cardiac surgery subsequently and the presence and severity of retrosternal adhesions were noted at the time of the redo sternotomies. RESULTS Median age at the time of CMR and operation were 5.5 years (range, 0.2-18.4y) and 6.1 years (range, 0.3-18.8y) respectively. There were 15 males and 8 females in the study group. Preoperative retrosternal adhesions were identified on RTC in 13 patients and confirmed in 11 (85%) at the time of surgery. In only 2 patients, no adhesions were identified on CMR but were found to have significant retrosternal adhesions at surgery; false positive rate 15% (CI 0.4-29.6%), false negative rate 20% (CI 3.7-36.4%). The total classification error of the real time cine sequence was 17% (CI 1.7-32.4%) with an overall accuracy of 83% (CI 67.7-98.4%). Standard breath-hold cine images correlated poorly with surgical findings and did not increase the diagnostic yield. CONCLUSIONS RTC imaging can predict the presence of significant retrosternal adhesions and thus help in risk assessment prior to redo sternotomy. These findings complement the surgical planning and potentially reduce surgical complications .
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Lobenhofer E, Werner J, Giffin M, Engwall M, Davies R, Homann O, Lafleur M, Moffat G. P1.12-18 Nonclinical Safety Assessment of AMG 757, a DLL3 Bispecific T Cell Engager, in the Cynomolgus Monkey. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scaife J, Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Rees O, Morcam C, Webb N, Davies R, Smith E, Leopold N, Harris W, Hudson C, Edwards R. 20INTEGRATED CARE OF OLDER PEOPLE (ICOP): A NEW SERVICE DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) ON THE ACUTE ASSESSMENT UNIT AT SINGLETON HOSPITAL: RESULTS OF 2 PDSA CYCLES. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patel K, Bachiller RE, Boubertakh R, Moir S, Kozor R, Davies R, Bhuva A, Scully P, Herrey AS, Manisty C, Moon JC, Treibel TA. P434Left ventricular mechanics reveals a benign reduction in ejection fraction after valve replacement in aortic stenosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bhuva A, Bai W, Lau C, Davies R, Yang Y, Bulluck H, Mcalindon E, Cole GD, Petersen SE, Greenwood JP, Bucciarelli-Ducci C, Hughes AD, Rueckert D, Moon JC, Manisty CH. 349Fully automated left ventricular analysis matches clinician precision: a multi-centre, multi-vendor, multi-field strength, multi-disease scan:rescan CMR study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Connor M, Lorts A, Mascio C, Sutcliffe D, Davies R, Law S, Chai P, Rosenthal D, Maeda K, Nandi D, McConnell P, Morales D. Real World Data from the ACTION Quality Improvement Network - Preliminary Experience with a Magnetically Levitated Ventricular Assist Device in US Pediatric Centers. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Baez N, Kirk R, Davies R, Sutcliffe D, Bano M, Jaquiss R, Butts R. Standardized Donor Acceptance Criteria: Impact on Pediatric Waitlist and Heart Transplant Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Baez N, Davies R, Kirk R, Bano M, Sutcliffe D, Jaquiss R, Butts R. Transplant Center Refusal Rate and Waitlist Outcomes in Pediatric Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Duffield C, Davies R, Barclay P. Advances in thromboelastograph technology. Anaesthesia 2019; 73:398-399. [PMID: 29437209 DOI: 10.1111/anae.14231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barnes MC, Haase AM, Scott LJ, Linton MJ, Bard AM, Donovan JL, Davies R, Dursley S, Williams S, Elliott D, Potokar J, Kapur N, Hawton K, O'Connor RC, Hollingworth W, Metcalfe C, Gunnell D. Correction to: The help for people with money, employment or housing problems (HOPE) intervention: pilot randomised trial with mixed methods feasibility research. Pilot Feasibility Stud 2018; 4:177. [PMID: 30505459 PMCID: PMC6260749 DOI: 10.1186/s40814-018-0374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s40814-018-0365-6.].
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Phillips D, Holmes J, Davies R, Geen J, Williams JD, Phillips AO. The influence of socioeconomic status on presentation and outcome of acute kidney injury. QJM 2018; 111:849-857. [PMID: 30137472 DOI: 10.1093/qjmed/hcy180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
AIM Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. DESIGN The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. METHODS Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. RESULTS Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. CONCLUSION This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.
