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Begna KH, Abdallah NH, Janania-Martinez M, Mangaonkar AA, Rangan A, Herrick JL, Gangat N. Daratumumab and brentuximab vedotin combination therapy in T-cell acute lymphoblastic leukemia refractory to conventional chemotherapy and allogeneic stem cell transplant. Haematologica 2024; 109:689-692. [PMID: 37706335 PMCID: PMC10828762 DOI: 10.3324/haematol.2023.283740] [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] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Kebede H Begna
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester.
| | - Nadine H Abdallah
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester
| | | | | | - Aruna Rangan
- Department of Laboratory medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester
| | - Jennifer L Herrick
- Department of Laboratory medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester
| | - Naseema Gangat
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester
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Rangan A, Balaji D, Chand U, Raghunathan E, Deepthi N, Karthik P. TRIGLYCERIDE - GLUCOSE INDEX, REMNANT CHOLESTEROL AND COMMON CAROTID ARTERY INTIMA-MEDIA THICKNESS AS AN ATHEROSCLEROTIC MARKER IN ISCHEMIC STROKE PATIENTS. Georgian Med News 2024:59-65. [PMID: 38609115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Ischemic stroke (IS) is a major global health concern, often resulting from atherosclerosis and insulin resistance (IR). The triglyceride-glucose index (TyG index), remnant cholesterol (RC), and common artery intima-media thickness (CIMT) are potential markers for assessing atherosclerosis and cardiovascular risk in IS patients. A cross-sectional study was conducted to investigate the association between TyG index, RC, CIMT, and IS in adult patients recruited from a hospital. Demographic, clinical, and laboratory data were collected, and statistical analysis was performed. The study included 50 participants with a balanced gender distribution and a mean age of 57.64 years. Laboratory characteristics showed notable values, and CIMT > 0.6 mm was associated with higher NIH Stroke Scale scores. RC exhibited significant correlations with age, CIMT, lipid profile, and TyG index. The study highlights the potential of TyG index, RC, and CIMT as atherosclerotic markers in IS patients. Favorable prognostic outcomes were observed, emphasizing the importance of early diagnosis and management to improve patient outcomes.
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Affiliation(s)
- A Rangan
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
| | - D Balaji
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
| | - U Chand
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
| | - E Raghunathan
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
| | - N Deepthi
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
| | - P Karthik
- Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamilnadu, India
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Rangan A, Balaji D, Saranya C, Raghunathan E, Deepthi N, Karthik P. ASSOCIATION OF MPV AND RDW WITH DISEASE ACTIVITY IN PATIENT WITH RHEUMATOID ARTHRITIS. Georgian Med News 2024:77-81. [PMID: 38609118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by inflammation of the synovial joints. Disease activity assessment plays a crucial role in guiding treatment decisions and monitoring disease progression in RA patients. Thus, the current study examines the association between Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), and disease activity in RA patients. A total of 100 patients were included following the inclusion and exclusion criteria. All participants underwent physical examination and laboratory tests. Disease activity was assessed using the Disease Activity Score 28 (DAS28). The cut-off levels for RDW and MPV were 14.8 and 11.25, respectively. However, a significant association was observed between RDW levels and DAS28, indicating that the group with RDW ≤14.8% displayed higher DAS compared to the RDW >14.8% group. Also, MPV levels did not exhibited statistically significant variations. RDW levels did not show significant disparities among patients with different comorbidities. There is a significant correlation exists between RDW and disease activity in RA exists. Moreover, RDW can be utilized in clinical settings to monitor disease activity effectively. Since RDW is routinely included in standard blood tests, it is cost-effective and more convenient for treating RA cases.
