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Gray AJ, Hoffman MR, Yang ZM, Vandiver B, Purvis J, Morgan JP, Hapner ER, Dominguez L, Tibbetts K, Simpson CB. Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block. Ann Otol Rhinol Laryngol 2024; 133:174-180. [PMID: 37608685 PMCID: PMC10771019 DOI: 10.1177/00034894231194384] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. METHODS Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. RESULTS A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. CONCLUSION SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. LAY SUMMARY Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alan J. Gray
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Matthew R. Hoffman
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Zao M. Yang
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Beau Vandiver
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Joshua Purvis
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Jake P. Morgan
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Edie R. Hapner
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Laura Dominguez
- Department of Otolaryngology—Head and Neck Surgery, Cleveland Clinic Florida, Coral Springs, FL, USA
| | - Kathleen Tibbetts
- Department of Otolaryngology—Head and Neck Surgery, University of Texas-Southwestern, Dallas, TX, USA
| | - C. Blake Simpson
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
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Lee K, Bularga A, O'Brien R, Ferry A, Doudesis D, Fujisawa T, Stewart S, Wereski R, Cranley D, Van Beek E, Lowe D, Newby DE, Williams MC, Gray AJ, Mills NL. Troponin to risk stratify patients with suspected acute coronary syndrome for computed tomography coronary angiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/14/2022] Open
Abstract
Abstract
Background
Patients with suspected acute coronary syndrome in whom myocardial infarction has been ruled-out are at risk of future adverse cardiac events. However, the optimal approach to risk stratify and investigate these patients is uncertain.
Methods
We performed a prospective cohort study of 250 patients presenting to the Emergency Department with suspected acute coronary syndrome and troponin concentrations below the sex-specific 99th centile (16 ng/L for women and 34 ng/L for men). Patients were recruited in a 2:1 fashion stratified by peak high-sensitivity cardiac troponin I concentration above and below the early rule-out threshold of 5 ng/L (167 patients with intermediate troponin concentrations between 5 ng/L and the sex-specific 99th centile threshold and 83 patients with troponin concentrations <5 ng/L). All patients underwent computed tomography coronary angiography after they were discharged from hospital.
Results
Overall, 37.6% (94/250) of patients had normal coronary arteries whilst 36.0% (90/250) and 26.4% (66/250) had non-obstructive and obstructive coronary artery disease, respectively. Patients with intermediate troponin concentrations were more likely to have coronary artery disease than those with troponin concentrations <5 ng/L (71.9% [120/167] versus 43.4% [36/83]; odds ratio 3.33 [95% confidence interval 1.92–5.78]). This association persisted irrespective of whether patients had anginal symptoms. Conversely, there was no difference in the prevalence of coronary artery disease between those with and without anginal symptoms (63.2% [67/106] and versus 61.8% [89/144]; odds ratio 0.92 [0.48–1.76]). The majority of patients found to have coronary artery disease did not have a prior diagnosis and were not on optimal preventative medical therapy prior to undergoing computed tomography coronary angiography (50.8% [61/120] and 61.0% [22/36], versus 61.7% [74/120] and 69.4% [25/36] in patients with intermediate versus low troponin concentrations, respectively).
Conclusions
In patients with suspected acute coronary syndrome who have myocardial infarction ruled out, those with intermediate cardiac troponin concentrations are three-times more likely to have coronary artery disease than those with low troponin concentrations. Conversely anginal symptoms did not discriminate between those with and without coronary artery disease. Further studies are required to determine if targeting computed tomography coronary angiography to those with intermediate cardiac troponin concentrations can improve the use of preventative medical therapies and clinical outcomes.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Odds ratio of coronary artery diseaseCumulative proportion with CAD
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Affiliation(s)
- K Lee
- University of Edinburgh, Edinburgh, United Kingdom
| | - A Bularga
- University of Edinburgh, Edinburgh, United Kingdom
| | - R O'Brien
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - A Ferry
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Doudesis
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Fujisawa
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Stewart
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Wereski
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Cranley
- University of Edinburgh, Edinburgh Clinical Trials Unit, Usher Institute, Edinburgh, United Kingdom
| | - E Van Beek
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Lowe
- University of Glasgow, Glasgow, United Kingdom
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - M C Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | - A J Gray
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, Edinburgh, United Kingdom
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Gray AJ, Nielsen KR, Ellington LE, Earley M, Johnson K, Smith LS, DiBlasi RM. Tracheal pressure generated by high-flow nasal cannula in 3D-Printed pediatric airway models. Int J Pediatr Otorhinolaryngol 2021; 145:110719. [PMID: 33894521 PMCID: PMC10549990 DOI: 10.1016/j.ijporl.2021.110719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Heated and humidified high flow nasal cannula (HFNC) is an increasingly used form of noninvasive respiratory support with the potential to generate significant tracheal pressure. The aim of this study was to quantify the pressure generated by HFNC within the trachea in anatomically correct, pediatric airway models. METHODS 3D-printed upper airway models of a preterm neonate, term neonate, toddler, and small child were connected to a spontaneous breathing computerized lung model at age-appropriate ventilation settings. Two commercially available HFNC systems were applied to each airway model at increasing flows and the positive end-expiratory pressure (PEEP) was recorded at the level of the trachea. RESULTS Increasing HFNC flow produced a quadratically curved increase in tracheal pressure in closed-mouth models. The maximum flow tested in each model generated a tracheal pressure of 7 cm H2O in the preterm neonate, 10 cm H2O in the term neonate, 9 cm H2O in the toddler, and 24 cm H2O in the small child. Tracheal pressure decreased by at least 50% in open-mouth models. CONCLUSIONS HFNC was found to demonstrate a predictable flow-pressure relationship that achieved sufficient distending pressure to consider treatment of pediatric obstructive sleep apnea and tracheomalacia in the closed-mouth models tested.
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Affiliation(s)
- Alan J Gray
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Katie R Nielsen
- Division of Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Laura E Ellington
- Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Marisa Earley
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Kaalan Johnson
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA.
| | - Lincoln S Smith
- Division of Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Rob M DiBlasi
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
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Gray AJ, Huston M, Didericksen D, Meyer TK, Merati A, Brisebois S. The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis. Laryngoscope 2019; 130:1775-1779. [PMID: 31593339 DOI: 10.1002/lary.28331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Dyspnea Index (DI) is a validated patient-reported outcome (PRO) instrument that has been used in the management of laryngotracheal stenosis (LTS). The minimal clinically important difference (MCID) is an established concept to help determine the change in a PRO instrument that reflects meaningful change for the patient. It is not known what change in the DI is of clinical significance in airway surgery. This study aims to determine the MCID for the DI in patients undergoing surgical treatment for LTS. METHODS This is a prospective cohort study in which 26 patients with LTS completed the DI (score range 0 to 40) before and 6 to 8 weeks postoperatively, in addition to a Global Ratings Change Questionnaire (GRCQ), scored from -7 to +7, at the postoperative interval. A hypothesis test was carried out to test the association between GRCQ and change in DI. The MCID for change in DI was determined using anchor-based analysis. RESULTS Overall mean change in DI was -11, and mean change in GRCQ was +5. Change in DI scores were significantly different among the improvement and no improvement groups (P value <0.002). Area under the receiver operating curve was 0.92, demonstrating high discriminatory ability of the change in DI score. A change of -4 was determined to be the threshold that discriminated between significant improvement and no improvement. CONCLUSION A decrease of 4 in the DI can be considered as the MCID for patients with LTS after surgical treatment. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1775-1779, 2020.