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Barnes MC, Haase AM, Scott LJ, Linton MJ, Bard AM, Donovan JL, Davies R, Dursley S, Williams S, Elliott D, Potokar J, Kapur N, Hawton K, O'Connor RC, Hollingworth W, Metcalfe C, Gunnell D. The help for people with money, employment or housing problems (HOPE) intervention: pilot randomised trial with mixed methods feasibility research. Pilot Feasibility Stud 2018; 4:172. [PMID: 30459961 PMCID: PMC6233378 DOI: 10.1186/s40814-018-0365-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/29/2018] [Indexed: 12/03/2022] Open
Abstract
Background Job loss, austerity measures, financial difficulties and house repossession contribute to the risk of self-harm and suicide during recessions. Navigating the benefits system and accessing sources of welfare and debt advice is a difficult experience for vulnerable people, further contributing to their distress. Whilst there is some evidence that advice-type interventions can lead to financial gain, there is mixed evidence for their effectiveness in improving mental health in those experiencing financial difficulties. There have been no interventions targeting those who have self-harmed due to economic hardship. Methods Our aim was to determine the feasibility and acceptability of a brief psychosocial intervention (the ‘HOPE’ service) for people presenting to hospital emergency departments (ED) following self-harm or in acute distress because of financial, employment or welfare (benefit) difficulties. Nineteen people consented to random allocation to the intervention or control arm on a 2:1 basis. Participants randomised to the intervention arm (n = 13) received up to six sessions of 1:1 support provided by community support staff trained in Motivational Interviewing (MI). Control participants (n = 6) received a one-off session signposting them to relevant support organisations. Fourteen participants were followed up after 3 months. Participants and mental health workers took part in qualitative interviews. The acceptability of outcome measures including the PHQ-9, GAD-7, repeat self-harm, EQ5D-5 L and questions about debt, employment and welfare benefits were explored. Results Interviews indicated the main benefits of the service as the resolution of specific financial problems and receiving support when participants were feeling most vulnerable. Randomisation was acceptable to most participants although not always fully understood and control participants could be disappointed. Recruitment was slow (1–2 per month). The outcome measures were acceptable and appeared sensitive to change. Discussion The HOPE intervention is feasible and acceptable. There was evidence of need and it is a relatively inexpensive intervention. Refining aspects of the intervention would be straightforward. A full-scale RCT would be feasible, if broadened eligibility criteria led to increased recruitment and improvements were made to staff training and support. Trial registration ISRCTN58531248. Electronic supplementary material The online version of this article (10.1186/s40814-018-0365-6) contains supplementary material, which is available to authorized users.
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Aleksova N, So D, Simard T, Davies R, Stadnick E, Mielniczuk L, Chih S. ANTIPLATELET THERAPY AND PLATELET REACTIVITY AFTER HEART TRANSPLANTATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hutson J, Garuba H, Boodhwani M, McDonald B, So D, De Roock S, Ruel M, Stadnick E, Rubens F, Davies R, Le May M, Labinaz M, Bowes B, Mielniczuk L, Chih S. MULTIDISCIPLINARY SHOCK TEAM APPROACH TO MANAGEMENT OF CARDIOGENIC SHOCK. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Archbold H, Rankin A, Webb M, Nicholas R, Eames N, Wilson R, Henderson L, Heyes G, Davies R, Bleakley C. Recurrent injury patterns in adolescent rugby. Phys Ther Sport 2018; 33:12-17. [DOI: 10.1016/j.ptsp.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/01/2018] [Accepted: 06/15/2018] [Indexed: 12/21/2022]
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Bhuva A, Treibel TA, De Marvao A, Biffi C, Dawes T, Doumou G, Bai W, Oktay O, Jones S, Davies R, Chaturvedi N, Rueckert D, Hughes A, Moon JC, Manisty CH. P5470Septal hypertrophy in aortic stenosis and its regression after valve replacement is more plastic in males than females: insights from 3D machine learning approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Davies R, Taylor K, Davies L. "Six-Pack Ileus" - Profound paralytic ileus after strenuous abdominal resistance exercise. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aarebrot AK, Solberg SM, Davies R, Bader LI, Holmes TD, Gavasso S, Bryceson YT, Jonsson R, Sandvik LF, Appel S. Phosphorylation of intracellular signalling molecules in peripheral blood cells from patients with psoriasis on originator or biosimilar infliximab. Br J Dermatol 2018; 179:371-380. [PMID: 29274242 DOI: 10.1111/bjd.16269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psoriasis vulgaris is a chronic, inflammatory skin disease characterized by a dysregulated immune response and it is associated with substantial systemic comorbidities. Biological drugs such as tumour necrosis factor (TNF)-α inhibitors can ameliorate the disease but are expensive. Biosimilar drugs have the same amino-acid sequence as the originator, but differences in manufacturing can affect biological activity, efficacy and tolerability. OBJECTIVES To explore potential differences in intracellular phosphorylation of signalling molecules in peripheral blood cells from patients with psoriasis treated with the TNF-α inhibitor infliximab compared with healthy controls, and to investigate if the phosphorylation pattern was influenced by switching from the originator infliximab to the biosimilar CT-P13. METHODS By flow cytometry, we measured phosphorylation of nuclear factor kappa B, extracellular signal-regulated kinase 1/2, p38 mitogen-activated protein kinase and signal transducer and activator of transcription 3, before and after TNF-α stimulation in monocytes and T, B, natural killer and CD3+ CD56+ cells from 25 patients with psoriasis treated with infliximab and 19 healthy controls. RESULTS At inclusion, phosphorylation levels of peripheral blood mononuclear cells (PBMCs) were increased in patients with psoriasis compared with healthy controls, even though clinical remission had already been achieved. Phosphorylation levels declined in patients on both originator infliximab and biosimilar during continued treatment. No significant differences were detected between the two medications after 12 months. CONCLUSIONS Patients with psoriasis on infliximab have higher activation levels of PBMCs than do healthy controls, possibly reflecting systemic inflammation. Switching from the originator infliximab to biosimilar CT-P13 did not affect phosphorylation levels or clinical parameters, suggesting that CT-P13 is a noninferior treatment alternative to the originator infliximab.
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Davies R, Wilson S, Bronsky S, Walk S, Yeoman C, Miles MP. Increase In Beta-hydroxybutyrate After High-fat Meal In Metabolically Healthy Overweight/obese Adults. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535800.77283.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Almufleh A, Rayner K, Zhang L, Susser L, Mielniczuk L, Stadnick E, Davies R, Liu P, Chih S. Biomarker Discovery in Cardiac Allograft Vasculopathy: Novel Aptamer Proteomic and MicroRNA Profiling. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Babcook J, Davies R, Barnscher S, Rich J, Yin K, Fung V, Winters G, Garnett G, Kaminker P, Hamblett K. A novel drug conjugate platform: Redefining the therapeutic window for ADCs. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy046.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Davies R, Watkins WJ, Kotecha S, Watts P. The presentation, clinical features, complications, and treatment of congenital dacryocystocele. Eye (Lond) 2018; 32:522-526. [PMID: 29075016 PMCID: PMC5848278 DOI: 10.1038/eye.2017.235] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo determine the incidence and presenting features of congenital dacryocystocele in the United Kingdom. To report on those cases complicated by dacryocystitis, respiratory compromise, and the treatment undertaken.MethodsA prospective observational study of cases of congenital dacryocystocele presenting in the United Kingdom between September 2014 and October 2015. Infants <3 months of age presenting with a cystic swelling in the medial canthal area were included. Cases were identified via the British Ophthalmology Surveillance Unit (BOSU) reporting system.ResultsA total of 49 cases were reported during the study period. This gives an incidence of 1 in 18 597 live births. There was a 71% response rate to the questionnaire. The average age at presentation was 16.94 days. Dacryocystoceles were unilateral in 91% of cases. Dacryocystitis was a complicating factor in 49% of patients and 17% had respiratory distress. Uncomplicated dacryocystocele responded well to conservative measures in 86%. Surgical intervention was required in 23% of patients. Those cases complicated by dacryocystitis (29%) and nasal obstruction (17%) were more likely to require surgical intervention compared to those with dacryocystocele alone (14%). Digital massage appears to reduce the likelihood of requiring surgical intervention. The mean time to resolution was 19 days.ConclusionsCongenital dacryocystocele is a rare presentation in the United Kingdom. Dacryocystitis and respiratory compromise commonly complicate a dacryocystocele. The use of digital massage as an early intervention is advocated and conservative measures may be sufficient in cases of uncomplicated dacryocystocele.