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Affiliation(s)
- A Rangan
- 1Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India
| | - D Balaji
- 1Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India
| | - C Saranya
- 2Department of Rheumatology, Saveetha medical college and hospital, Thandalam, Chennai, Tamil Nadu, India
| | - E Raghunathan
- 1Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India
| | - N Deepthi
- 1Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India
| | - P Karthik
- 1Department of General Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India
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Simpson J, Keding A, Spencer S, Brealey S, Rangan A. Factor structure of the Oxford Shoulder Score: secondary analyses of the UK FROST and PROFHER trial populations. J Orthop Surg Res 2023; 18:846. [PMID: 37940977 PMCID: PMC10631035 DOI: 10.1186/s13018-023-04319-x] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS Frozen shoulder and proximal humeral fracture can cause pain, stiffness and loss of function. The impact of these symptoms on patients can be measured using the comprehensively validated, 12-item Oxford Shoulder Score (OSS). Evidence suggests that pain and function may have a differential impact on patients' experience of shoulder conditions, and this may be important for clinical management. We therefore explored the factor structure of the OSS within the UK FROST and PROFHER trial populations. METHODS We performed exploratory factor analysis (EFA), followed by confirmatory factor analysis (CFA), on baseline UK FROST data from 490 of the 503 trial participants. Data at 6 months post-randomisation were used for 228 of the 250 participants for the PROFHER trial. RESULTS UK FROST factor extraction results, using Velicer's Minimum Average Partial and Horn's Parallel Analysis tests, suggested a unifactorial solution, but two factors were weakly indicated by the less reliable 'Kaiser's eigenvalue > 1' and scree tests. We explored this further using EFA. Eight items (2 to 7, 9 and 10) loaded onto a 'Function' factor, three on a 'Pain' factor (1, 8 and 12) and item 11 cross-loaded. However, one- and two-factor models were rejected in CFA. Factor extraction of PROFHER data at 6 months demonstrated a single first-order factor solution, which was also subsequently rejected in CFA. CONCLUSION Insufficient evidence was found, within the constraints of the data available, to support the use of 'Pain' and 'Function' sub-scales of the OSS in either patient population.
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Affiliation(s)
- J Simpson
- York Trials Unit, Department of Health Sciences, University of York, York, UK.
- Hull York Medical School, University of York, York, UK.
| | - A Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - S Spencer
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - S Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - A Rangan
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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Rangan A, Norgan AP. Hydrophilic polymer embolus in the bone marrow. Blood 2023; 142:939. [PMID: 37676692 DOI: 10.1182/blood.2023021763] [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: 09/08/2023] Open
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Oliveira JL, Thompson CH, Saravanaperumal SA, Koganti T, Jenkinson G, Hein MS, Kohorst MA, Hasadsri L, Nguyen PL, Matern D, Kipp BR, Klee EW, Wieben ED, Hoyer JD, Rangan A. εγ-Thalassemia, a New Hemoglobinopathy Category. Clin Chem 2023:7136664. [PMID: 37086467 DOI: 10.1093/clinchem/hvad038] [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: 01/12/2023] [Accepted: 03/07/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Large β-globin gene cluster deletions (hereditary persistence of fetal hemoglobin [Hb] or β-, δβ-, γδβ-, and ϵγδβ-thalassemia), are associated with widely disparate phenotypes, including variable degrees of microcytic anemia and Hb F levels. When present, increased Hb A2 is used as a surrogate marker for β-thalassemia. Notably, ϵγδβ-thalassemias lack the essential regulatory locus control region (LCR) and cause severe transient perinatal anemia but normal newborn screen (NBS) results and Hb A2 levels. Herein, we report a novel deletion of the ϵ, Aγ, Gγ, and ψβ loci with intact LCR, δ-, and β-regions in 2 women and newborn twins. METHODS Capillary electrophoresis (CE), high-performance liquid chromatography (HPLC), DNA sequencing, multiplex ligation-dependent probe amplification (MLPA), gap-polymerase chain reaction (gap-PCR), and long-read sequencing (LRS) were performed. RESULTS NBS showed an Hb A > Hb F pattern for both twins. At 20 months, Hb A2 was increased similarly to that in the mother and an unrelated woman. Unexplained microcytosis was absent and the twins lacked severe neonatal anemia. MLPA, LRS, and gap-PCR confirmed a 32 599 base pair deletion of ϵ (HBE1) through ψβ (HBBP1) loci. CONCLUSIONS This deletion represents a hemoglobinopathy category with a distinct phenotype that has not been previously described, an ϵγ-thalassemia. Both the NBS Hb A > F pattern and the subsequent increased Hb A2 without microcytosis are unusual. A similar deletion should be considered when this pattern is encountered and appropriate test methods selected for detection. Knowledge of the clinical impact of this new category will improve genetic counselling, with distinction from the severe transient anemia associated with ϵγδβ-thalassemia.