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Affiliation(s)
- Alan J Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Molly Huston
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Devin Didericksen
- Department of Statistics, University of Washington, Seattle, Washington, U.S.A
| | - Tanya K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Albert Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Simon Brisebois
- Department of Surgery, Otolaryngology-Head and Neck Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Chapman AR, Adamson PD, Anand A, Shah ASV, Lee KK, Strachan FE, Ferry ASV, Sandeman DE, Berry C, Gray AJ, Tuck C, Fox KAA, Newby DE, Weir C, Mills NL. 249High-sensitivity cardiac troponin and the universal definition of myocardial infarction: a randomised controlled trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2022] Open
Abstract
Abstract
Background
The Universal Definition of Myocardial Infarction recommends the 99th centile diagnostic threshold using a high-sensitivity cardiac troponin (hs-cTn) assay and the classification of patients by the etiology of myocardial injury. Whether implementation of this definition improves risk stratification, treatment or outcomes is unknown.
Methods
In a stepped-wedge cluster randomized controlled trial, we implemented a high-sensitivity troponin assay and the recommendations of the Universal Definition in 48,282 consecutive patients with suspected acute coronary syndrome across ten hospitals. In a pre-specified secondary analysis, we compared the primary outcome of myocardial infarction or cardiovascular death, and secondary outcome of non-cardiovascular death at one year across diagnostic categories as per the Fourth Universal Definition. We applied competing risks methodology in all analyses, using a cumulative incidence function and determining the cause-specific hazard ratio (csHR) for competing outcomes.
Results
Cardiac troponin concentrations were elevated in 21.5% (10,360/48,282) of all trial participants. Implementation increased the diagnosis of type 1 myocardial infarction by 11% (510/4,471), type 2 myocardial infarction by 22% (205/916), acute myocardial injury by 36% (443/1,233) and chronic myocardial injury by 43% (389/898). The risk and rate of the primary outcome was highest in those with type 1 myocardial infarction, whereas the risk and rate of non-cardiovascular death was highest in those with acute myocardial injury (Table, Figure). Despite increases in anti-platelet therapy and coronary revascularization after implementation, the primary outcome was unchanged in patients with type 1 myocardial infarction (csHR 1.00, 95% CI 0.82 to 1.21), or in any other category.
Adjusted csHR for competing outcomes Myocardial infarction or cardiovascular death Non-cardiovascular death Adjusted csHR (95% CI) Adjusted csHR (95% CI) Type 1 myocardial infarction 5.64 (5.12 to 6.22) 0.83 (0.72 to 0.96) Type 2 myocardial infarction 3.50 (2.94 to 4.15) 1.72 (1.44 to 2.06) Acute myocardial injury 4.38 (3.80 to 5.05) 2.65 (2.33 to 3.00) Chronic myocardial injury 3.88 (3.31 to 4.55) 2.06 (1.77 to 2.40) Cox regression models adjusted for age, sex, diabetes, ischaemic heart disease, season, days since trial onset and site of recruitment (as a random effect).
Cumulative incidence and number at risk
Conclusions
Implementation of the recommendations of the Universal Definition identified patients with different risks of future cardiovascular and non-cardiovascular events, but did not improve outcomes. Greater understanding of the underlying mechanisms and effective strategies for the investigation and treatment of patients with myocardial injury and infarction are required if we are to improve outcomes.
Acknowledgement/Funding
British Heart Foundation
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Affiliation(s)
- A R Chapman
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Anand
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A S V Shah
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K K Lee
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - F E Strachan
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A S V Ferry
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Sandeman
- Victoria Hospital, Cardiology, Kirkcaldy, United Kingdom
| | - C Berry
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - A J Gray
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Edinburgh, United Kingdom
| | - C Tuck
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - K A A Fox
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - C Weir
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
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6
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Bortolus A, Adam P, Adams JB, Ainouche ML, Ayres D, Bertness MD, Bouma TJ, Bruno JF, Caçador I, Carlton JT, Castillo JM, Costa CSB, Davy AJ, Deegan L, Duarte B, Figueroa E, Gerwein J, Gray AJ, Grosholz ED, Hacker SD, Hughes AR, Mateos-Naranjo E, Mendelssohn IA, Morris JT, Muñoz-Rodríguez AF, Nieva FJJ, Levin LA, Li B, Liu W, Pennings SC, Pickart A, Redondo-Gómez S, Richardson DM, Salmon A, Schwindt E, Silliman BR, Sotka EE, Stace C, Sytsma M, Temmerman S, Turner RE, Valiela I, Weinstein MP, Weis JS. Supporting Spartina: Interdisciplinary perspective shows Spartina as a distinct solid genus. Ecology 2019; 100:e02863. [PMID: 31398280 DOI: 10.1002/ecy.2863] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Received: 05/22/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/11/2022]
Abstract
In 2014, a DNA-based phylogenetic study confirming the paraphyly of the grass subtribe Sporobolinae proposed the creation of a large monophyletic genus Sporobolus, including (among others) species previously included in the genera Spartina, Calamovilfa, and Sporobolus. Spartina species have contributed substantially (and continue contributing) to our knowledge in multiple disciplines, including ecology, evolutionary biology, molecular biology, biogeography, experimental ecology, biological invasions, environmental management, restoration ecology, history, economics, and sociology. There is no rationale so compelling to subsume the name Spartina as a subgenus that could rival the striking, global iconic history and use of the name Spartina for over 200 yr. We do not agree with the subjective arguments underlying the proposal to change Spartina to Sporobolus. We understand the importance of both the objective phylogenetic insights and of the subjective formalized nomenclature and hope that by opening this debate we will encourage positive feedback that will strengthen taxonomic decisions with an interdisciplinary perspective. We consider that the strongly distinct, monophyletic clade Spartina should simply and efficiently be treated as the genus Spartina.
