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Prior C, Swales H, Sharman M, Reed N, Bommer N, Kent A, Glanemann B, Clarke K, Kortum A, Kelly D, Lea C, Roberts E, Rutherford L, Tamborini A, Murphy K, Batchelor DJ, Calleja S, Burrow R, Jamieson P, Best M, Borgonovi S, Calvo-Saiz I, Elgueta I, Piazza C, Gil Morales C, Hrovat A, Keane M, Kennils J, Lopez E, Spence S, Izaguirre E, Hernandez-Perello M, Lau N, Paul A, Ridyard A, Shales C, Shelton E, Farges A, Specchia G, Espada L, Fowlie SJ, Tappin S, Van den Steen N, Sparks TH, Allerton F. Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021). J Small Anim Pract 2024. [PMID: 38679786 DOI: 10.1111/jsap.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 02/28/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.
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Affiliation(s)
- C Prior
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
| | - H Swales
- Moorview Referrals, Cramlington, UK
| | | | - N Reed
- Veterinary Specialists Scotland, Livingston, UK
| | - N Bommer
- Veterinary Specialists Scotland, Livingston, UK
| | - A Kent
- Blaise Veterinary Referral Hospital, Birmingham, UK
| | | | - K Clarke
- Davies Veterinary Specialists, Hitchin, UK
| | - A Kortum
- Cambridge Veterinary School, Cambridge, UK
| | - D Kelly
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - C Lea
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - E Roberts
- Bristol Veterinary Specialists, Bristol, UK
| | | | | | - K Murphy
- Rowe Veterinary Referrals, Bristol, UK
| | - D J Batchelor
- School of Veterinary Science, University of Liverpool, Neston, UK
| | - S Calleja
- Lumbry Park Veterinary Specialists, Hampshire, UK
| | - R Burrow
- Northwest Veterinary Specialists, Runcorn, UK
| | - P Jamieson
- VetsNow 24/7 Emergency & Specialty Hospital, Glasgow, UK
| | - M Best
- Eastcott Veterinary Referrals, Swindon, UK
| | | | | | - I Elgueta
- VetsNow 24/7 Emergency & Specialty Hospital, Glasgow, UK
| | - C Piazza
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | | | - A Hrovat
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | - M Keane
- School of Veterinary Science, University of Liverpool, Neston, UK
| | - J Kennils
- Langford Veterinary Services Ltd, Langford, UK
| | - E Lopez
- Langford Veterinary Services Ltd, Langford, UK
| | - S Spence
- North Downs Specialist Referrals, Surrey, UK
| | - E Izaguirre
- North Downs Specialist Referrals, Surrey, UK
| | | | - N Lau
- Davies Veterinary Specialists, Hitchin, UK
| | - A Paul
- Anderson Moores Veterinary Specialists, Hampshire, UK
| | - A Ridyard
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - C Shales
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
| | - E Shelton
- The Royal Veterinary College, London, UK
| | - A Farges
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - G Specchia
- Scarsdale Vets Pride Veterinary Centre, Derby, UK
| | - L Espada
- University of Glasgow Small Animal Hospital, Glasgow, UK
| | - S J Fowlie
- Southfields Veterinary Specialists, Essex, UK
| | - S Tappin
- Dick White Referrals, Cambridge, UK
| | | | - T H Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Part of Linnaeus Veterinary Limited, Solihull, UK
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Patel VR, Rozycki G, Jopling J, Subramanian M, Kent A, Manukyan M, Sakran JV, Haut E, Levy M, Nathens AB, Brown C, Byrne JP. Association Between Geospatial Access to Trauma Center Care and Motor Vehicle Crash Mortality in the United States. J Trauma Acute Care Surg 2023:01586154-990000000-00580. [PMID: 38053239 DOI: 10.1097/ta.0000000000004221] [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] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Motor vehicle crashes (MVCs) are a leading cause of preventable trauma death in the United States (US). Access to trauma center care is highly variable nationwide. The objective of this study was to measure the association between geospatial access to trauma center care and MVC mortality. METHODS This was a population-based study of MVC-related deaths that occurred in 3,141 US counties (2017-2020). ACS and state-verified level I-III trauma centers were mapped. Geospatial network analysis estimated the ground transport time to the nearest trauma center from the population-weighted centroid for each county. In this way, the exposure was the predicted access time to trauma center care for each county population. Hierarchical negative binomial regression measured the risk-adjusted association between predicted access time and MVC mortality, adjusting for population demographics, rurality, access to trauma resources, and state traffic safety laws. RESULTS We identified 92,398 crash fatalities over the four-year study period. Trauma centers mapped included 217 level I, 343 level II, and 495 level III trauma centers. The median county predicted access time was 47 min (IQR 26-71 min). Median county MVC mortality was 12.5 deaths/100,000 person-years (IQR 7.4-20.3 deaths/100,000 person-years). After risk-adjustment, longer predicted access times were significantly associated with higher rates of MVC mortality (>60 min vs. <15 min; MRR 1.36; 95%CI 1.31-1.40). This relationship was significantly more pronounced in urban/suburban vs. rural/wilderness counties (p for interaction, <0.001). County access to trauma center care explained 16% of observed state-level variation in MVC mortality. CONCLUSIONS Geospatial access to trauma center care is significantly associated with MVC mortality and contributes meaningfully to between-state differences in road traffic deaths. Efforts to improve trauma system organization should prioritize access to trauma center care to minimize crash fatalities. LEVEL OF EVIDENCE Level III, Epidemiological.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Grace Rozycki
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey Jopling
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Madhu Subramanian
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alistair Kent
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mariuxi Manukyan
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Avery B Nathens
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON
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Torres CM, Florecki K, Haghshenas J, Manukyan M, Kent A, Lawrence C, Sakran JV. The evolution and development of a robotic acute care surgery program. J Trauma Acute Care Surg 2023; 95:e26-e30. [PMID: 37277903 DOI: 10.1097/ta.0000000000004020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Acute care surgeons perform more than 850,000 operations annually on emergency general surgery patients in the United States. Emergency general surgery conditions are associated with a disproportionate excess of patient complications and death. Innovative quality improvement strategies have focused on addressing the excess morbidity and mortality among this patient population. Minimally invasive surgical techniques have been shown to reduce the burden experienced by emergency general surgery patients. Still, limited adoption by acute care surgeons has restricted this application's potential. An institutional robotics acute care surgery program provides acute care surgeons additional opportunities to expand minimally invasive surgery access to emergency general surgery patients irrespective of the time or day of the week. METHODS A robotics acute care surgery program was developed and implemented at a high-volume academic institution within the division of trauma and acute care surgery. RESULTS Three attending surgeons and two fellows within the trauma and acute care surgery division had successfully completed a defined robotics clinical pathway. As a result, around-the-clock use of a robotic surgical platform for emergency general surgery cases was implemented with routine use by trained robotic acute care surgeons and practicing fellows. CONCLUSION The advancement of robotic surgical technology has opened new avenues for surgical application in the emergency setting. The development of a robotic acute care surgery program allows acute care surgeons to diversify their practice while providing greater access to minimally invasive approaches for emergency general surgery patients.
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Affiliation(s)
- Crisanto M Torres
- From the Division of Trauma and Acute Care Surgery (C.M.T.), Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; Division of Acute Care Surgery (K.F., M.M., A.K., J.V.S.), Johns Hopkins Hospital, Baltimore, Maryland; Division of Trauma and Acute Care Surgery (J.H.), University of Illinois-Chicago School of Medicine, Chicago, Illinois; Department of Surgery (J.V.S.), Johns Hopkins School of Medicine, Baltimore, Maryland; and Department of Surgery (C.L.), Johns Hopkins School of Nursing, Baltimore, Maryland
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McCormick NE, Earle M, Kent A, Ha C, Hakes L, Anderson L, Stoddart AK, Langille MGI, Gagnon GA. Betaproteobacteria are a key component of surface water biofilters that maintain sustained manganese removal in response to fluctuations in influent water temperature. Water Res 2023; 244:120515. [PMID: 37634461 DOI: 10.1016/j.watres.2023.120515] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
The health risks associated with manganese (Mn) in drinking water, and an improved understanding of Mn accumulation within, and subsequent release from, distribution systems, have increased the need for robust, sustainable treatment options to minimize Mn concentrations in finished water. Biofiltration is an established and effective method to remove Mn in groundwater however, Mn removal in surface water biofilters is an emerging treatment process that has not been extensively studied. Seasonal variations in water temperature can present an operational challenge for surface water biofilters which may see reduced Mn removal under colder conditions. This study examined the microbiomes of surface water biofilters at three utilities (ACWD WTP, WTP B, and WTP D) which all experienced similar seasonal fluctuations in influent water temperature. High Mn removal was observed at the ACWD WTP for much of the year, but Mn removal decreased with a concurrent decrease in the influent water temperature (58% ± 22%). In contrast, both WTP B and WTP D achieved year-round Mn removal (84% ± 5% and 93% ± 8% respectively). Marker gene (16S rRNA) sequencing analysis of the biofilter microbiomes identified a high abundance of Betaproteobacteria in WTP B and WTP D (37% ± 12% and 21% ± 3% respectively), but a low abundance of Betaproteobacteria in the ACWD WTP (2% ± 2%). The microbiomes of new bench-scale biofilters, in operation at the ACWD WTP, were also investigated. The abundance of Betaproteobacteria was significantly greater (p < 0.05) after the biofilters had acclimated than before acclimation, and differential abundance analysis identified 6 genera within the Betaproteobacteria class were enriched in the acclimated microbiome. Additionally, the acclimated biofilters were able to maintain high Mn removal performance (87% ± 10%) when the influent water temperature decreased to 10 °C or less. Further analysis of previously published studies found the abundance of Betaproteobacteria was also significantly greater (p < 0.001) in biofilters with sustained Mn removal than in biofilters which did not treat for Mn as a contaminant, despite differences in design scale, source water, and media type. Microbiome network analysis identified multiple co-occurrence relationships between Betaproteobacteria and Mn oxidizing bacteria in the WTP B and WTP D biofilters, suggesting indirect contributions by Betaproteobacteria to biological Mn oxidation. These co-occurrence relationships were not present in the full-scale ACWD WTP microbiome. Whether the role of Betaproteobacteria in biological Mn oxidation is direct, indirect, or a combination of both, they are consistently present at a high abundance in both groundwater and surface water biofilters with sustained Mn removal, and their absence may contribute to the seasonal fluctuations in Mn removal observed at the ACWD WTP. This new insight to Betaproteobacteria and their role in Mn biofiltration could contribute to water innovation and design that would improve the reliability of Mn removal.