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Affiliation(s)
- Jennifer L Oliveira
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Tejaswi Koganti
- Department of Clinical Genomics, Quantitative Health Sciences - Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - Garrett Jenkinson
- Department of Clinical Genomics, Quantitative Health Sciences - Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - Molly S Hein
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Mira A Kohorst
- Department of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, MN, United States
| | - Linda Hasadsri
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Phuong L Nguyen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Dietrich Matern
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Benjamin R Kipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eric W Klee
- Department of Clinical Genomics, Quantitative Health Sciences - Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - Eric D Wieben
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States
- Department of Clinical Genomics, Quantitative Health Sciences - Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - James D Hoyer
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Aruna Rangan
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Burton R, Adam J, Holland P, Rangan A. A review of custom implants for glenoid bone deficiency in reverse shoulder arthroplasty. J Orthop 2023; 36:65-71. [PMID: 36605459 PMCID: PMC9807744 DOI: 10.1016/j.jor.2022.11.016] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Reverse Total Shoulder Arthroplasty is being increasingly performed, with indications in both elective and trauma settings. Accordingly, there are an increasing number of revision cases where glenoid bone loss is a concern. There are well recognised surgical techniques for dealing with mild to moderate glenoid wear, including eccentric reaming and impaction grafting. In cases of severe wear or uncontained glenoid defects these may not be suitable, and the surgeon may look to a customised implant to deal with such bone loss. There are several implant manufacturers who currently market and produce patient specific instrumentation and customised glenoid baseplates to achieve the best possible fixation in cases of severe bone loss. This article outlines some examples of custom implants currently available to surgeons, and the process by which they may be procured and used. Implant and surgical considerations, and key aspects of surgical technique are also covered. Literature on outcomes and complications following custom shoulder arthroplasty shows promising results, but at present is limited to relatively small case series with no long-term outcome data.
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Affiliation(s)
- R. Burton
- James Cook University Hospital, Linthorpe Road, Middlesbrough, TS4 3BW, UK
| | - J. Adam
- Scarborough Hospital, Woodland Drive, Scarborough, YO12 6QL, UK
| | - P. Holland
- James Cook University Hospital, Linthorpe Road, Middlesbrough, TS4 3BW, UK
| | - A. Rangan
- James Cook University Hospital, Linthorpe Road, Middlesbrough, TS4 3BW, UK
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Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Haem Iron Intake Is Associated with Increased Major Adverse Cardiovascular Events, All-Cause Mortality, Congestive Cardiac Failure, and Coronary Revascularisation in Older Men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2023; 27:559-570. [PMID: 37498103 DOI: 10.1007/s12603-023-1945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Nutritional intake can influence major adverse cardiovascular events (MACE). Dietary iron is found in two forms: haem-iron (HI) only found in animal sources and non-haem iron (NHI) present mostly in plant sources. OBJECTIVE We evaluated the associations between dietary iron intakes with MACE and iron status biomarkers. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 539 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent nutritional assessment using a validated diet history questionnaire. Entries were converted to food groups and nutrients. The dietary calculation was used to derive HI and NHI intakes from total iron intakes. Analyses of iron intakes with iron status biomarkers were conducted using linear regression, and with MACE and individual endpoints were conducted using Cox regression. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality. RESULTS At a median of 5.3 (4.6 - 6.3) years follow-up, the incidences were: 31.2% (n = 168) five-point MACE, 17.8% (n = 96) four-point MACE excluding all-cause mortality, 20.1% (n = 111) all-cause mortality, 11.3% (n = 61) CCF, and 3.1% (n = 15) coronary revascularisation. In adjusted analyses, higher HI intake (per 1mg increment) was associated with increased five-point MACE (HR: 1.45 [95% CI: 1.16, 1.80, P = .001]), four-point MACE excluding all-cause mortality (HR: 1.64 [95% CI: 1.26, 2.15, P <.001]), all-cause mortality (HR: 1.51 [95% CI: 1.15, 1.99, P = .003]), CCF (HR: 2.08 [95% CI: 1.45, 2.98, P <.001]), and coronary revascularisation (HR: 1.89 [95% CI: 1.15, 3.10, P = .012]). Compared with the bottom tertile of NHI intake, the middle tertile of NHI intake was associated with reduced risk of all-cause mortality (HR: 0.56 [95% CI: 0.33, 0.96, P = .035]). Total iron intake was not associated with MACE and individual endpoints. Dietary iron intakes were not associated with serum iron and haemoglobin. CONCLUSION Higher haem iron intake was independently associated with increased risks of five-point MACE, four-point MACE excluding all-cause mortality, all-cause mortality, CCF, and coronary revascularisation in older men over 5 years.
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Affiliation(s)
- R Luong
- Rebecca Luong, Level 4, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia,
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Rangan A, Herrick JL. Morphologic and Clinical Features of Acute on Chronic Valproate Toxicity. Mayo Clin Proc 2022; 97:1692-1693. [PMID: 36058581 DOI: 10.1016/j.mayocp.2022.06.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/07/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Aruna Rangan
- Division of Hematopathology, Mayo Clinic, Rochester, MN.