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Affiliation(s)
- Alejandro Bortolus
- Grupo de Ecología en Ambientes Costeros (GEAC), Instituto Patagónico para el Estudio de los Ecosistemas Continentales (IPEEC), CONICET, Boulevard Brown 2915, Puerto Madryn (U9120ACD), Chubut, Argentina
| | - Paul Adam
- School of Biological, Earth and Environmental Science, University of New South Wales, Sydney, New South Wales, 2052, Australia
| | - Janine B Adams
- Department of Botany, Nelson Mandela University, Port Elizabeth, 6031, South Africa
| | - Malika L Ainouche
- UMR CNRS 6553 Ecosystems, Biodiversity Evolution (ECOBIO), University of Rennes 1, Campus de Beaulieu, 35 042, Rennes Cedex, France
| | - Debra Ayres
- Evolution and Ecology, University of California, Davis, California, 95616, USA
| | - Mark D Bertness
- Department of Ecology and Evolutionary Biology, Brown University, 02901, Providence, Rhode Island, USA
| | - Tjeerd J Bouma
- Department of Estuarine and Delta Systems, Royal Netherlands Institute for Sea Research (NIOZ), Utrecht University, P.O. Box 140, 4400 AC, Yerseke, The Netherlands.,Faculty of Geosciences, Department of Physical Geography, Utrecht University, 3584 CS, Utrecht, The Netherlands
| | - John F Bruno
- Department of Biology, University of North Carolina, Chapel Hill, North Carolina, 27599-3280, USA
| | - Isabel Caçador
- MARE - Marine and Environmental Sciences Centre, Faculty of Sciences of the University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - James T Carlton
- Maritime Studies Program, Williams College, Mystic Seaport, Mystic, Connecticut, 96355, USA
| | - Jesus M Castillo
- Departamento de Biología Vegetal y Ecología, Universidad de Sevilla, 41080, Sevilla, Spain
| | - Cesar S B Costa
- Universidade Federal do Rio Grande-FURG, Campus Carreiros, Rio Grande, RS, 96203-900, Brazil
| | - Anthony J Davy
- School of Biological Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Linda Deegan
- Woods Hole Research Center, 129 Woods Hole Road, Falmouth, Massachusetts, 02543, USA
| | - Bernardo Duarte
- MARE - Marine and Environmental Sciences Centre, Faculty of Sciences of the University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal
| | - Enrique Figueroa
- Departamento de Biología Vegetal y Ecología, Universidad de Sevilla, 41080, Sevilla, Spain
| | - Joel Gerwein
- California State Coastal Conservancy, Oakland, California, 94612-1401, USA
| | - Alan J Gray
- Centre for Ecology and Hydrology, Edinburgh Research Station, Penicuik, Midlothian, EH26 0QB, United Kingdom
| | - Edwin D Grosholz
- Department of Environmental Science and Policy, University of California, Davis, California, 95616, USA
| | - Sally D Hacker
- Department of Integrative Biology, Oregon State University, 3029 Cordley Hall, Corvallis, Oregon, 97331, USA
| | - A Randall Hughes
- Department of Marine and Environmental Science, Northeastern University, Nahant, Massachusetts, 01908, USA
| | - Enrique Mateos-Naranjo
- Departamento de Biología Vegetal y Ecología, Universidad de Sevilla, 41080, Sevilla, Spain
| | - Irving A Mendelssohn
- Department of Oceanography and Coastal Sciences, Louisiana State University, Baton Rouge, Louisiana, 70803, USA
| | - James T Morris
- Belle Baruch Institute for Marine and Coastal Sciences, University of South Carolina, Columbia, South Carolina, 29208, USA
| | | | - Francisco J J Nieva
- Integrative Oceanography Division and Center for Marine Biodiversity and Conservation, Scripps Institution of Oceanography, La Jolla, California, 92093, USA
| | - Lisa A Levin
- Integrative Oceanography Division and Center for Marine Biodiversity and Conservation, Scripps Institution of Oceanography, La Jolla, California, 92093, USA
| | - Bo Li
- Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Coastal Ecosystems Research Station of the Yangtze River Estuary, Institute of Biodiversity Science and Institute of Eco-Chongming, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Wenwen Liu
- Key Laboratory of the Ministry of Education for Coastal and Wetland Ecosystems, College of the Environment and Ecology, Xiamen University, Fujian, 361102, China
| | - Steven C Pennings
- Department of Biology and Biochemistry, University of Houston, Houston, Texas, 77204, USA
| | - Andrea Pickart
- U.S. Fish and Wildlife Service, Humboldt Bay National Wildlife Refuge, 6800 Lanphere Road, Arcata, California, 95521, USA
| | - Susana Redondo-Gómez
- Departamento de Biología Vegetal y Ecología, Universidad de Sevilla, 41080, Sevilla, Spain
| | - David M Richardson
- Centre for Invasion Biology, Department of Botany and Zoology, Stellenbosch University, Matieland, 7602, South Africa
| | - Armel Salmon
- UMR CNRS 6553 Ecosystems, Biodiversity Evolution (ECOBIO), University of Rennes 1, Campus de Beaulieu, 35 042, Rennes Cedex, France
| | - Evangelina Schwindt
- Instituto de Biología de Organismos Marinos (IBIOMAR-CONICET), U9120 ACD, Puerto Madryn, Argentina
| | - Brian R Silliman
- Division of Marine Science and Conservation, Nicholas School of the Environment, Duke University, Beaufort, North Carolina, 28516, USA
| | - Erik E Sotka
- Grice Marine Laboratory and the Department of Biology, College of Charleston, Charleston, South Carolina, 29412, USA
| | - Clive Stace
- Apletree House, Larters Lane, Middlewood Green, Sufolk, IP14 5HB, United Kingdom
| | - Mark Sytsma
- Portland State University, Portland, Oregon, 97207, USA
| | - Stijn Temmerman
- Ecosystem Management Research Group, University of Antwerp, Antwerp, BE-2610, Belgium
| | - R Eugene Turner
- Department of Oceanography and Coastal Sciences, Louisiana State University, Baton Rouge, Louisiana, 70803, USA
| | - Ivan Valiela
- The Ecosystems Center, Marine Biological Laboratory, Woods Hole, Massachusetts, 02543, USA
| | | | - Judith S Weis
- Department of Biological Sciences, Rutgers University, Newark, New Jersey, 07102, USA
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7
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Harbison RA, Gray AJ, Westling T, Carone M, Rodriguez CP, Futran ND, Cannon RB, Houlton J. The role of elective neck dissection in high-grade parotid malignancy: A hospital-based cohort study. Laryngoscope 2019; 130:1487-1495. [PMID: 31468551 DOI: 10.1002/lary.28238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The role of elective neck dissection (END) in patients with clinically N0 (cN0), high-grade parotid carcinoma is unclear. The objective of this study was to assess the association between END and survival in patients with cN0, high-grade parotid carcinoma. STUDY DESIGN Retrospective, multicenter cohort study. METHODS A review of hospital-based cases from the National Cancer Data Base was performed. Participants included patients diagnosed with cN0, high-grade parotid cancer between January 1, 2004 and December 31, 2013. The primary exposure was receipt of neck dissection. Secondary exposures included receipt of adjuvant radiation and/or chemotherapy. Univariate and multivariate survival analyses were performed. Unadjusted and adjusted survival estimates were determined. RESULTS Overall, 1,547 patients were included, with a median follow-up time of 48 months. END did not have a statistically significant effect on 3-year survival (3-year: 69.9%, 95% confidence interval [CI]: 67.2 to 72.6). Survival at 3-years among those not receiving END was 66.1% (95% CI: 62.7 to 69.5). Parotidectomy and adjuvant radiotherapy had the strongest effect on mortality. There was no difference in 3-year survival among patients who underwent parotidectomy and adjuvant radiation stratified by receipt of END nor did END have a statistically significant effect on survival in mucoepidermoid carcinoma, adenocarcinoma, high-risk histology, high T stage, or academic center treatment subgroups. CONCLUSIONS END did not have a statistically significant effect on survival among cN0 patients with high-grade parotid cancer when taking into account receipt of adjuvant therapy and confounding. The role of END on survival and locoregional control remains to be further elucidated in prospective studies. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1487-1495, 2020.