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Affiliation(s)
- N E McCormick
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada.
| | - M Earle
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - A Kent
- Arcadis US, Inc., Austin, TX, USA
| | - C Ha
- Alameda County Water District, Freemont, CA, USA
| | - L Hakes
- Alameda County Water District, Freemont, CA, USA
| | - L Anderson
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - A K Stoddart
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
| | - M G I Langille
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - G A Gagnon
- Centre for Water Resources Studies, Department of Civil and Resource Engineering, Dalhousie University, Halifax, NS, Canada
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Haghshenas J, Florecki K, Torres CM, Manukyan M, Kent A, Lawrence C, Sakran JV. Incorporation of a robotic surgery training curriculum in acute care surgical fellowship. J Trauma Acute Care Surg 2023; 95:e11-e14. [PMID: 37125919 DOI: 10.1097/ta.0000000000003996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Jafar Haghshenas
- From the Division of Trauma and Acute Care Surgery (J.H.), Advocate Christ Medical Center, University of Illinois-Chicago School of Medicine, Chicago, Illinois; Division of Acute Care Surgery (K.F., M.M., A.K., J.V.S.), Johns Hopkins Hospital, Baltimore, Maryland; Division of Trauma and Acute Care Surgery (C.M.T.), Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; Johns Hopkins School of Medicine (J.V.S.), Baltimore, Maryland; and Johns Hopkins School of Nursing (C.L., J.V.S.), Baltimore, Maryland
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Dunton Z, Seamon MJ, Subramanian M, Jopling J, Manukyan M, Kent A, Sakran JV, Stevens K, Haut E, Byrne JP. Emergency department versus operating room intubation of patients undergoing immediate hemorrhage control surgery. J Trauma Acute Care Surg 2023; 95:69-77. [PMID: 36850033 DOI: 10.1097/ta.0000000000003907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Hemorrhage control surgery is an essential trauma center function. Airway management of the unstable bleeding patient in the emergency department (ED) presents a challenge. Premature intubation in the ED can exacerbate shock and precipitate extremis. We hypothesized that ED versus operating room intubation of patients requiring urgent hemorrhage control surgery is associated with adverse outcomes at the patient and hospital-levels. METHODS Patients who underwent hemorrhage control within 60 minutes of arrival at level 1 or 2 trauma centers were identified (National Trauma Data Bank 2017-2019). To minimize confounding, patients dead on arrival, undergoing ED thoracotomy, or with clinical indications for intubation (severe head/neck/face injury or Glasgow Coma Scale score of ≤8) were excluded. Two analytic approaches were used. First, hierarchical logistic regression measured the risk-adjusted association between ED intubation and mortality. Secondary outcomes included ED dwell time, units of blood transfused, and major complications (cardiac arrest, acute respiratory distress syndrome, acute kidney injury, sepsis). Second, a hospital-level analysis determined whether hospital tendency ED intubation was associated with adverse outcomes. RESULTS We identified 9,667 patients who underwent hemorrhage control surgery at 253 trauma centers. Patients were predominantly young men (median age, 33 years) who suffered penetrating injuries (71%). The median initial Glasgow Coma Scale and systolic blood pressure were 15 and 108 mm Hg, respectively. One in five (20%) of patients underwent ED intubation. After risk-adjustment, ED intubation was associated with significantly increased odds of mortality, longer ED dwell time, greater blood transfusion, and major complications. Hospital-level analysis identified significant variation in use of ED intubation between hospitals not explained by patient case mix. After risk adjustment, patients treated at hospitals with high tendency for ED intubation (compared with those with low tendency) were significantly more likely to suffer in-hospital cardiac arrest (6% vs. 4%; adjusted odds ratio, 1.46; 95% confidence interval, 1.04-2.03). CONCLUSION Emergency department intubation of patients who require urgent hemorrhage control surgery is associated with adverse outcomes. Significant variation in ED intubation exists between trauma centers not explained by patient characteristics. Where feasible, intubation should be deferred in favor of rapid resuscitation and transport to the operating room. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Zachary Dunton
- From the School of Medicine and Public Health (Z.D.), University of Wisconsin-Madison, Madison, Wisconsin; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery (M.J.S.), University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Trauma and Acute Care Surgery, Department of Surgery (M.S., J.J., M.M., A.K., J.V.S., K.S., E.H., J.P.B.), Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Work M, Scudder C, Bergum Hjellegjerde K, Dunning M, Gajanayake I, Kent A, Tintle L, Sparks T, Allerton F. A survey on Shar Pei autoinflammatory disease in the United Kingdom. J Small Anim Pract 2023; 64:401-408. [PMID: 36978210 DOI: 10.1111/jsap.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/12/2022] [Revised: 11/03/2022] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To characterise the fever episodes attributed to Shar Pei autoinflammatory disease and to identify common diagnostic and management strategies in the United Kingdom. A secondary objective was to determine risk factors associated with Shar Pei autoinflammatory disease fever episodes. METHODS A retrospective survey was performed to characterise episodes of Shar Pei autoinflammatory disease fever and to identify commonly used treatments in affected dogs. Clinical data were collected from owners and veterinarians. Frequencies of previously proposed risk factors (skin thickness and folding, muzzle conformation) and comorbid conditions were compared between dogs that had exhibited fever episodes consistent with Shar Pei autoinflammatory disease and those who had not. RESULTS At least one episode of fever attributed to Shar Pei autoinflammatory disease was reported in 52 of 106 (49%) Shar Pei. Nine other dogs had fever episodes consistent with Shar Pei autoinflammatory disease reported by their owners but not by veterinarians. Median rectal temperature at presentation for Shar Pei autoinflammatory disease fever was 40.1°C [104.2°F] (39.9 to 41.3°C [103.8 to 106.3°F]) and owners reported associated hyporexia (n=33, 63%) and vomiting (n=8, 15%) more frequently than veterinary records (n=22, 42% and n=0, 0%, respectively). The median number of veterinary appointments for Shar Pei autoinflammatory disease was two per dog (1 to 15) while owners reported a median of four episodes per dog per year. None of the assessed phenotypic variants or comorbidities were significantly associated with exhibiting Shar Pei autoinflammatory disease fever episodes. CLINICAL SIGNIFICANCE Episodes of Shar Pei autoinflammatory disease fever were reported approximately twice as frequently by owners compared to veterinary records, suggesting the burden of this condition may be underestimated by veterinarians. Specific risk factors for Shar Pei autoinflammatory disease fever were not identified.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - C Scudder
- Southfields Veterinary Specialists, Essex, UK
- Royal Veterinary College, Potters Bar, Hertfordshire, UK
| | | | - M Dunning
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - I Gajanayake
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Solihull, UK
| | - L Tintle
- Wurtsboro Veterinary Clinic, Wurtsboro, New York, USA
| | - T Sparks
- Waltham Petcare Science Institute, Leicestershire, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Solihull, UK
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Ravicini S, Kent A, Dunning M, Baines S, Clarke S, Allerton F. Description and outcome of dogs with primary immune-mediated polyarthritis: 73 cases (2012-2017). J Small Anim Pract 2023; 64:142-148. [PMID: 36321528 DOI: 10.1111/jsap.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To provide a description of primary idiopathic immune-mediated polyarthritis, including long-term outcome and relapse rates, for dogs starting treatment with corticosteroids alone or corticosteroids with a second immunosuppressant. MATERIALS AND METHODS Medical records were reviewed between January 2012 and December 2017 to identify dogs diagnosed with primary immune-mediated polyarthritis. Data including signalment, clinicopathological findings, type and duration of treatment, relapse and outcome were recorded. RESULTS Seventy-three dogs were included. Fifty-four dogs were started on corticosteroid monotherapy (an additional immunosuppressant was introduced later in 27/54 dogs) and 19 dogs were treated with multi-modal immunosuppression from the outset. Ninety-five percent (69/73) of dogs responded favourably to therapy although death was attributed to immune-mediated polyarthritis in 19% (14/73) of dogs. Relapse of clinical signs was reported in 53% (39/73) dogs (31/39 while on treatment), with multiple relapses observed in 17 dogs. Complete cure (permanent withdrawal of immunosuppressive medication) was achieved in 46 dogs (63%). Overall, 81% of dogs had a well-managed disease for an extended timeframe (≥1131 days). Fourteen of 19 (74%) dogs that started treatment with multi-modal immunosuppression and 32 of 54 (59%) started on corticosteroids alone achieved a complete cure. CLINICAL SIGNIFICANCE This study provides extended follow-up information for a large cohort of dogs with primary immune-mediated polyarthritis. Immunosuppressive therapy was discontinued in the majority of dogs but disease-associated mortality remains high.