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Scrimshire AB, Gawad M, Davies R, George H. Management and outcomes of isolated paediatric tibial spine fractures. Injury 2018; 49:437-442. [PMID: 29179907 DOI: 10.1016/j.injury.2017.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/02/2017] [Accepted: 11/14/2017] [Indexed: 02/02/2023]
Abstract
Paediatric fractures of the tibial spine are relatively rare and controversy remains around how these injuries are best managed (Gans et al., 2014; Hargrove et al., 2004). Consequently most non-specialised paediatric units have limited experience of managing these injuries. This study aims to review the management and outcomes of isolated paediatric tibial spine fractures in a tertiary paediatric orthopaedic centre between 2008 and 2016. Data were collected on patient demographics, mechanism of injury, imaging, Meyers and McKeever grade of injury (Meyers and McKeever), management and outcomes, including Cincinnati and Lysholm-Tegner knee scores at a mean of 36 months post-operatively. 40 patients were included, 21 were male and the mean age was 11.8 years. 3 cases were Meyers and McKeever type I, 13 were type II and 24 were type III. 30 underwent operative management comprising of open reduction and single screw fixation, with or without a washer. 9 patients underwent subsequent metalwork removal at a mean of 10 months post-operatively. 10 underwent non-operative management, consisting of cast immobilisation and bracing. 33 patients (83%) were available for follow up. No statistically significant differences were seen in either outcome score between those treated operatively or non-operatively, or between different grades of injury, or if metalwork were removed or not. Our study shows good functional outcomes following paediatric tibial spine fracture. We advocate the use of CT to assess fracture displacement to help guide management. We have shown type I and reducible type II injuries can successfully be managed conservatively and non-reducible type II and type III injuries can be successfully treated with open reduction and single screw fixation. In our experience post-operative knee stiffness can persist for up to 6 months but generally improves. Metalwork removal was only indicated if the patient had on going stiffness after this time or if they had on going pain.
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Davies R, Hammenfors D, Bergum B, Jakobsen K, Solheim M, Vogelsang P, Brun JG, Bryceson Y, Jonsson R, Appel S. Patients with Primary Sjögren's Syndrome Have Alterations in Absolute Quantities of Specific Peripheral Leucocyte Populations. Scand J Immunol 2017; 86:491-502. [PMID: 29072325 DOI: 10.1111/sji.12622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Abstract
An accurate dissection of peripheral blood enumeration is lacking in primary Sjögren's syndrome (pSS). The purpose of this study was to quantify different leucocyte populations in peripheral blood of patients with pSS. Numbers of specific leucocyte subsets were determined in 86 pSS patients and 74 healthy donors quantifying 21 distinct subtypes by flow cytometry. Subgroups of pSS patients were stratified based on presence of extraglandular manifestations (EGMs) and SSA/SSB autoantibodies. Overall, pSS patients manifested decreased lymphocyte subpopulations compared to healthy donors. Such decreases were more pronounced in SSA/SSB positive patients and patients with EGM. Granulocyte and monocyte subpopulations were increased in pSS patients compared to healthy donors, with the greatest increases in SSA/SSB positive patients. Unsupervised hierarchal clustering based on cell quantities was used to further subgroup the pSS patients into four clusters. One of the clusters characterized by higher concentrations of NKT cells, CD56hi NK cells, CD20+ CD38- B cells and CD8+ CD38- T cells was associated with weaker clinical symptoms than the other clusters, possibly marking a milder disease phenotype. In conclusion, our analyses indicate significant alterations in the cellular profiles of peripheral blood leucocytes in patients with pSS and may help to stratify the patients according to disease severity.
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