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Affiliation(s)
- R Alex Harbison
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Alan J Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Ted Westling
- Center for Causal Inference, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marco Carone
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Cristina P Rodriguez
- Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington
| | - Neal D Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Richard B Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah
| | - Jeffrey Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington
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Reed MJ, Grubb NJ, Lang CC, Gray AJ, Simpson K, Macraild AJ, Weir CJ. P422Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the Emergency Department: The PATCH-ED study. Europace 2018. [DOI: 10.1093/europace/euy015.233] [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: 11/14/2022] Open
Affiliation(s)
- M J Reed
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - N J Grubb
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C C Lang
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - A J Gray
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - K Simpson
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - A J Macraild
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - C J Weir
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, United Kingdom
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Reed MJ, Brutin H, Grubb NJ, Lang CC, Gray AJ, Simpson K, Macraild AJ, Weir CJ. P420Brain Natriuretic Peptide (BNP) and high-sensitivity troponin I at 3 hours post Emergency Department (ED) attendance predicts all significant arrhythmias at 3 months in unexplained ED syncope patients. Europace 2018. [DOI: 10.1093/europace/euy015.231] [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: 11/12/2022] Open
Affiliation(s)
- M J Reed
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - H Brutin
- University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, United Kingdom
| | - N J Grubb
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C C Lang
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - A J Gray
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - K Simpson
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - A J Macraild
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - C J Weir
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, United Kingdom
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Nielsen KR, Ellington LE, Gray AJ, Stanberry LI, Smith LS, DiBlasi RM. Effect of High-Flow Nasal Cannula on Expiratory Pressure and Ventilation in Infant, Pediatric, and Adult Models. Respir Care 2017; 63:147-157. [DOI: 10.4187/respcare.05728] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Devos Y, Gaugitsch H, Gray AJ, Maltby L, Martin J, Pettis JS, Romeis J, Rortais A, Schoonjans R, Smith J, Streissl F, Suter GW. Advancing environmental risk assessment of regulated products under EFSA's remit. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.s0508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Jörg Romeis
- Institute for Sustainability Sciences, Agroscope
| | | | | | - Joe Smith
- Advisor in Regulation, Science and Government (formerly Office of the Gene Technology Regulator)
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Datta D, Grahamslaw J, Gray AJ, Graham C. CVLA STUDY: CAPILLARY AND VENOUS LACTATE AGREEMENT—A PILOT OBSERVATIONAL STUDY. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Datta D, Grahamslaw J, Gray AJ, Walker C, Graham C. LAVAS: LACTATE—ARTERIAL AND VENOUS AGREEMENT IN SEPSIS. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Gray AJ. The policy chicken and the science egg. Has applied ecology failed the transgenic crops debate? Transgenic Res 2013; 23:923-32. [PMID: 24150917 DOI: 10.1007/s11248-013-9747-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
Abstract
Ecology has a long history of research relevant to and impacting on real-world issues. Nonetheless problems of communication remain between policy-makers and scientists because they tend to work at different levels of generality (policy deals with broad issues, science prefers specific questions), and complexity (policy-makers want simple answers, ecologists tend to offer multi-factorial solutions) and to different timescales (policy-makers want answers tomorrow, ecologists always seem to want more time). These differences are not unique to the debate about the cultivation of transgenic crops. Research on gene flow is used to illustrate how science and policy are intimately bound together in a value-laden, iterative and messy process unlike that characterised by the 'encounter problem-do science-make policy' model. It also demonstrates how the gap between science and policy is often characterised by value-laden language. Scientists involved in ERA for transgenic crops may find their engagement with policy- and decision-makers clouded by misunderstanding about what one should expect from the other. Not the least of these, that science can define harm, is explored in a discussion of the U.K. Farm Scale Evaluations of herbicide-tolerant GM crops. The varied responses to these extensive trials highlight the problems of linking specific scientific experiments with broad policy objectives. The problems of applied ecology in the transgenic crops debate are not unique but may differ from other areas of environmental policy in the intense politicisation of the debate, the emphasis on assessment of risk and the particularly broad policy objectives.
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Affiliation(s)
- A J Gray
- Centre for Ecology and Hydrology, CEH Wallingford, Crowmarsh Gifford, Wallingford, Oxon, OX10 8BB, UK,
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15
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Morris DJ, Gray AJ, Kay JF, Gettinby G. EU sampling strategies for the detection of veterinary drug residues in aquaculture species: are they working? Drug Test Anal 2012; 4 Suppl 1:1-9. [PMID: 22851354 DOI: 10.1002/dta.1350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 50 years, the culture of aquatic species in controlled conditions to enhance production has grown in importance and now provides nearly 50% of the world's seafood supply. In part, this expansion has been made possible by the use of antibiotics, antifungals, and other veterinary medicines to control disease and improve welfare. Despite guidelines being available, the sampling programmes for drug residue surveillance of aquaculture products recommended by the CODEX Alimentarius Commission were withdrawn in 2008 and put under review. Directive 96/23/EC sets out legislation to govern how sampling programmes for drug residue surveillance should be conducted within the EU. This directive applies both to produce raised within the EU and also imported products from third countries. This communication examines the existing EU sampling regimen for aquaculture products and comments on its possible application in a global context. We examine UK statutory sampling data that, while indicating the effectiveness of the directive, also suggests that the directive may lead to unnecessary sampling. Regarding imports, examination of the Rapid Alert System for Food and Feed (RASFF) database using process control charts and statistical modelling suggests that the sampling regimen described in the directive is effective but not sufficiently flexible for the range of aquaculture practices that exist. Limitations of the directive, datasets, and practices are further discussed.
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Affiliation(s)
- D J Morris
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
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Bonney ME, Reed MJ, Gray AJ. The Prediction of Risk In Syncope using ECG characteristics (PRISE) pilot study: can heart rate variability be used to predict risk in patients presenting to the emergency department with syncope? Emerg Med J 2008; 26:32-6. [PMID: 19104093 DOI: 10.1136/emj.2008.061176] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM This study was conducted as a feasibility pilot for the Prediction of Risk In Syncope using ECG characteristics (PRISE) study. The secondary aim was to determine whether heart rate variability (HRV) characteristics may be useful to distinguish low and high-risk syncope patients. METHODS Adult patients presenting to the emergency department (ED) with syncope over a one-month period underwent a 5-minute 12-lead ECG. Study patients were assigned high, medium or low-risk status according to the ED's existing syncope guidelines as well as one of four likely diagnostic categories. ECG signals from all patients were then analysed and time domain HRV characteristics were derived using WelchAllyn's Cardioperfect interpretation software. A control group of patients was also recruited. RESULTS Over a 4-week period in July 2007, 32 patients were recruited into the study group and 23 into the control group. ECG tracings of five study group patients were not suitable for analysis. According to the ED's existing syncope guidelines there were nine low-risk, 12 medium-risk and six high-risk patients with diagnostic categories as follows: postural hypotension, five; vasovagal, 16; cardiac, five and other, one. Patients with cardiac syncope had greater mean values for all HRV characteristics except NN number and NN minimum; however, with overlapping confidence intervals. Low-risk patients were more likely to be younger than medium and high-risk patients. No HRV parameters showed any significant differences. CONCLUSIONS Measuring HRV in the acute ED setting is feasible. If patients with cardiac and neurocardiogenic syncope have different HRV characteristics then it could be useful to determine a patient's underlying cause of syncope in the ED, which would allow earlier decision-making.
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Affiliation(s)
- M E Bonney
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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Abstract
AIM To assess the clinical management of adults presenting with sudden, severe headache. METHODS We retrospectively reviewed the medical records of consecutive adults presenting with sudden, severe headache to the emergency department (ED) or medical admissions unit at one teaching hospital. RESULTS Of 12 025 consecutive attendances over 3 months, 91 adults (0.8%, 95% CI 0.6-0.9%) presented with sudden severe headache. Documentation of time to peak headache intensity and headache duration was complete in only 33% of cases. Brain computed tomography was performed in each of the 29 patients (33%) in whom it appeared indicated for the investigation of headaches peaking within 5 min and lasting more than 1 h, as well as 11 patients (13%) who did not meet these criteria. Lumbar puncture was attempted in every patient for whom it appeared indicated (although it was unsuccessful and abandoned on three of 24 patients), as well as one patient in whom it appeared not to be indicated. When subarachnoid haemorrhage was suspected, 81% of patients had spectrophotometry. Of the patients, 52 (60%) were given a specific diagnosis, 17 (33%) of whom were given a diagnosis despite an apparently insufficient history. A further 12 (14%) could have been diagnosed if the International Headache Society classification had been applied to the documented history. Neurological advice was sought for only 20 patients (23%). CONCLUSION Patients with sudden, severe headache might benefit if EDs used simple protocols, emphasizing the crucial elements of history and examination, appropriate investigation and targeted consultation with neurologists.