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Affiliation(s)
- S Ravicini
- Washington State University, College of Veterinary Medicine, Pullman, WA, USA
| | - A Kent
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - M Dunning
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK.,School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - S Baines
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - S Clarke
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
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Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. JAMA Surg 2023; 158:532-540. [PMID: 36652255 PMCID: PMC9857728 DOI: 10.1001/jamasurg.2022.6978] [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] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Whole-blood (WB) resuscitation has gained renewed interest among civilian trauma centers. However, there remains insufficient evidence that WB as an adjunct to component therapy-based massive transfusion protocol (WB-MTP) is associated with a survival advantage over MTP alone in adult civilian trauma patients presenting with severe hemorrhage. Objective To assess whether WB-MTP compared with MTP alone is associated with improved survival at 24 hours and 30 days among adult trauma patients presenting with severe hemorrhage. Design, Setting, and Participants This retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program databank from January 1, 2017, and December 31, 2018, included adult trauma patients with a systolic blood pressure less than 90 mm Hg and a shock index greater than 1 who received at least 4 units of red blood cells within the first hour of emergency department (ED) arrival at level I and level II US and Canadian adult civilian trauma centers. Patients with burns, death within 1 hour of ED arrival, and interfacility transfers were excluded. Data were analyzed from February 2022 to September 2022. Exposures Resuscitation with WB-MTP compared with MTP alone within 24 hours of ED presentation. Main Outcomes and Measures Primary outcomes were survival at 24 hours and 30 days. Secondary outcomes selected a priori included major complications, hospital length of stay, and intensive care unit length of stay. Results A total of 2785 patients met inclusion criteria: 432 (15.5%) in the WB-MTP group (335 male [78%]; median age, 38 years [IQR, 27-57 years]) and 2353 (84.5%) in the MTP-only group (1822 male [77%]; median age, 38 years [IQR, 27-56 years]). Both groups included severely injured patients (median injury severity score, 28 [IQR, 17-34]; median difference, 1.29 [95% CI, -0.05 to 2.64]). A survival curve demonstrated separation within 5 hours of ED presentation. WB-MTP was associated with improved survival at 24 hours, demonstrating a 37% lower risk of mortality (hazard ratio, 0.63; 95% CI, 0.41-0.96; P = .03). Similarly, the survival benefit associated with WB-MTP remained consistent at 30 days (HR, 0.53; 95% CI, 0.31-0.93; P = .02). Conclusions and Relevance In this cohort study, receipt of WB-MTP was associated with improved survival in trauma patients presenting with severe hemorrhage, with a survival benefit found early after transfusion. The findings from this study are clinically important as this is an essential first step in prioritizing the selection of WB-MTP for trauma patients presenting with severe hemorrhage.
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Affiliation(s)
- Crisanto M. Torres
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Division of Trauma and Acute Care Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Alistair Kent
- Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dane Scantling
- Division of Trauma and Acute Care Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Bellal Joseph
- College of Medicine, Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
| | - Elliott R. Haut
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joseph V. Sakran
- Division of Acute Care Surgery, Johns Hopkins Hospital, Baltimore, Maryland,Johns Hopkins School of Medicine, Baltimore, Maryland,Johns Hopkins School of Nursing, Baltimore, Maryland,Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia
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Mc Gowan S, Goumalatsou C, Kent A. Fantastic niches and where to find them: the current diagnosis and management of uterine niche. Facts Views Vis Obgyn 2022; 14:37-47. [PMID: 35373546 PMCID: PMC9612856 DOI: 10.52054/fvvo.14.1.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Caesarean section (CS) scar niche is a well recognised complication of caesarean delivery and is defined as an indentation at the site of the CS scar with a depth of at least 2mm. Objectives To review systematically the medical literature regarding the current diagnosis and management of uterine niche Materials and methods We carried out a systematic review using MeSH terms ‘niche’ OR ‘sacculation’ OR ‘caesarean scar defect’ OR ‘caesarean section scar’ OR ‘uterine defect’ OR ‘isthmocele.’ Articles included were peer-reviewed and in English language. Main outcome measures Prevalence, symptoms, diagnosis, pathophysiology and management of uterine niche. Results CS scar niche is common and, in a subgroup, produces a range of symptoms including post-menstrual bleeding, dyspareunia and subfertility. It may be linked to use of locked sutures during CS closure. Niche repair can be achieved laparoscopically or hysteroscopically and appears to improve symptoms, although solid conclusions regarding fertility outcomes cannot be drawn. Conclusions CS scar niche is associated with a range of symptoms. Repair may aid subfertile patients and those with post-menstrual spotting. The presence of a niche is probably irrelevant in the absence of symptoms. What is new? LNG-IUS and surgical repair appear to improve symptoms in those with a niche.
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Work M, Allerton F, Griffin S, Kent A. Percutaneous-endoscopic rendezvous cholangiography with biliary stent placement in a dog with extra-hepatic biliary duct obstruction. J Small Anim Pract 2021; 63:416-420. [PMID: 34658028 DOI: 10.1111/jsap.13442] [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] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
A middle-aged male springer spaniel was presented for investigation of acute vomiting, lethargy and icterus. Marked distension of the gall bladder and common bile duct was evident at ultrasound due to obstruction by mineralised intraluminal material. After 48 hours of hospitalisation with intravenous fluid therapy, analgesia and antimicrobial therapy, intervention was deemed necessary to relieve the obstruction. A percutaneous-endoscopic rendezvous approach was used to achieve placement of a pigtail stent into the distal common bile duct, successfully relieving the obstruction. Serial biochemistry measurements postprocedure confirmed marked improvements in serum bilirubin. The patient remains clinically well 24 months postprocedure, and all hepatic enzyme activities have normalised. Based on the literature search performed, this is the first successful application of this technique in the management of canine extrahepatic biliary duct obstruction.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - S Griffin
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
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Ghai V, Jan H, Shakir F, Kent A. A Retrospective Cohort Study: Identifying Pre-Operative Factors Associated with Non-Responders in Women Undergoing Comprehensive Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.092] [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: 10/28/2022]
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Shakir F, Clemente G, Jan H, Jan T, Kent A. The Design and Validation of Observational Clinical Human Reliability Analysis (OCHRA) as a Competency Tool for Assessment in Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.137] [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: 11/29/2022]
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Kent A, Hardcastle N, Kron T, Wheeler G, Hegi-Johnson F. P3.08-17 Paediatric Motion Management Solutions for Particle Therapy Based Thoracic Stereotactic Ablative Body Radiotherapy (SABR). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Allerton F, Swinbourne F, Barker L, Black V, Kathrani A, Tivers M, Henriques T, Kisielewicz C, Dunning M, Kent A. Gall bladder mucoceles in Border terriers. J Vet Intern Med 2018; 32:1618-1628. [PMID: 30079451 PMCID: PMC6189338 DOI: 10.1111/jvim.15249] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
Background Gall bladder mucoceles (GBM) are a leading cause of biliary disease in dogs with several breeds, including the Shetland Sheepdog, American Cocker Spaniel, Chihuahua, Pomeranian, and Miniature Schnauzer apparently predisposed. Objective To determine risk factors, clinical features, and response to treatment of GBM in Border terriers (BT). Animals Medical records of 99 dogs (including 51 BT) with an ultrasonographic (±histopathologic) diagnosis of GBM from three referral centers in the United Kingdom were collected. A control group of 87 similar‐aged BT with no ultrasonographic evidence of gall bladder disease was selected for comparison. Method Retrospective case‐control study. Odds ratios were calculated to establish breed predisposition. Signalment, presence of endocrine disease, clinicopathologic results, and outcome were compared between the BT, other breeds, and control BTs. Results The odds of identifying a GBM in a BT in this hospital population was 85 times that of all other breeds (95% confidence interval 56.9‐126.8). BT had similar clinical signs and clinicopathologic changes to other breeds with GBM. There was no evidence that endocrinopathies were associated with GBM in BT. Clinical Significance A robust breed predisposition to GBM is established for the BT.
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Affiliation(s)
- F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
| | - F Swinbourne
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
| | - L Barker
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - V Black
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - A Kathrani
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - M Tivers
- Bristol Veterinary School, University of Bristol, Langford, Bristol, BS40 5DU, The United Kingdom
| | - T Henriques
- Pride Veterinary Centre, Riverside Road, Derby, DE24 8HX, The United Kingdom
| | - C Kisielewicz
- Pride Veterinary Centre, Riverside Road, Derby, DE24 8HX, The United Kingdom
| | - M Dunning
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, The United Kingdom
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, The United Kingdom
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Rebelo P, Green A, Aziz T, Kent A, Schafer D, Venkatesan L, Cheeran B. Thalamic Directional Deep Brain Stimulation for tremor: Spend less, get more. Brain Stimul 2018; 11:600-606. [DOI: 10.1016/j.brs.2017.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 11/26/2022] Open
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Kent A, Vinken PJ. The Center for International Biomedical Communications Research. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A joint center has been established by the University of Pittsburgh and the Excerpta Medica Foundation. The basic objective of the Center is to seek ways in which the health sciences community may achieve increasingly convenient and economical access to scientific findings. The research center will make use of facilities and resources of both participating institutions. Cooperating from the University of Pittsburgh will be the School of Medicine, the Computation and Data Processing Center, and the Knowledge Availability Systems (KAS) Center. The KAS Center is an interdisciplinary organization engaging in research, operations, and teaching in the information sciences.Excerpta Medica Foundation, which is the largest international medical abstracting service in the world, with offices in Amsterdam, New York, London, Milan, Tokyo and Buenos Aires, will draw on its permanent medical staff of 54 specialists in charge of the 35 abstracting journals and other reference works prepared and published by the Foundation, the 700 eminent clinicians and researchers represented on its International Editorial Boards, and the 6,000 physicians who participate in its abstracting programs throughout the world. Excerpta Medica will also make available to the Center its long experience in the field, as well as its extensive resources of medical information accumulated during the Foundation’s twenty years of existence. These consist of over 1,300,000 English-language _abstract of the world’s biomedical literature, indexes to its abstracting journals, and the microfilm library in which complete original texts of all the 3,000 primary biomedical journals, monitored by Excerpta Medica in Amsterdam are stored since 1960.The objectives of the program of the combined Center include: (1) establishing a firm base of user relevance data; (2) developing improved vocabulary control mechanisms; (3) developing means of determining confidence limits of vocabulary control mechanisms in terms of user relevance data; 4. developing and field testing of new or improved media for providing medical literature to users; 5. developing methods for determining the relationship between learning and relevance in medical information storage and retrieval systems’; and (6) exploring automatic methods for retrospective searching of the specialized indexes of Excerpta Medica.The priority projects to be undertaken by the Center are (1) the investigation of the information needs of medical scientists, and (2) the development of a highly detailed Master List of Biomedical Indexing Terms. Excerpta Medica has already been at work on the latter project for several years.
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Abstract
An experiment is described which attempts to derive quantitative indicators regarding the potential relevance predictability of the intermediate stimuli used to represent documents in information retrieval systems. In effect, since the decision to peruse an entire document is often predicated upon the examination of one »level of processing« of the document (e.g., the citation and/or abstract), it became interesting to analyze the properties of what constitutes »relevance«. However, prior to such an analysis, an even more elementary step had to be made, namely, to determine what portions of a document should be examined.An evaluation of the ability of intermediate response products (IRPs), functioning as cues to the information content of full documents, to predict the relevance determination that would be subsequently made on these documents by motivated users of information retrieval systems, was made under controlled experimental conditions. The hypothesis that there might be other intermediate response products (selected extracts from the document, i.e., first paragraph, last paragraph, and the combination of first and last paragraph), that would be as representative of the full document as the traditional IRPs (citation and abstract) was tested systematically. The results showed that:1. there is no significant difference among the several IRP treatment groups on the number of cue evaluations of relevancy which match the subsequent user relevancy decision on the document;2. first and last paragraph combinations have consistently predicted relevancy to a higher degree than the other IRPs;3. abstracts were undistinguished as predictors; and4. the apparent high predictability rating for citations was not substantive.Some of these results are quite different than would be expected from previous work with unmotivated subjects.
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Kent A. Digital Computer Use in Medical Bibliography. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1636231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A brief review has been provided with regard to some approaches to information retrieval that are now under development in the United States. These developments are discussed in terms of the unit operations of documentation: acquisition; analysis (abstracting, indexing, classifying, extracting); terminology control; recording of results of analysis on searchable medium; storage of source documents; question analysis and development of search strategy;conductingofsearch;anddelivery of search results.At the present time efforts in this field are largely uncoordinated, with decisions on depth of analysis of documents and philosophy of coding system left largely to the desires and opinions of individuals or separate organizations.Two programs in medjcal documentation at Western Reserve University are discussed: one in communicable diseases; and the other in diabetes. Both programs involve the analysis of the literature in considerable detail, using roles and links, and the control of the meaning of terminology using the technique , of semantic factoring.
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Affiliation(s)
- A Kent
- Genetic Alliance UK, London, UK
| | - J Spink
- Genetic Alliance UK, London, UK
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Kent A, Shakir F. Redo Modified Laparoscopic Colposuspension. J Minim Invasive Gynecol 2016; 22:S249. [PMID: 27679180 DOI: 10.1016/j.jmig.2015.08.869] [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: 10/22/2022]
Affiliation(s)
- A Kent
- Minimal Access Training Therpy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - F Shakir
- Minimal Access Training Therpy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
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Shakir F, Jan H, Pearson C, Haines P, Rae-Mitchell W, Kent A. Uterine Endometriosis - Incidence in Patients Undergoing Laparoscopic Surgery for Severe Recto-Vaginal Endometriosis. A Prospective Cohort Study. J Minim Invasive Gynecol 2016; 22:S30. [PMID: 27679201 DOI: 10.1016/j.jmig.2015.08.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- F Shakir
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - H Jan
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - C Pearson
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - P Haines
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - W Rae-Mitchell
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - A Kent
- Minimal Access Training Therapy Unit (MATTU), Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
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Abstract
A review of the literature was carried out to determine the importance of pre-hospital scene times and how it can be affected. In the UK, and certain centres in North America, mortality and morbidity in critically injured patients appears to be related to scene times. The majority of these patients only require basic life support at the scene. Consequently the possible benefits of more advanced procedure need to be compared with the transportation period, the time needed to mobilize a medical team and skill proficiency. Cardiovascular resuscitation procedures in particular require reappraisal. Though haemostasis is essential, there is little evidence to support the use of fluid resuscitation in nontrapped urban patients with a significant haemorrhage problem. In contrast patients who are not bleeding do appear to benefit from advanced life support procedures even though this increases scene time. There is therefore a need for pre-hospital paramedic workers to triage patients so that appropriate resuscitation can be carried out.
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Affiliation(s)
| | - A Kent
- Hope Hospital, Salford, UK
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Tamborini A, Jahns H, McAllister H, Kent A, Harris B, Procoli F, Allenspach K, Hall EJ, Day MJ, Watson PJ, O'Neill EJ. Bacterial Cholangitis, Cholecystitis, or both in Dogs. J Vet Intern Med 2016; 30:1046-55. [PMID: 27203848 PMCID: PMC5084764 DOI: 10.1111/jvim.13974] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022] Open
Abstract
Background Bacterial cholangitis and cholecystitis are rarely reported, poorly characterized diseases in the dog. Objectives To characterize the clinical features of these conditions. Animals Twenty‐seven client‐owned dogs with bacterial cholangitis, cholecystitis, or both. Methods Multicenter, retrospective cases series of dogs with bacterial cholangitis, cholecystitis, or both, presenting January 2000 to June 2011 to 4 Veterinary Schools in Ireland/United Kingdom. Interrogation of hospital databases identified all cases with the inclusion criteria; histopathologically confirmed cholangitis or cholecystitis and bile culture/cytology results supporting a bacterial etiology. Results Twenty‐seven dogs met the inclusion criteria with approximately 460 hepatitis cases documented over the same study period. Typical clinical pathology findings were increases in liver enzyme activities (25/26), hyperbilirubinemia (20/26), and an inflammatory leukogram (21/24). Ultrasound findings, although nonspecific, aided decision‐making in 25/26 cases. The most frequent hepatobiliary bacterial isolates were Escherichia coli (n = 17; 16 cases), Enterococcus spp. (n = 8; 6 cases), and Clostridium spp. (n = 5; 5 cases). Antimicrobial resistance was an important feature of aerobic isolates; 10/16 E. coli isolates resistant to 3 or more antimicrobial classes. Biliary tract rupture complicated nearly one third of cases, associated with significant mortality (4/8). Discharged dogs had a guarded to fair prognosis; 17/18 alive at 2 months, although 5/10 re‐evaluated had persistent liver enzyme elevation 2–12 months later. Conclusion and Clinical Significance Bacterial cholangitis and cholecystitis occur more frequently than suggested by current literature and should be considered in dogs presenting with jaundice and fever, abdominal pain, or an inflammatory leukogram or with ultrasonographic evidence of gallbladder abnormalities.
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Affiliation(s)
- A Tamborini
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - H Jahns
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - H McAllister
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - A Kent
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - B Harris
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - F Procoli
- Department of Veterinary Clinical Sciences, Royal Veterinary College, London, UK
| | - K Allenspach
- Department of Veterinary Clinical Sciences, Royal Veterinary College, London, UK
| | - E J Hall
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - M J Day
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - P J Watson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - E J O'Neill
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Kent A, Shakir F, Rockall T. Laparoscopic Hysterectomy Intrafascial (LHi) Following Pelvic Vein Embolization With Coils. J Minim Invasive Gynecol 2015; 22:S215. [DOI: 10.1016/j.jmig.2015.08.765] [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: 11/16/2022]
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Stawicki SP, Kent A, Patil P, Jones C, Stoltzfus JC, Vira A, Kelly N, Springer AN, Vazquez D, Evans DC, Papadimos TJ, Bahner DP. Dynamic behavior of venous collapsibility and central venous pressure during standardized crystalloid bolus: A prospective, observational, pilot study. Int J Crit Illn Inj Sci 2015; 5:80-4. [PMID: 26157649 PMCID: PMC4477400 DOI: 10.4103/2229-5151.158392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical intensive care unit (SICU). Most surrogates for volume status, including central venous pressure (CVP) and pulmonary artery wedge pressure, require invasive lines associated with a number of potential complications. Sonographic assessment of the collapsibility of the inferior vena cava (IVC) has been described as a noninvasive method for determining volume status. The purpose of this study was to analyze the dynamic response in IVC collapsibility index (IVC-CI) to changes in CVP in SICU patients receiving fluid boluses for volume resuscitation. MATERIALS AND METHODS A prospective pilot study was conducted on a sample of SICU patients who met clinical indications for intravenous (IV) fluid bolus and who had preexisting central venous access. Boluses were standardized to crystalloid administration of either 500 mL over 30 min or 1,000 mL over 60 min, as clinically indicated. Concurrent measurements of venous CI (VCI) and CVP were conducted right before initiation of IV bolus (i.e. time 0) and then at 30 and 60 min (as applicable) after bolus initiation. Patient demographics, ventilatory parameters, and vital sign assessments were recorded, with descriptive outcomes reported due to the limited sample size. RESULTS Twenty patients received a total of 24 IV fluid boluses. There were five recorded 500 mL boluses given over 30 min and 19 recorded 1,000 mL boluses given over 60 min. Mean (median) CVP measured at 0, 30, and 60 minutes post-bolus were 6.04 ± 3.32 (6.5), 9.00 ± 3.41 (8.0), and 11.1 ± 3.91 (12.0) mmHg, respectively. Mean (median) IVC-CI values at 0, 30, and 60 min were 44.4 ± 25.2 (36.5), 26.5 ± 22.8 (15.6), and 25.2 ± 21.2 (14.8), respectively. CONCLUSIONS Observable changes in both VCI and CVP are apparent during an infusion of a standardized fluid bolus. Dynamic changes in VCI as a measurement of responsiveness to fluid bolus are inversely related to changes seen in CVP. Moreover, an IV bolus tends to produce an early response in VCI, while the CVP response is more gradual. Given the noninvasive nature of the measurement technique, VCI shows promise as a method of dynamically measuring patient response to fluid resuscitation. Further studies with larger sample sizes are warranted.