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Affiliation(s)
- D P Breen
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland.
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Affiliation(s)
- M J G Dunn
- The Royal Infirmary of Edinburgh, Edinburgh, UK
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Breen DP, Dunn MJG, Davenport RJ, Gray AJ. Epidemiology, clinical characteristics, and management of adults referred to a teaching hospital first seizure clinic. Postgrad Med J 2006; 81:715-8. [PMID: 16272236 PMCID: PMC1743386 DOI: 10.1136/pgmj.2004.031203] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 01/04/2023]
Abstract
BACKGROUND There are scarce data describing the epidemiology, clinical characteristics, and management of adults who suffer a suspected first seizure. AIM To describe the epidemiology, clinical characteristics, and management of adults with a suspected first seizure who are referred to a teaching hospital first seizure clinic over a one year period. DESIGN Prospective descriptive study. METHODS Data were collected on consecutive adults referred to the Royal Infirmary of Edinburgh between 4 February 2003 and 10 February 2004. RESULTS 232 patients were referred to the first seizure clinic. Median age was 32 years; 53% of patients were male. Lower socioeconomic groups were more likely to present with a suspected first seizure. Nineteen per cent of patients were admitted to hospital after their suspected seizure episode. Appropriate driving advice was reported in 64% of cases. Seventy two per cent of patients were offered a first seizure clinic appointment within six weeks of referral. Nine per cent of patients had a subsequent seizure while awaiting review. Fifty two per cent of patients were confirmed as having a first seizure at the clinic, of which 56% were provoked by alcohol, recreational drugs, or sleep deprivation. Electroencephalography and computed tomography of the brain were the most common investigations ordered at the first seizure clinic (22% and 22% of patients respectively). CONCLUSION Adults who suffer a suspected first seizure, and who make a full neurological recovery, can be safely managed as an outpatient. Around half of these patients will have a specialist diagnosis of first seizure and alcohol will be a common precipitating factor.
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Affiliation(s)
- D P Breen
- Department of General Surgery, Borders General Hospital, Melrose, Scotland.
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Loftus LT, Li HF, Gray AJ, Hirata-Fukae C, Stoica BA, Futami J, Yamada H, Aisen PS, Matsuoka Y. In vivo protein transduction to the CNS. Neuroscience 2006; 139:1061-7. [PMID: 16529872 DOI: 10.1016/j.neuroscience.2006.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 01/13/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
Proteins and peptides are useful research and therapeutic tools, however applications are limited because delivery to the desired location is not easily achievable. There are two hurdles in protein/peptide delivery to the brain: the blood-brain barrier and intracellular penetration. Penetration to both brain and the intracellular space can be achieved by adjusting hydrophilicity, and small molecule pharmacological agents have been successfully developed using this approach. But with proteins and peptides, it is difficult to modify the hydrophilicity without influencing biological functions. Trans-acting factor protein from the human immunodeficiency virus contains a highly conserved cationic peptide sequence necessary for transduction across the cell membrane. While trans-acting factor peptide has been used for in vitro protein transduction, its in vivo application is very limited because it is rapidly degraded by proteolysis. Polyethylenimine is a chemically synthesized small molecule cationization agent; the charge density is greater than a peptide-based cationic cluster such as trans-acting factor, and it is resistant to proteolysis in vivo. We first tested intracellular protein transduction following direct brain injection in mice using polyethylenimine-conjugated green fluorescence protein and beta-galactosidase (molecular weights 29 and 540 kDa, respectively). Polyethylenimine-conjugates penetrated to the intracellular space immediately surrounding the injection site within one hour. We further tested polyethylenimine-mediated protein transduction following intranasal administration, which bypasses the blood-brain barrier. Polyethylenimine-conjugates in pH 7.5 solution did not reach the brain, probably because the polyethylenimine-conjugates penetrated into the intracellular space where first exposed to the tissue, i.e. at the nasal mucosae. We temporarily reduced the electrostatic interaction between cationized polyethylenimine-conjugates and cellular surfaces by adjusting the pH to 4.5; solution rapidly reached the brain and penetrated to the intracellular space. This study suggests that polyethylenimine is a useful protein transduction agent in the brain in vivo, and adjusting cationic charge interaction can determine the extent of brain penetration.
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Affiliation(s)
- L T Loftus
- Department of Neurology, Georgetown University Medical Center, Washington, DC 20057, USA
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Garbutt RA, Reading CJ, Wolters M, Gray AJ, Rothery P. Monitoring the development of intertidal habitats on former agricultural land after the managed realignment of coastal defences at Tollesbury, Essex, UK. Mar Pollut Bull 2006; 53:155-64. [PMID: 16253290 DOI: 10.1016/j.marpolbul.2005.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The managed realignment of coastal defences and subsequent creation of intertidal habitats is one of several 'soft' engineering options that could reduce the costs of maintaining embankments and at the same time deliver environmental benefits. The managed realignment at Tollesbury was one of the first in the UK, undertaken as an experimental test case to improve understanding of the practical techniques and processes involved. Independent studies were undertaken on the development of soils, benthic invertebrates and vegetation within the site in addition to methods of enhancing the process of natural colonisation of saltmarsh plants. Bathymetric and vegetation monitoring were undertaken on the adjacent estuary to determine any breach effect that may be attributed to the realignment. This paper summarises the results from the vegetation, sedimentation and invertebrate monitoring and discusses the implications for other managed realignment schemes in the UK.
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Affiliation(s)
- R A Garbutt
- NERC Centre for Ecology and Hydrology, Monks Wood, Abbots Ripton, Huntingdon, Cambridgeshire PE29 2LS, UK.
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Abstract
A literature review of first seizures in adults was performed and a management algorithm was constructed. This review highlights the importance of a thorough history and examination, routine biochemistry and haematology, an electrocardiogram, selected neuroimaging, discharge planning with driving and lifestyle advice, and follow-up in a specialist clinic.
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Affiliation(s)
- M J G Dunn
- Emergency Department, The Royal Infirmary of Edinburgh at Little France, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, Scotland.
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Sukumaran S, Henry JM, Beard D, Lawrenson R, Gordon MWG, O'Donnell JJ, Gray AJ. Prehospital trauma management: a national study of paramedic activities. Emerg Med J 2005; 22:60-3. [PMID: 15611550 PMCID: PMC1726541 DOI: 10.1136/emj.2004.016873] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/04/2022]
Abstract
OBJECTIVES The benefits of prehospital trauma management remain controversial. This study aimed to compare the processes of care and outcomes of trauma patients treated by paramedics, who are trained in advanced prehospital trauma care, with those treated by ambulance technicians. METHODS A six year prospective study was conducted of adult trauma patients attended to by the Scottish Ambulance Service and subsequently admitted to hospital. Prehospital times, interventions, triage, and outcomes were compared between patients treated by paramedics and those treated by technicians. RESULTS Paramedics attended more severely injured patients (16.5% versus 13.9%, p<0.001); they attended a higher proportion of patients with penetrating trauma (6.6% versus 5.7%, p = 0.014) and had longer prehospital times. Patients managed by paramedics were more likely to be taken to the intensive care unit, operating theatre or mortuary, (11.2% versus 7.8%, p<0.001) and had higher crude mortality rates (5.3% versus 4.5%, p = 0.07). However, no difference in mortality between the two groups was noted when corrected for age, Glasgow coma score and injury severity score. CONCLUSIONS This large scale national study shows that paramedics show good triage skills and clinical judgement when managing trauma patients. However, the value of the individual interventions they perform could not be ascertained. Further controlled trials are necessary to determine the true benefits of advanced prehospital trauma life support.
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Affiliation(s)
- S Sukumaran
- Emergency Department, Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh EH16 4SU, UK.
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Choi HC, Gray AJ, Vicente CL, Xia JS, Gervais G, Halperin WP, Mulders N, Lee Y. A1 and A2 transitions in superfluid 3He in 98% porosity aerogel. Phys Rev Lett 2004; 93:145302. [PMID: 15524807 DOI: 10.1103/physrevlett.93.145302] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Indexed: 05/24/2023]
Abstract
Superfluid 3He in high porosity aerogel is the system in which the effects of static impurities on a p-wave superfluid can be investigated in a systematic manner. We performed shear acoustic impedance measurements on this system (98% porosity aerogel) in the presence of magnetic fields up to 15 T at the sample pressures of 28.4 and 33.5 bars. We observed the splitting of the superfluid transition into two transitions in high fields in both bulk and liquid in aerogel. The field dependence of the splitting in aerogel resembles that of the bulk superfluid 3He caused by the presence and growth of the A1 phase. Our results provide the first evidence of the A1 phase in superfluid (3)He/aerogel.
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Affiliation(s)
- H C Choi
- Department of Physics, University of Florida, Gainesville, Florida 32611-8440, USA
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Hussein JR, Villar RN, Gray AJ, Farrington M. Use of light handles in the laminar flow operating theatre--is it a cause of bacterial concern? Ann R Coll Surg Engl 2001; 83:353-4. [PMID: 11806565 PMCID: PMC2503393] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Airborne bacteria introduced during routine joint replacement surgery are known to be an important source of joint sepsis with disastrous results. Recently, Robinson et al. [Robinson AHN, Bentley G, Drew S, Anderson J, Ridgway GL. Suction tip contamination in the ultraclean air operating theatre. Ann R Coll Surg Engl 1993; 75: 254-6] have demonstrated that the conventional surgical sucker forms a focus for airborne pathogens which results in septic loosening of hip prostheses. Similarly, the potential contamination of theatre light handles, commonly used during total hip and knee replacements, gives cause for concern. To assess if there was any evidence of contamination, we cultured bacterial swabs taken from the light handles before and after 15 such procedures, all of which were held in a conventional orthopaedic operating theatre. Fortunately, our study found no reason to stop the use of light handles in joint replacement operations.
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Affiliation(s)
- J R Hussein
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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Gray AJ, Staples V, Murren K, Dhariwal A, Bentham P. Olfactory identification is impaired in clinic-based patients with vascular dementia and senile dementia of Alzheimer type. Int J Geriatr Psychiatry 2001; 16:513-7. [PMID: 11376468 DOI: 10.1002/gps.383] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS It is now well established that there are abnormalities in the sense of smell in patients suffering from Alzheimer's disease (AD). They have both raised olfactory thresholds and impaired odour identification. The situation in vascular dementia is unclear. We used the University of Pennsylvania Smell Identification Test (UPSIT), a 40-item, forced choice, cued, 'scratch-and- sniff' test, to examine olfactory identification in vascular dementia and to determine whether it would differentiate the disorder from AD and normal elderly. METHODS We investigated three matched subject groups: 13 people having a Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) diagnosis of definite senile dementia of Alzheimer type, 13 having a CAMDEX diagnosis of definite vascular dementia and 13 non-cognitively impaired controls. The subjects were then tested with the UPSIT in their own home by an independent blind researcher to see if the test could distinguish the different diagnostic groups in this setting. RESULTS The median UPSIT score was 30 (out of a maximum of 40) for controls, 12 for the vascular group and 15 for the AD group. The difference was significant (p = 0.05) between both demented groups and the normal controls. Similarly there was a significant difference in the UPSIT score between the AD group and controls (p = 0.001) and between the vascular dementia group and controls (p = 0.001), but there was no significant difference between the AD group and the vascular dementia group. The UPSIT score correlated strongly with the degree of cognitive impairment as measured by the CAMCOG (r(s) = 0.683, p = 0.01) CONCLUSIONS Patients with vascular dementia had a similar degree of olfactory impairment to those with AD. The UPSIT successfully differentiated between dementia patients and normal elderly British subjects tested in their own homes. The UPSIT did not differentiate between those with AD and vascular dementia.
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Affiliation(s)
- A J Gray
- Worcestershire Community Healthcare NHS Trust, UK.
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Crawford MJ, Hopkins W, Thomas P, Moncreiff J, Bindman J, Gray AJ. Most psychiatrists oppose plans for new mental health act. BMJ 2001; 322:866. [PMID: 11321020 PMCID: PMC1120033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
Semiautomatic image analysis techniques are particularly useful in biological applications, which commonly generate very complex images, and offer considerable flexibility. However, systematic study of such methods is lacking; most research develops fully automatic algorithms. This paper describes a study to evaluate several different semiautomatic or computer-assisted approaches to contour segmentation within the context of segmenting degraded images of fungal hyphae. Four different types of contour segmentation method, with varying degrees and types of user input, are outlined and applied to hyphal images. The methods are evaluated both quantitatively and qualitatively by comparing results obtained by several test subjects segmenting simulated images qualitatively similar to the hyphal images of interest. An active contour model approach, using control points, emerges as the method to be preferred to three more traditional approaches. Feedback from the image provider indicates that any of the methods described have something useful to offer for segmentation of hyphae.
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Affiliation(s)
- L M Inglis
- Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, Scotland, UK
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Abstract
We report two cases of venous air embolism which occurred in association with infusion of Haemaccel(R) using a pressure bag. As a result of these incidents, we performed a study that showed that up to 45 ml of air can be infused into a patient from a pressurised Haemaccel(R) plastic bottle using a standard administration set. We also demonstrated that the volume of air infused was influenced by the type and size of the pressure bag and the warming of the Haemaccel(R) plastic container.
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Affiliation(s)
- A J Gray
- Department of Anaesthesia, Hutt Hospital, High St., Lower Hutt, New Zealand
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Khafaga YM, Jamshed A, Allam AA, Mourad WA, Ezzat A, Al Eisa A, Gray AJ, Schultz H. Stevens-Johnson syndrome in patients on phenytoin and cranial radiotherapy. Acta Oncol 1999; 38:111-6. [PMID: 10090698 DOI: 10.1080/028418699431898] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [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: 10/17/2022]
Abstract
The use of phenytoin as a prophylactic anticonvulsant after brain surgery, particularly for brain tumors, is a common practice, regardless of whether the patient has a previous history of convulsions. This treatment policy assumes that the benefits exceed the risks. Four cases are described of adverse reactions to phenytoin during the concomitant use of cranial radiotherapy. In one patient this proved fatal. There is increasing anecdotal support in the literature for a synergistic effect between phenytoin therapy and cranial radiotherapy that can result in the life-threatening Stevens-Johnson syndrome. While the association is uncommon, four cases within 24 months in one department suggest that the routine use of postoperative phenytoin as a prophylactic anticonvulsant in the absence of a history of seizures may not be warranted, particularly if the patient is to receive cranial radiotherapy.