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Affiliation(s)
- Stanislaw P Stawicki
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Alistair Kent
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Prabhav Patil
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Christian Jones
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Jill C Stoltzfus
- Department of Research and Innovation, St Luke's University Health Network, Bethlehem, Pennsylvania, United States ; The Research Institute, St Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Amar Vira
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Nicholas Kelly
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Andrew N Springer
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Daniel Vazquez
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - David C Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
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De Wit M, Bakker M, van Bodegom-Vos L, Buch M, Caeyers N, Carluccio A, Geenen R, Greiff R, Glüsing B, Gossec L, Kent A, Poldema I, Vliet Vlieland T, Wiek D, Schipper K. OP0245-PARE Helping Patients to Make Informed Decisions. The Pare Guide to Disseminate Eular Recommendations Among Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6069] [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: 11/03/2022]
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Kent A, Patil P, Davila V, Bailey JK, Jones C, Evans DC, Boulger CT, Adkins E, Balakrishnan JM, Valiyaveedan S, Galwankar SC, Bahner DP, Stawicki SP. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med 2015; 10:44-9. [PMID: 25593607 PMCID: PMC4286845 DOI: 10.4103/1817-1737.146872] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Inferior vena cava collapsibility index (IVC-CI) has been shown to correlate with both clinical and invasive assessment of intravascular volume status, but has important limitations such as the requirement for advanced sonographic skills, the degree of difficulty in obtaining those skills, and often challenging visualization of the IVC in the postoperative patient. The current study aims to explore the potential for using femoral (FV) or internal jugular (IJV) vein collapsibility as alternative sonographic options in the absence of adequate IVC visualization. METHODS A prospective, observational study comparing IVC-CI and Fem- and/or IJV-CI was performed in two intensive care units (ICU) between January 2012 and April 2014. Concurrent M-mode measurements of IVC-CI and FV- and/or IJV-CI were collected during each sonographic session. Measurements of IVC were obtained using standard technique. IJV-CI and FV-CI were measured using high-frequency, linear array ultrasound probe placed in the corresponding anatomic areas. Paired data were analyzed using coefficient of correlation/determination and Bland-Altman determination of measurement bias. RESULTS We performed paired ultrasound examination of IVC-IJV (n = 39) and IVC-FV (n = 22), in 40 patients (mean age 54.1; 40% women). Both FV-CI and IJV-CI scans took less time to complete than IVC-CI scans (both, P < 0.02). Correlations between IVC-CI/FV-CI (R(2) = 0.41) and IVC-CI/IJV-CI (R(2) = 0.38) were weak. There was a mean -3.5% measurement bias between IVC-CI and IJV-CI, with trend toward overestimation for IJV-CI with increasing collapsibility. In contrast, FV-CI underestimated collapsibility by approximately 3.8% across the measured collapsibility range. CONCLUSION Despite small measurement biases, correlations between IVC-CI and FV-/IJV-CI are weak. These results indicate that IJ-CI and FV-CI should not be used as a primary intravascular volume assessment tool for clinical decision support in the ICU. The authors propose that IJV-CI and FV-CI be reserved for clinical scenarios where sonographic acquisition of both IVC-CI or subclavian collapsibility are not feasible, especially when trended over time. Sonographers should be aware that IJV-CI tends to overestimate collapsibility when compared to IVC-CI, and FV-CI tends to underestimates collapsibility relative to IVC-CI.
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Affiliation(s)
- Alistair Kent
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Prabhav Patil
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Victor Davila
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - J. Kevin Bailey
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christian Jones
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David C. Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
| | - Creagh T. Boulger
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Eric Adkins
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jayaraj M. Balakrishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India
| | - Sebastian Valiyaveedan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Kerala, India
| | - Sagar C. Galwankar
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Global Hospital Group, Mumbai, Maharashtra, India
| | - David P. Bahner
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stanislaw P. Stawicki
- OPUS 12 Foundation Multi-Center Trials Group, Inc, USA
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
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Shakir F, Jan H, Kent A. A case of laparoscopic surgical excision of a bulletproof nodule from the pelvic side wall. J OBSTET GYNAECOL 2014; 34:751. [PMID: 25340850 DOI: 10.3109/01443615.2014.923818] [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: 11/13/2022]
Affiliation(s)
- F Shakir
- Department of Obstetrics and Gynaecology, Royal Surrey County Hospital , Guildford , UK
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Lunghi T, Kaniewski J, Bussières F, Houlmann R, Tomamichel M, Kent A, Gisin N, Wehner S, Zbinden H. Experimental bit commitment based on quantum communication and special relativity. Phys Rev Lett 2013; 111:180504. [PMID: 24237497 DOI: 10.1103/physrevlett.111.180504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 06/02/2023]
Abstract
Bit commitment is a fundamental cryptographic primitive in which Bob wishes to commit a secret bit to Alice. Perfectly secure bit commitment between two mistrustful parties is impossible through asynchronous exchange of quantum information. Perfect security is however possible when Alice and Bob split into several agents exchanging classical and quantum information at times and locations suitably chosen to satisfy specific relativistic constraints. Here we report on an implementation of a bit commitment protocol using quantum communication and special relativity. Our protocol is based on [A. Kent, Phys. Rev. Lett. 109, 130501 (2012)] and has the advantage that it is practically feasible with arbitrary large separations between the agents in order to maximize the commitment time. By positioning agents in Geneva and Singapore, we obtain a commitment time of 15 ms. A security analysis considering experimental imperfections and finite statistics is presented.
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Affiliation(s)
- T Lunghi
- Group of Applied Physics, University of Geneva, CH-1211 Genève 4, Switzerland
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Parke E, Hart J, Baldock D, Barchard K, Etcoff L, Allen D, Stolberg P, Nardi N, Cohen J, Jones W, Loe S, Etcoff L, Delgaty L, Tan A, Bunner M, Delgaty L, Tan A, Bunner M, Tan A, Delgaty L, Bunner M, Tan A, Delgaty L, Bunner M, Goodman G, Kim W, Nolty A, Marion S, Davis A, Finch W, Piehl J, Moss L, Nogin R, Dean R, Davis J, Lindstrom W, Poon M, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fields K, Hill B, Corley E, Russ K, Boettcher A, Musso M, Rohling M, Rowden A, Downing K, Benners M, Miller D, Maricle D, Dugbartey T, Anum A, Anderson J, Daniel M, Hoskins L, Gillis K, Khen S, Carter K, Ayers C, Neeland I, Cullum M, Weiner M, Rossetti H, Buddin W, Mahal S, Schroeder R, Baade L, Macaluso M, Phelps K, Evans C, Clark J, Vickery C, Chow J, Stokic D, Phelps K, Evans C, Watson S, Odom R, Clark J, Clark J, Odom R, Evans C, Vickery C, Thompson J, Noggle C, Kane C, Kecala N, Lane E, Raymond M, Woods S, Iudicello J, Dawson M, Ghias A, Choe M, Yudovin S, McArthur D, Asarnow R, Giza C, Babikian T, Tun S, O'Neil M, Ensley M, Storzbach D, Ellis R, O'Neil M, Carlson K, Storzbach D, Brenner L, Freeman M, Quinones A, Motu'apuaka M, Ensley M, Kansagara D, Brickell T, Grant I, Lange R, Kennedy J, Ivins B, Marshall K, Prokhorenko O, French L, Brickell T, Lange R, Bhagwat A, French L, Weber E, Nemeth D, Songy C, Gremillion A, Lange R, Brubacher J, Shewchuk J, Heran M, Jarrett M, Rauscher A, Iverson G, Woods S, Ukueberuwa D, Medaglia J, Hillary F, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Levan A, Gale S, Atkinson J, Boettcher A, Hill B, Rohling M, Stolberg P, Hart J, Allen D, Mayfield J, Ellis M, Marion SD, Houshyarnejad A, Grant I, Akarakian R, Kernan C, Babikian T, Asarnow R, Bens M, Fisher M, Garrett C, Vinogradov S, Walker K, Torstrick A, Uderman J, Wellington R, Zhao L, Fromm N, Dahdah M, Salisbury D, Monden K, Lande E, Wanlass R, Fong G, Smith K, Miele A, Novakovic-Agopian T, Chen A, Rome S, Rossi A, Abrams G, Murphy M, Binder D, Muir J, Carlin G, Loya F, Rabinovitz B, Bruhns M, Adler M, Schleicher-Dilks S, Messerly J, Babika C, Ukpabi C, Golden C, Schleicher-Dilks S, Coad S, Messerly J, Schaffer S, Babika C, Golden C, Cowad S, Paisley S, Fontanetta R, Messerly J, Golden C, Holder C, Kloezeman K, Henry B, Burns W, Patt V, Minassian A, Perry W, Cooper L, Allen D, Vogel S, Woolery H, Ciobanu C, Simone A, Bedard A, Olivier T, O'Neill S, Rajendran K, Halperin J, Rudd-Barnard A, Steenari M, Murry J, Le M, Becker T, Mucci G, Zupanc M, Shapiro E, Santos O, Cadavid N, Giese E, Londono N, Osmon D, Zamzow J, Culnan E, D'Argenio D, Mosti C, Spiers M, Schleicher-Dilks S, Kloss J, Curiel A, Miller K, Olmstead R, Gottuso A, Saucier C, Miller J, Dye R, Small G, Kent A, Andrews P, Puente N, Terry D, Faraco C, Brown C, Patel A, Siegel J, Miller L, Lee B, Joan M, Thaler N, Fontanetta R, Carla F, Allen D, Nguyen T, Glass L, Coles C, Julie K, May P, Sowell E, Jones K, Riley E, Demsky Y, Mattson S, Allart A, Freer B, Tiersky L, Sunderaraman P, Sylvester P, Ang J, Schultheis M, Newton S, Holland A, Burns K, Bunting J, Taylor J, Muetze H, Coe M, Harrison D, Putnam M, Tiersky L, Freer B, Holland A, Newton S, Sakamoto M, Bunting J, Taylor J, Coe M, Harrison D, Musso M, Hill B, Barker A, Pella R, Gouvier W, Davis J, Woods S, Wall J, Etherton J, Brand T, Hummer B, O'Shea C, Segovia J, Thomlinson S, Schulze E, Roskos P, Gfeller J, Loftis J, Fogel T, Barrera K, Sherzai A, Chappell A, Harrison A, Armstrong I, Flaro L, Pedersen H, Shultz LS, Roper B, Huckans M, Basso M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Silk-Eglit G, Stenclik J, Miele A, Lynch J, Musso M, McCaffrey R, Martin P, VonDran E, Baade L, Heinrichs R, Schroeder R, Hunter B, Calloway J, Rolin S, Akeson S, Westervelt H, Mohammed S, An K, Jeffay E, Zakzanis K, Lynch A, Drasnin D, Ikanga J, Graham O, Reid M, Cooper D, Long J, Lange R, Kennedy J, Hopewell C, Lukaszewska B, Pachalska M, Bidzan M, Lipowska M, McCutcheon L, Kaup A, Park J, Morgan E, Kenton J, Norman M, Martin P, Netson K, Woods S, Smith M, Paulsen J, Hahn-Ketter A, Paxton J, Fink J, Kelley K, Lee R, Pliskin N, Segala L, Vasilev G, Bozgunov K, Naslednikova R, Raynov I, Gonzalez R, Vassileva J, Bonilla X, Fedio A, Johnson K, Sexton J, Blackstone K, Weber E, Moore D, Grant I, Woods S, Pimental P, Welch M, Ring M, Stranks E, Crowe S, Jaehnert S, Ellis C, Prince C, Wheaton V, Schwartz D, Loftis J, Fuller B, Hoffman W, Huckans M, Turecka S, McKeever J, Morse C, Schultheis M, Dinishak D, Dasher N, Vik P, Hachey D, Bowman B, Van Ness E, Williams C, Zamzow J, Sunderaraman P, Kloss J, Spiers M, Swirsky-Sacchetti T, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stricker N, Kimmel C, Grant I, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stephan R, Stricker N, Grant I, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Davis A, Collier M, Schroeder R, Buddin W, Schroeder R, Moore C, Andrew W, Ghelani A, Kim J, Curri M, Patel S, Denney D, Taylor S, Huberman S, Greenberg B, Lacritz L, Brown D, Hughes S, Greenberg B, Lacritz L, Vargas V, Upshaw N, Whigham K, Peery S, Casto B, Barker L, Otero T, La D, Nunan-Saah J, Phoong M, Gill S, Melville T, Harley A, Gomez R, Adler M, Tsou J, Schleicher-Dilks S, Golden C, Tsou J, Schleicher-Dilks S, Adler M, Golden C, Cowad S, Link J, Barker T, Gulliver K, Golden C, Young K, Moses J, Lum J, Vik P, Legarreta M, Van Ness E, Williams C, Dasher N, Williams C, Vik P, Dasher N, Van Ness E, Bowman B, Nakhutina L, Margolis S, Baek R, Gonzalez J, Hill F, England H, Horne-Moyer L, Stringer A, DeFilippis N, Lyon A, Giovannetti T, Fanning M, Heverly-Fitt S, Stambrook E, Price C, Selnes O, Floyd T, Vogt E, Thiruselvam I, Quasney E, Hoelzle J, Grant N, Moses J, Matevosyan A, Delano-Wood L, Alhassoon O, Hanson K, Lanni E, Luc N, Kim R, Schiehser D, Benners M, Downing K, Rowden A, Miller D, Maricle D, Kaminetskaya M, Moses J, Tai C, Kaminetskaya M, Melville T, Poole J, Scott R, Hays F, Walsh B, Mihailescu C, Douangratdy M, Scott B, Draffkorn C, Andrews P, Schmitt A, Waksmunski C, Brady K, Andrews A, Golden C, Olivier T, Espinoza K, Sterk V, Spengler K, Golden C, Olivier T, Spengler K, Sterk V, Espinoza K, Golden C, Gross J, DeFilippis N, Neiman-Kimel J, Romers C, Isaacs C, Soper H, Sordahl J, Tai C, Moses J, D'Orio V, Glukhovsky L, Beier M, Shuman M, Spat J, Foley F, Guatney L, Bott N, Moses J, Miranda C, Renteria MA, Rosario A, Sheynin J, Fuentes A, Byrd D, Mindt MR, Batchelor E, Meyers J, Patt V, Thomas M, Minassian A, Geyer M, Brown G, Perry W, Smith C, Kiefel J, Rooney A, Gouaux B, Ellis R, Grant I, Moore D, Graefe A, Wyman-Chick K, Daniel M, Beene K, Jaehnert S, Choi A, Moses J, Iudicello J, Henry B, Minassian A, Perry W, Marquine M, Morgan E, Letendre S, Ellis R, Woods S, Grant I, Heaton R, Constantine K, Fine J, Palewjala M, Macher R, Guatney L, Earleywine M, Draffkorn C, Scott B, Andrews P, Schmitt A, Dudley M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Scharaga E, Gomes W, McGinley J, Miles-Mason E, Colvin M, Carrion L, Romers C, Soper H, Zec R, Kohlrus S, Fritz S, Robbs R, Ala T, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Edwards M, Hall J, O'Bryant S, Miller J, Dye R, Miller K, Baerresen K, Small G, Moskowitz J, Puente A, Ahmed F, Faraco C, Brown C, Evans S, Chu K, Miller L, Young-Bernier M, Tanguay A, Tremblay F, Davidson P, Duda B, Puente A, Terry D, Kent A, Patel A, Miller L, Junod A, Marion SD, Harrington M, Fonteh A, Gurnani A, John S, Gavett B, Diaz-Santos M, Mauro S, Beaute J, Cronin-Golomb A, Fazeli P, Gouaux B, Rosario D, Heaton R, Moore D, Puente A, Lindbergh C, Chu K, Evans S, Terry D, Duda B, Mackillop J, Miller S, Greco S, Klimik L, Cohen J, Robbins J, Lashley L, Schleicher-Dilks S, Golden C, Kunkes I, Culotta V, Kunkes I, Griffits K, Loughan A, Perna R, Hertza J, Cohen M, Northington S, Tyson K, Musielak K, Fine J, Kaczorowski J, Doty N, Braaten E, Shah S, Nemanim N, Singer E, Hinkin C, Levine A, Gold A, Evankovich K, Lotze T, Yoshida H, O'Bryan S, Roberg B, Glusman M, Ness A, Thelen J, Wilson L, Feaster T, Bruce J, Lobue C, Brown D, Hughes S, Greenberg B, Lacritz L, Bristow-Murray B, Andrews A, Bermudez C, Golden C, Moore R, Pulver A, Patterson T, Bowie C, Harvey P, Jeste D, Mausbach B, Wingo J, Fink J, Lee R, Pliskin N, Legenkaya A, Henry B, Minassian A, Perry W, McKeever J, Morse C, Thomas F, Schultheis M, Ruocco A, Daros A, Gill S, Grimm D, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Grimm D, Gill S, Saini G, Relova R, Hoblyn J, Lee T, Stasio C, Mahncke H, Drag L, Verbiest R, Ringdahl E, Thaler N, Sutton G, Vogel S, Reyes A, Ringdahl E, Vogel S, Freeman A, Call E, Allen D, March E, Salzberg M, Vogel S, Ringdahl E, Freeman A, Dadis F, Allen D, Sisk S, Ringdahl E, Vogel S, Freeman A, Allen D, DiGangi J, Silva L, Pliskin N, Thieme B, Daniel M, Jaehnert S, Noggle C, Thompson J, Kecala N, Lane E, Kane C, Noggle C, Thompson J, Lane E, Kecala N, Kane C, Palmer G, Happe M, Paxson J, Jurek B, Graca J, Olson S, Melville T, Harley A, La D, Phoong M, Gill S, Jocson VA, Nunan-Saah J, Keller J, Gomez R, Melville T, Kaminetskaya M, Poole J, Vernon A, Van Vleet T, DeGutis J, Chen A, Marini C, Dabit S, Gallegos J, Zomet A, Merzenich M, Thaler N, Linck J, Heyanka D, Pastorek N, Miller B, Romesser J, Sim A, Allen D, Zimmer A, Marcinak J, Hibyan S, Webbe F, Rainwater B, Francis J, Baum L, Sautter S, Donders J, Hui E, Barnes K, Walls G, Erikson S, Bailie J, Schwab K, Ivins B, Boyd C, Neff J, Cole W, Lewis S, Bailie J, Schwab K, Ivins B, Boyd C, Neff J, Cole W, Lewis S, Ramirez C, Oganes M, Gold S, Tanner S, Pina D, Merritt V, Arnett P, Heyanka D, Linck J, Thaler N, Pastorek N, Miller B, Romesser J, Sim A, Parks A, Roskos P, Gfeller J, Clark A, Isham K, Carter J, McLeod J, Romero R, Dahdah M, Barisa M, Schmidt K, Barnes S, Dubiel R, Dunklin C, Harper C, Callender L, Wilson A, Diaz-Arrastia R, Shafi S, Jacquin K, Bolshin L, Jacquin K, Romers C, Gutierrez E, Messerly J, Tsou J, Adler M, Golden C, Harmell A, Mausbach B, Moore R, Depp C, Jeste D, Palmer B, Hoadley R, Hill B, Rohling M, Mahdavi S, Fine J, daCruz K, Dinishak D, Richardson G, Vertinski M, Allen D, Mayfield J, Margolis S, Miele A, Rabinovitz B, Schaffer S, Kline J, Boettcher A, Hill B, Hoadley R, Rohling M, Eichstaedt K, Vale F, Benbadis S, Bozorg A, Rodgers-Neame N, Rinehardt E, Mattingly M, Schoenberg M, Fares R, Fares R, Carrasco R, Grups J, Evans B, Simco E, Mittenberg W, Carrasco R, Grups J, Evans B, Simco E, Mittenberg W, Rach A, Baughman B, Young C, Bene E, Irwin C, Li Y, Poulin R, Jerram M, Susmaras T, Gansler D, Ashendorf L, Miarmi L, Fazio R, Cantor J, Fernandez A, Godoy-Garcete G, Marchetti P, Harrison A, Armstrong I, Harrison L, Iverson G, Brinckman D, Ayaz H, Schultheis M, Heinly M, Vitelli K, Russler K, Sanchez I, Jones W, Loe S, Raines T, Hart J, Bene E, Li Y, Irwin C, Baughman B, Rach A, Bravo J, Schilling B, Weiss L, Lange R, Shewchuk J, Heran M, Rauscher A, Jarrett M, Brubacher J, Iverson G, Zink D, Barney S, Gilbert G, Allen D, Martin P, Schroeder