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Affiliation(s)
- Y M Khafaga
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Raybould AF, Maskell LC, Edwards ML, Cooper JI, Gray AJ. The prevalence and spatial distribution of viruses in natural populations of Brassica oleracea. New Phytol 1999; 141:265-275. [PMID: 33862926 DOI: 10.1046/j.1469-8137.1999.00339.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report a survey of four viruses (beet western yellows luteovirus (BWYV), cauliflower mosaic caulimovirus (CaMV), turnip mosaic potyvirus (TuMV), turnip yellow mosaic tymovirus (TYMV)) in five natural populations of Brassica oleracea in Dorset (UK). All four viruses were common; 43% of plants were infected with BWYV, 60% with CaMV, 43% with TuMV and 18% with TYMV. For each virus there were significant differences in the proportion of infected plants among populations, which were not completely explained by differences in the age of plants. Multiple virus infections were prevalent, with 54% of plants having two or more virus types. There were statistically significant associations between pairs of viruses. The CaMV was positively associated with the other three viruses, and BWYV was also positively associated with TuMV. There was no detectable association between BWYV and TYMV, whereas TuMV and TYMV were negatively associated. We suggest these associations result from BWYV, CaMV and TuMV having aphid vectors in common, as aphids are attracted to plants that already have a virus infection. Infected plants were distributed randomly or were very weakly aggregated within populations. The implications of widespread multiple virus infections in natural plant populations are discussed with respect to the release of transgenic plants expressing virus-derived genes.
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Affiliation(s)
- A F Raybould
- 1 Natural Environment Research Council Institute of Terrestrial Ecology, Furzebrook Research Station, Wareham, Dorset BH20 5AS, UK
| | - L C Maskell
- 1 Natural Environment Research Council Institute of Terrestrial Ecology, Furzebrook Research Station, Wareham, Dorset BH20 5AS, UK
| | - M-L Edwards
- 1 Natural Environment Research Council Institute of Terrestrial Ecology, Furzebrook Research Station, Wareham, Dorset BH20 5AS, UK
| | - J I Cooper
- 1 Natural Environment Research Council Institute of Terrestrial Ecology, Furzebrook Research Station, Wareham, Dorset BH20 5AS, UK
| | - A J Gray
- 1 Natural Environment Research Council Institute of Terrestrial Ecology, Furzebrook Research Station, Wareham, Dorset BH20 5AS, UK
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Warren JM, Raybould AF, Ball T, Gray AJ, Hayward MD. Genetic structure in the perennial grasses Lolium perenne and Agrostis curtisii. Heredity (Edinb) 1998. [DOI: 10.1046/j.1365-2540.1998.00426.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
A general method is proposed for constructing templates of cells in differential interference contrast (DIC) microscopy. This takes account of the optics which generate DIC images, and is applicable to both transparent and semi-transparent cells of simple and complex shapes. Then, a template matching methodology is presented, which uses fast Fourier transforms to fit templates of a range of sizes and orientations to images. For illustration, this is used to automatically identify and measure individual Candida yeast cells in clusters.
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Affiliation(s)
- D Young
- Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, U.K
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Abstract
BACKGROUND AND PURPOSE This report presents long-term follow-up data from a prospective but unrandomized trial of a continuous 3.5-week course of accelerated radiation treatment (ART) used as primary treatment for patients with loco-regionally advanced head and neck cancer. MATERIALS AND METHODS Ninety-three patients in three centres in New Zealand and Australia were treated with ART (59.40 Gy in 33 fractions over 24-25 days). Their disease originated from three anatomical regions (oral cavity, 35 patients; pharynx, 31 patients; larynx, 27 patients). Seventy-nine of these patients had stage III or IV cancers. RESULTS Follow-up ranged from 68 to 203 months (median 139 months). Loco-regional (LR) failure occurred in 52 patients leading to a 10-year actuarial expectation of LR control of 38%. The actuarial expectation of LR control at 10 years was highly dependent on stage and for stage III, IVA and IVB patients it was 57+/-8.1%, 32+/-1.7% and 7+/-0.5%, respectively. Multivariate analysis could not confirm an independent impact of primary site or histological differentiation on LR failure. Two patients died of acute toxicity of treatment and six patients developed grade 3/4 late complications affecting soft tissues only, yielding an actuarial expectation of complications of this severity at 5 years of 9%. No cases of osteoradionecrosis or myelitis were observed. CONCLUSION This ART, which has proved easy to use at a number of large and small centres, has produced encouraging long-term LR control at a cost of limited soft tissue morbidity.
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Affiliation(s)
- D S Lamb
- Wellington Regional Oncology Unit, Wellington Hospital, New Zealand
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Gray AJ. The aftermath of the Bristol case. Deaths are acceptable in some specialties but not all. BMJ 1998; 317:812. [PMID: 9786664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Chambers RC, Dabbagh K, McAnulty RJ, Gray AJ, Blanc-Brude OP, Laurent GJ. Thrombin stimulates fibroblast procollagen production via proteolytic activation of protease-activated receptor 1. Biochem J 1998; 333 ( Pt 1):121-7. [PMID: 9639571 PMCID: PMC1219564 DOI: 10.1042/bj3330121] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thrombin is a multifunctional serine protease that has a crucial role in blood coagulation. It is also a potent mesenchymal cell mitogen and chemoattractant and might therefore have an important role in the recruitment and local proliferation of mesenchymal cells at sites of tissue injury. We hypothesized that thrombin might also affect the deposition of connective tissue proteins at these sites by directly stimulating fibroblast procollagen production. To address this hypothesis, the effect of thrombin on procollagen production and gene expression by human foetal lung fibroblasts was assessed over 48 h. Thrombin stimulated procollagen production at concentrations of 1 nM and above, with maximal increases of between 60% and 117% at 10 nM thrombin. These effects of thrombin were, at least in part, due to increased steady-state levels of alpha1(I) procollagen mRNA. They could furthermore be reproduced with thrombin receptor-activating peptides for the protease-activated receptor 1 (PAR-1) and were completely abolished when thrombin was rendered proteolytically inactive with the specific inhibitors d-Phe-Pro-ArgCH2Cl and hirudin, indicating that thrombin is mediating these effects via the proteolytic activation of PAR-1. These results suggest that thrombin might influence the deposition of connective tissue proteins during normal wound healing and the development of tissue fibrosis by stimulating fibroblast procollagen production.
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Affiliation(s)
- R C Chambers
- Centre for Cardiopulmonary Biochemistry and Respiratory Research, University College London Medical School, Rayne Institute, 5 University Street, London WC1E 6JJ, U.K.
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Abstract
Three patients are described who sustained injuries around the time of a collapse that led to out of hospital cardiac arrest. In this group of patients the importance of taking a complete medical history and recording the circumstances of the syncopal episode cannot be overemphasised. If cardiac output is successfully restored the possibility of occult traumatic injury must be considered in high risk patients.
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Abstract
Pathology of the ligamentum teres is rarely diagnosed. We describe the classification of the lesions seen at hip arthroscopy based on a group of 20 patients. Three groups are noted: complete rupture, partial rupture, and the degenerate ligamentum. The complete ligamentum teres rupture group had a history of either major trauma or surgery and had a high incidence of other hip pathology such as labral tears and articular damage. The partial ligamentum rupture group presented with a long history of ill-defined hip pain. Minor associated hip abnormalities were seen at arthroscopy. Degenerate ligamentum teres rupture presented with symptoms of the underlying osteoarthritis. Debridement or washout was performed but, at 2 years, patients had severe persistent symptoms or had had a joint replacement.