R, Klas P, Jeffay E, Zakzanis K, Iverson G, Lanting S, Saffer B, Koehle M, Palmer B, Barrio C, Vergara R, Muniz M, Pinto L, Jeste D, Stenclik J, Lynch J, McCaffrey R, Shultz LS, Pedersen H, Roper B, Crouse E, Crucian G, Dezhkam N, Mulligan K, Singer R, Psihogios A, Davis A, Stephens B, Love C, Mulligan K, Webbe F, West S, McCue R, Goldin Y, Cicerone K, Ruchinskas R, Seidl JT, Massman P, Tam J, Schmitter-Edgecombe M, Baerresen K, Hanson E, Miller K, Miller J, Yeh D, Kim J, Ercoli L, Siddarth P, Small G, Noback M, Noback M, Baldock D, Mahmoud S, Munic-Miller D, Bonner-Jackson A, Banks S, Rabin L, Emerson J, Smith C, Roberts R, Hass S, Duhig A, Pankratz V, Petersen R, Leibson C, Harley A, Melville T, Phoong M, Gill S, Nunan-Saah J, La D, Gomez R, Lindbergh C, Puente A, Gray J, Chu K, Evans S, Sweet L, MacKillop J, Miller L, McAlister C, Schmitter-Edgecombe M, Baldassarre M, Kamm J, Wolff D, Dombrowski C, Bullard S, Edwards M, Hall J, Parsons T, O'Bryant S, Lawson R, Papadakis A, Higginson C, Barnett J, Wills M, Strang J, Dominska A, Wallace G, Kenworthy L, Bott N, Kletter H, Carrion V, Ward C, Getz G, Peer J, Baum C, Edner B, Mannarino A, Casnar C, Janke K, van der Fluit F, Natalie B, Haberman D, Solomon M, Hunter S, Klein-Tasman B, Starza-Smith A, Talbot E, Hart A, Hall M, Baker J, Kral M, Lally M, Zisk A, Lo T, Ross P, Cuevas M, Patel S, Lebby P, Mouanoutoua A, Harrison J, Pollock M, Mathiowetz C, Romero R, Boys C, Vekaria P, Vasserman M, MacAllister W, Stevens S, Van Hecke A, Carson A, Karst J, Schohl K, Dolan B, McKindles R, Remel R, Reveles A, Fritz N, McDonald G, Wasisco J, Kahne J, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Newman A, Garmoe W, Clark J, Loughan A, Perna R, Hertza J, Cohen M, Northington S, Tyson K, Whithers K, Puente A, Dedmon A, Capps J, Lindsey H, Francis M, Weigand L, Steed A, Puente A, Edmed S, Sullivan K, Puente A, Lindsey H, Dedmon A, Capps J, Whithers K, Weigand L, Steed A, Kark S, Lafleche G, Brown T, Bogdanova Y, Strongin E, Spickler C, Drasnin D, Strongin C, Poreh A, Houshyarnejad A, Ellis M, Babikian T, Kernan C, Asarnow R, Didehbani N, Cullum M, Loneman L, Mansinghani S, Hart J, Fischer J. POSTER SESSIONS SCHEDULE. Arch Clin Neuropsychol 2013. [DOI: 10.1093/arclin/act054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Christianson A, Zimmern R, Kristoffersson U, Schmidtke J, Kent A, Raouf R, Barreiro C, Nippert I. Health needs assessment for medical genetic services for congenital disorders in middle- and low-income nations. J Community Genet 2013; 4:297-308. [PMID: 23794314 PMCID: PMC3739852 DOI: 10.1007/s12687-013-0150-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022] Open
Abstract
Medical genetic services for the care and prevention of congenital disorders have received little attention in most middle- and low-income countries to date. In 2010, the World Health Organisation prioritized services for the care and prevention of birth defects in these nations, emphasising their importance in assisting such countries to reach their Millennium Development Goals. Health Needs Assessment is an inclusive, rational, epidemiological-assisted approach for providing information to plan, introduce and beneficially change health care services to improve the health of populations. It is intrinsic to much of the development of health care systems in industrialised nations. Its use by middle- and low-income countries to introduce and develop medical genetic services commensurate with their needs and circumstances would be beneficial. An approach to applying Health Needs Assessment in these circumstances is described.
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Affiliation(s)
- A Christianson
- Division of Human Genetics, National Health Laboratory Service & University of the Witwatersrand, PO Box 1038, Johannesburg, South Africa,
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Kent A, Bahner DP, Boulger CT, Eiferman DS, Adkins EJ, Evans DC, Springer AN, Balakrishnan JM, Valiyaveedan S, Galwankar SC, Njoku C, Lindsey DE, Yeager S, Roelant GJ, Stawicki SPA. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index. J Surg Res 2013; 184:561-6. [PMID: 23764308 DOI: 10.1016/j.jss.2013.05.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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] [Received: 01/04/2013] [Revised: 04/03/2013] [Accepted: 05/09/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Traditional methods for intravascular volume status assessment are invasive and are associated significant complications. While focused bedside sonography of the inferior vena cava (IVC) has been shown to be useful in estimating intravascular volume status, it may be technically difficult and limited by patient factors such as obesity, bowel gas, or postoperative surgical dressings. The goal of this investigation is to determine the feasibility of subclavian vein (SCV) collapsibility as an adjunct to IVC collapsibility in intravascular volume status assessment. METHODS A prospective study was conducted on a convenience sample of surgical intensive care unit patients to evaluate interchangeability of IVC collapsibility index (IVC-CI) and SCV-CI. After demographic and acuity of illness information was collected, all patients underwent serial, paired assessments of IVC-CI and SCV-CI using portable ultrasound device (M-Turbo; Sonosite, Bothell, WA). Vein collapsibility was calculated using the formula [collapsibility (%) = (max diameter - min diameter)/max diameter × 100%]. Paired measurements from each method were compared using correlation coefficient and Bland-Altman measurement bias analysis. RESULTS Thirty-four patients (mean age 56 y, 38% female) underwent a total of 94 paired SCV-CI and IVC-CI sonographic measurements. Mean acute physiology and chronic health evaluation II score was 12. Paired SCV- and IVC-CI showed acceptable correlation (R(2) = 0.61, P < 0.01) with acceptable overall measurement bias [Bland-Altman mean collapsibility difference (IVC-CI minus SCV-CI) of -3.2%]. In addition, time needed to acquire and measure venous diameters was shorter for the SCV-CI (70 s) when compared to IVC-CI (99 s, P < 0.02). CONCLUSIONS SCV collapsibility assessment appears to be a reasonable adjunct to IVC-CI in the surgical intensive care unit patient population. The correlation between the two techniques is acceptable and the overall measurement bias is low. In addition, SCV-CI measurements took less time to acquire than IVC-CI measurements, although the clinical relevance of the measured time difference is unclear.
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Affiliation(s)
- Alistair Kent
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio 43210, USA
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Knoppers BM, Chisholm RL, Kaye J, Cox D, Thorogood A, Burton P, Brookes AJ, Fortier I, Goodwin P, Harris JR, Hveem K, Kent A, Little J, Riegman PHJ, Ripatti S, Stolk RP. A P3G generic access agreement for population genomic studies. Nat Biotechnol 2013; 31:384-5. [PMID: 23657386 PMCID: PMC3736100 DOI: 10.1038/nbt.2567] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thompson L, Kowalczyk W, Golub S, Davis A, Lemann E, Piehl J, Rita N, Moss L, Davis A, Boseck J, Berry K, Koehn E, Meyer B, Gelder B, Davis A, Nogin R, Moss L, Drapeau C, Malm S, Davis A, Lemann E, Koehn E, Drapeau C, Malm S, Boseck J, Armstrong L, Glidewell R, Orr W, Mears G. Grand Rounds. Arch Clin Neuropsychol 2012. [DOI: 10.1093/arclin/acs070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Levy BF, De Guara J, Willson PD, Soon Y, Kent A, Rockall TA. Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series. Ann R Coll Surg Engl 2012; 94:e118-20. [PMID: 22507707 DOI: 10.1308/003588412x13171221502149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The use of laparoscopy as a diagnostic and therapeutic tool is being used increasingly in the emergency setting with many of these procedures being performed by trainees. While the incidence of iatrogenic injuries is reported to be low, we present six emergency or expedited cases in which the bladder was perforated by the suprapubic trocar. CASES Three cases were related to the management of appendicitis, two to negative diagnostic laparoscopies for lower abdominal pain and one to an ectopic pregnancy. Management of the bladder injuries varied from a urinary catheter alone to laparotomy with debridement of the abdominal wall due to sepsis and later reconstruction. Four of the six cases were performed by registrars. CONCLUSIONS Although the incidence of bladder injury is low, its importance is highlighted by the large number of laparoscopies being performed. In addition to catheterisation of the patient, care must be taken with the insertion of low suprapubic ports and consideration should be made regarding alternative sites. Adequate laparoscopic supervision and training in port site planning is required for surgical trainees.
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Affiliation(s)
- B F Levy
- Royal Surrey County Hospital NHS Foundation Trust, UK.