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Affiliation(s)
- A J Gray
- Department of Orthopaedic and Trauma Surgery, Western Infirmary, Glasgow, Scotland
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Pradhan DG, Sandridge AL, Mullaney P, Abboud E, Karcioglu ZA, Kandil A, Mustafa MM, Gray AJ. Radiation therapy for retinoblastoma: a retrospective review of 120 patients. Int J Radiat Oncol Biol Phys 1997; 39:3-13. [PMID: 9300734 DOI: 10.1016/s0360-3016(97)00156-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [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: 02/05/2023]
Abstract
PURPOSE To characterize the patient population and treatment outcomes in patients with Retinoblastoma (RB) referred for External Beam Orbital Radiotherapy (EBORT) to King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia from 1976 to 1993. METHODS AND MATERIALS A retrospective study of 120 patients with RB affecting a total of 192 eyes. Patients were divided into three groups. Group A are 60 patients (64 eyes) treated with EBORT to the intact eye to preserve vision. Reese-Ellsworth (RE) Staging was: 1: 12%; 2: 10%; 3: 12%; 4: 23%; and 5: 43%. Twenty-eight patients (47%) also received Vincristine, Adriamycin, and Cyclophosphamide chemotherapy (C/T). Mean follow-up, per patient, was 48.5 months. Standard treatment until 1992 was 45 Gy in 12 fractions of 3.75 Gy, three times weekly over 18 days. Assuming the alpha/beta ratio for early effects and tumor control at 10, Tk = 21 days, Tpot = 5 days, then the Biological Equivalent Dose (BED) was 62 Gy10 for early effects, and 101 Gy3 for late effects. Group B are 28 patients (28 eyes) treated for curative intent with EBORT to the orbit for locally advanced disease, usually after enucleation (24 eyes). Nineteen patients (83%) also had C/T. Mean follow-up was 22.6 months. Group C are 37 patients with advanced disease treated with radiotherapy for palliation. Seventeen (46%) also received C/T. Mean follow-up was 11.7 months. RESULTS Group A-following EBORT useful vision was retained in RE Stage 1 to 5: 7 of 7, 6 of 6, 4 of 8, 10 of 15, and 7 of 28 eyes, respectively. There was no significant difference between patients who received adjuvant chemotherapy and those who did not. Complications included cataract (27%), retinopathy (25%), vitreous hemorrhage (19%), and orbital deformities (11%). In Group B the local control rate was 71%. In Group C, 10 (27%) of the 37 patients were alive at last contact, and 27 (73%) were either terminal or dead of disease. None of Group A or B patients had positive CSF cytology, bone scan, or bone marrow examination. In Group C 19% had positive CSF cytology, and bone marrow, and 14% had a positive bone scan. CONCLUSIONS 1) EBORT preserved useful vision in a significant proportion of patients even in eyes with advanced RE Stage RB, but longer follow-up is likely to reveal an even higher complication rate with this regime. 2) High dose per fraction probably contributed to the increased complications. 3) Chemotherapy did not demonstrate any effect on retaining vision in this study. 4) For disease that is confined to within the eye clinically and radiologically, invasive procedures for CSF cytology, bone marrow examination, and bone scan do not seem warranted. 5) The optimum technique, fractionation, and dosage for RB is still not well defined.
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Affiliation(s)
- D G Pradhan
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Hardern RD, Gray AJ. Care of the polytraumatised patient. J Bone Joint Surg Br 1997; 79:510. [PMID: 9180342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Hardern RD, Gray AJ. Carbon monoxide poisoning. Postgrad Med J 1997; 73:189. [PMID: 9135847 PMCID: PMC2431245 DOI: 10.1136/pgmj.73.857.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
OBJECTIVE (1) To determine the accuracy of accident and emergency (A&E) doctors' diagnosis of radio-opaque ureteric calculi on plain abdominal radiographs; (2) to study the predictive value of haematuria with a history suggestive of ureteric colic. DESIGN A prospective study of all patients seen in a three month period with a provisional diagnosis of ureteric colic. Intravenous urography (IVU) was used as the gold standard for diagnosis of ureteric calculi. SETTING The accident and emergency department and medical unit of a large teaching hospital. SUBJECTS 60 patients who were admitted with an initial diagnosis of ureteric colic, 51 subsequently undergoing intravenous urography. RESULTS A&E doctors achieved a calculated sensitivity of 29% (95% confidence intervals 13% to 49%) and a specificity of 73% (52% to 90%) for identification of renal calculi on plain abdominal radiograph, compared with figures of 68% (48% to 84%) and 96% (78% to 100%) respectively for consultant radiologists. The difference between these results was highly significant (P = 0.0011). No patient with a definitive diagnosis of ureteric colic had a negative result for haematuria on urinary dipstick analysis. CONCLUSIONS A&E doctors are poor at identifying radio-opaque ureteric calculi on plain abdominal radiographs. If haematuria is absent on urinalysis then ureteric colic is an unlikely diagnosis.
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Affiliation(s)
- R Boyd
- Department of Accident and Emergency, Royal Infirmary of Edinburgh, United Kingdom
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Birkinshaw RI, Gleeson A, Gray AJ. Hairdryer syncope. Br J Clin Pract 1996; 50:398-9. [PMID: 9015915] [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: 02/03/2023]
Abstract
Six cases of hairdryer syncope are presented. This is a recurrent phenomenon, never previously described in medical literature, though it has been recognised for some time by some hairdressers. Elderly ladies sit under hood hairdryers at hairdressing salons for periods of up to 30 minutes. We observed that under these circumstances, some ladies attended the Accident and Emergency department with a history of 'fainting'. A brief survey of hairdressers was conducted around the Stockport area. Possible causes of hairdryer syncope are discussed.
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Cooper AE, Gray AJ, Collington J, Seddon H, Beattie I, Logan CJ. Excretion and metabolism of tipredane, a novel glucocorticoid, in the rat, mouse, monkey, and human. Drug Metab Dispos 1996; 24:1071-80. [PMID: 8894507] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The excretion and metabolism of [3H]tipredane, a novel glucocorticoid, has been studied in mice, rats, marmosets, rhesus and cynomolgus monkeys, and humans. After oral administration, [3H]tipredane was rapidly absorbed, metabolized, and excreted into urine and feces. In mice and male rats, radioactivity was excreted primarily into feces or bile, whereas in female rats, monkeys, and humans, excretion was mainly via the renal route. Some sex differences in the proportions excreted into urine and feces were noted in rodents, with females eliminating relatively more radioactivity in urine. Tipredane was shown to be extensively metabolized, but the routes were highly species-dependent and, in the rat, they were sex-dependent. Unchanged tipredane was not detected in any urine, bile, or blood extracts. Urinary and blood extract profiles indicated that there were between 10 and 30 metabolites in rats and mice, the majority of which constituted < 2% of the dose. In these species, the major pathways involved loss of the thioethyl moiety, S-oxidation of the thiomethyl group, and saturation of the adjacent saturated C16-17 bond. Hydroxylation of the steroid B-ring was seen in the 7 alpha-position in mice and female rats, and in the 6 beta-position in male rats. Metabolism of tipredane in rhesus and cynomolgus monkeys and humans was similar, but less extensive and different to that seen in rodents. The major products, the 6 beta-hydroxylated sulfoxide and sulfone metabolites of tipredane, accounted for 21-36% of the dose in human and monkey urine, and were also major components in blood. In contrast to mice and rats, S-oxidation and an unsaturated C16-17 bond were evident in primates. Metabolism of tipredane was rapid and complex, with significant species differences, although the disposition in rhesus and cynomolgus monkeys seemed to be similar to humans.
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Affiliation(s)
- A E Cooper
- Department of Drug Metabolism and Pharmacokinetics, Astra Chamwood, Loughborough, Leicestershire, UK
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Gray AJ, Goodacre S, Johnson G, McGowan A. Regional standards in trauma care. J Accid Emerg Med 1996; 13:365. [PMID: 8894873 PMCID: PMC1342783 DOI: 10.1136/emj.13.5.365-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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