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Mcmahon L, Usvyat LA, Carter M, Van der Sande FM, Kooman J, Raimann J, Levin NW, Kotanko P, Usvyat LA, Malhotra R, Ouellet G, Penne EL, Raimann J, Thijssen S, Levin NW, Kotanko P, Etter M, Tashman A, Guinsburg A, Grassmann A, Barth C, Marelli C, Marcelli D, Van der Sande FM, Von Gersdorff G, Bayh I, Kooman J, Scatizzi L, Lam M, Schaller M, Thijssen S, Toffelmire T, Wang Y, Sheppard P, Usvyat LA, Levin NW, Kotanko P, Neri L, Andreucci VA, Rocca-Rey LA, Bertoli SV, Brancaccio D, Tjipto A, Simmonds R, Agar J, Huang X, Stenvinkel P, Qureshi AR, Riserus U, Cederholm T, Barany P, Heimburger O, Lindholm B, Carrero JJ, Vecchio M, Palmer S, De Berardis G, Craig J, Lucisano G, Johnson D, Pellegrini F, Nicolucci A, Sciancalepore M, Saglimbene V, Gargano L, Bonifati C, Ruospo M, Navaneethan SD, Montinaro V, Stroumza P, Zsom M, Torok M, Celia E, Gelfman R, Bednarek-Skublewska A, Dulawa J, Graziano G, Gentile G, Ferrari JN, Santoro A, Zucchelli A, Triolo G, Maffei S, Hegbrant J, Wollheim C, De Cosmo S, Manfreda VM, Strippoli GF, Janus N, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Grace B, Clayton P, Cass A, Mcdonald S, Baharani J, Furumatsu Y, Kitamura T, Fujii N, Ogata S, Nakamoto H, Iseki K, Tsubakihara Y, Chien CC, Wang JJ, Hwang JC, Wang HY, Kan WC, Kuster N, Kuster N, Patrier L, Bargnoux AS, Morena M, Dupuy AM, Badiou S, Canaud B, Cristol JP, Desmet JM, Fernandes V, Collart F, Spinogatti N, Pochet JM, Dratwa M, Goffin E, Nortier J, Zilisteanu DS, Voiculescu M, Rusu E, Achim C, Bobeica R, Balanica S, Atasie T, Florence S, Anne-Marie S, Michel L, Cyrille C, Emmanuel V, Strakosha A, Strakosha A, Pasko N, Kodra S, Thereska N, Lowney A, Lowney E, Grant R, Murphy M, Casserly L, O' Brien T, Plant WD, Radic J, Radic J, Ljutic D, Kovacic V, Radic M, Dodig-Curkovic K, Sain M, Jelicic I, Fujii N, Hamano T, Nakano C, Yonemoto S, Okuno A, Katayama M, Isaka Y, Nordio M, Limido A, Postorino M, Nichelatti M, Khil M, Dudar I, Khil V, Shifris I, Momtaz M, Soliman AR, El Lawindi MI, Dzekova-Vidimliski P, Pavleska-Kuzmanovska S, Trajceska L, Nikolov I, Selim G, Gelev S, Amitov V, Sikole A, Shoji T, Kakiya R, Hayashi T, Tatsumi-Shimomura N, Tsujimoto Y, Tabata T, Shima H, Mori K, Fukumoto S, Tahara H, Koyama H, Emoto M, Ishimura E, Nishizawa Y, Inaba M. Epidemiology and outcome research in CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Cystic adventitial disease (CAD) is rare. The popliteal artery is the most commonly affected artery. Patients with CAD are usually young and present with ischaemic lower limb symptoms. We report a case of a 39-year-old male patient with popliteal CAD. The affected segment was resected and repaired with an interposition vein graft. In conclusion, we highlight the importance of correct diagnosis and outline the different management strategies.
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Affiliation(s)
- C N Parnaby
- Vascular Department, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, Scotland, UK
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- Department of Orthopaedics, Raigmore Hospital, Inverness IV2 3UJ, Scotland, UK
| | - B Wolf
- Vascular Department, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, Scotland, UK
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Baweja S, Kent A, Masterson R, Roberts S, McMahon LP. Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG 2011; 118:1126-32. [DOI: 10.1111/j.1471-0528.2011.02960.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Strange G, Playford D, Stewart S, Kent A, Gabbay E, Deague J. Pulmonary Hypertension is a Common Disease: The Armadale Echo Study. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.524] [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: 10/18/2022]
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Strange G, Playford D, Stewart S, Kent A, Gabbay E, Deague J. Pulmonary Hypertension Remains a Deadly Disease: Insights from the Armadale Echo Study. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.525] [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: 10/18/2022]
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Maytham GD, Dowson HM, Levy B, Kent A, Rockall TA. Laparoscopic excision of rectovaginal endometriosis: report of a prospective study and review of the literature. Colorectal Dis 2010; 12:1105-12. [PMID: 19575737 DOI: 10.1111/j.1463-1318.2009.01993.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM The surgical management of rectovaginal endometriosis is challenging. We present our experience of the laparoscopic management of these difficult cases, together with a review of the current literature. METHOD A prospective database was established for all patients undergoing surgery for Deep Infiltrating Endometriosis (DIE) with rectovaginal and/or ureteric and bladder nodules. Outcomes analysed include operation performed, conversion and complication rates, and length of stay. These outcomes were compared with other laparoscopic rectal resections for alternative diagnoses recorded in the database and with outcomes seen in a literature review of studies on the surgical management of endometriosis. RESULTS Between April 2004 and November 2007, 54 patients underwent laparoscopic excision of rectovaginal endometriosis by a combined colorectal and gynaecological surgical team. Out of the 54 patients, 37% of patients underwent a rectal wall shave, 13% had a disc excision of the rectal wall, and 50% underwent segmental resection. There was a conversion rate of 4%, median duration of stay was 3 days, with 2% requiring transfusion. Major complications occurred in 7% of patients, with 4% requiring reoperation. Patients undergoing segmental resection for endometriosis had a higher complication rate than those having surgery for other diagnoses. There was an increased incidence of anastomotic stenosis, with histopathological results suggesting that the disease process might have contributed to this occurrence. CONCLUSIONS Laparoscopic resection of rectovaginal endometriosis may be associated with a higher incidence of complications than resections performed for other diagnoses.
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Affiliation(s)
- G D Maytham
- Minimal Access Therapy Training Unit (MATTU), Post-Graduate Medical School, University of Surrey, Manor Park, Guildford, UK.
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Kent A. Health visitor training reduces risk of postnatal depression 6 months after birth. Evidence-Based Mental Health 2010; 13:14. [DOI: 10.1136/ebmh.13.1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kent A, Bloomer S, Yamen E. Early Exclusion of Myocardial Infarction Using a Multiple Biomarker Protocol Influences the Casemix on the Cardiac Ward. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.519] [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: 10/19/2022]
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Ogden J, Heinrich M, Potter C, Kent A, Jones S. The impact of viewing a hysteroscopy on a screen on the patient’s experience: a randomised trial. BJOG 2008; 116:286-92; discussion 292-3. [DOI: 10.1111/j.1471-0528.2008.02035.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wopenka B, Kent A, Pasteris JD, Yoon Y, Thomopoulos S. The tendon-to-bone transition of the rotator cuff: a preliminary Raman spectroscopic study documenting the gradual mineralization across the insertion in rat tissue samples. Appl Spectrosc 2008; 62:1285-94. [PMID: 19094386 PMCID: PMC2701203 DOI: 10.1366/000370208786822179] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We applied Raman spectroscopy to monitor the distribution of mineral and the degree of mineralization across the tendon-bone insertion site in the shoulders of five rats. We acquired Raman spectra from 100 to 4,000 Deltacm(-1) on individual 1 microm points across the 120 microm wide transition zone of each tissue sample and identified all the peaks detected in pure tendon and in pure bone, as well as in the transition zone. The intensity of the 960 Deltacm(-1) P-O stretch for apatite (normalized to either the 2,940 Deltacm(-1) C-H stretch or the 1,003 Deltacm(-1) C-C stretch for collagen) was used as an indicator of the abundance of mineral. We relate the observed histological morphology in the tissue thin section with the observed Raman peaks for both the organic component (mostly collagen) and the inorganic component (a carbonated form of the mineral apatite) and discuss spectroscopic issues related to peak deconvolution and quantification of overlapping Raman peaks. We show that the mineral-to-collagen ratio at the insertion site increases linearly (R(2) = 0.8 for five samples) over the distance of 120 microm from tendon to bone, rather than abruptly, as previously inferred from histological observations. In addition, narrowing of the 960 Deltacm(-1) band across the traverse indicates that the crystalline ordering within the apatite increases concomitantly with the degree of mineralization. This finding of mineral gradation has important clinical implications and may explain why the uninjured tendon-to-bone connection of the rotator cuff can sustain very high loads without failure. Our finding is also consistent with recent mechanical models and calculations developed to better understand the materials properties of this unusually strong interface.
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Affiliation(s)
- Brigitte Wopenka
- Center for Materials Innovation, Department of Earth and Planetary Sciences, Washington University, St. Louis, Missouri 63130, USA.
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Jan H, Mehra G, Kent A. Postpartum hemorrhage due to a pseudo-aneurysm formation following cesarean delivery. Int J Gynaecol Obstet 2007; 98:263-4. [PMID: 17482620 DOI: 10.1016/j.ijgo.2007.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 03/28/2007] [Accepted: 03/28/2007] [Indexed: 10/23/2022]
Affiliation(s)
- H Jan
- Department of Obstetrics and Gynaecology, The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, UK
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Barton-Smith P, Kent A. Asymptomatic incarcerated retroverted uterus with anterior sacculation at term. Int J Gynaecol Obstet 2007; 96:128. [DOI: 10.1016/j.ijgo.2006.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 09/05/2006] [Accepted: 09/12/2006] [Indexed: 10/23/2022]
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