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10
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Oliveira JL, Greipp PT, Rangan A, Jatoi A, Nguyen PL. Myeloid malignancies in cancer patients treated with poly(ADP-ribose) polymerase (PARP) inhibitors: a case series. Blood Cancer J 2022; 12:11. [PMID: 35078980 PMCID: PMC8789926 DOI: 10.1038/s41408-022-00607-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Aruna Rangan
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
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Rangan A, Hein MS, Jenkinson WG, Koganti T, Aleff RA, Hilker CA, Blommel JH, Porter TR, Swanson KC, Lundquist P, Nguyen PL, Shi M, He R, Viswanatha DS, Jen J, Klee EW, Kipp BR, Hoyer JD, Wieben ED, Oliveira JL. Improved Characterization of Complex β-Globin Gene Cluster Structural Variants Using Long-Read Sequencing. J Mol Diagn 2021; 23:1732-1740. [PMID: 34839893 DOI: 10.1016/j.jmoldx.2021.08.013] [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: 02/13/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 10/19/2022] Open
Abstract
Complex insertion-deletion (indel) events in the globin genes manifest in widely variable clinical phenotypes. Many are incompletely characterized because of a historic lack of efficient methods. A more complete assessment enables improved prediction of clinical impact, which guides emerging therapeutic choices. Current methods have limited capacity for breakpoint assignment and accurate assessment of mutation extent, especially in cases containing duplications or multiple deletions and insertions. Technology, such as long-read sequencing, holds promise for significant impact in the characterization of indel events because of read lengths that span large regions, resulting in improved resolution. Four known complex β-globin gene cluster indel types were assessed using single-molecule, real-time sequencing technology and showed high correlation with previous reports, including the Caribbean locus control deletion (g.5,305,478_5,310,336del), a large β-gene duplication containing the Hb S mutation (g.4,640,335_5,290,171dup with g.5,248,232T>A, c.20A>T; variant allele fraction, 64%), and two nested variants (double deletions with intervening inversion): the Indian Gγ(Aγδβ)0-thalassemia (g.5,246,804-5,254,275del, g.5,254,276_5,269,600inv, and g.5,269,601_5,270,442del) and the Turkish/Macedonian (δβ)0 thalassemia (g.5,235,064_5,236,652del, g.5,236,653_5,244,280inv, and g.5,244,281_5,255,766del). Our data confirm long-read sequencing as an efficient and accurate method to identify these clinically significant complex events. Limitations include high-complexity sample preparation requirements, which hinder routine use in clinical laboratories. Continued improvements in sample and data workflow processes are needed to accommodate volumes in a tertiary clinical laboratory.
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Affiliation(s)
- Aruna Rangan
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| | - Molly S Hein
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Tejaswi Koganti
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Ross A Aleff
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph H Blommel
- Advanced Diagnostics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Tavanna R Porter
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kenneth C Swanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Patrick Lundquist
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Phuong L Nguyen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David S Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jin Jen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Eric W Klee
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - James D Hoyer
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Eric D Wieben
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Oliveira
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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Zheng G, He R, Reichard KK, Peterson JF, Olteanu H, Oliveira JL, Rangan A, Chen D, Shi M. Genetic and Clinical Studies of Patients With Increased Multinucleated Megakaryocytes in Bone Marrow as an Isolated Finding: A Diagnostic Pitfall for Myelodysplastic Syndrome. Am J Surg Pathol 2021; 45:1534-1540. [PMID: 33999554 DOI: 10.1097/pas.0000000000001732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of increased multinucleated megakaryocytes (aka osteoclast-like) is considered a dysplastic feature in myelodysplastic syndrome; however, its clinical significance in isolation is uncertain. Herein, we report the clinicopathologic and genetic features of 18 such cases of 40,539 bone marrow biopsies spanning 10 years. All 18 patients had ≥25% multinucleated megakaryocytes in otherwise normal bone marrow biopsies, which were evaluated for plasma cell neoplasms (n=9), lymphoma (n=4), or anemia/neutropenia (n=5). None of the 17 patients tested showed acquired cytogenetic abnormalities. Sixteen patients underwent targeted gene panel next-generation sequencing: 9 patients had no pathogenic mutations; 3 harbored a single pathogenic mutation with variant allele frequencies of 7.5%, 7.6%, and 10.7%, likely representing clonal hematopoiesis of indeterminate potential; 1 had 2 pathogenic mutations, 1 of which had a variant allele frequency >20%. Fourteen of 18 patients had a follow-up period >6 months (median: 36.5 mo, range: 7 to 110 mo) and no patients developed a new-onset cytopenia, a progressive cytopenia, or a myeloid neoplasm. The patient with 2 mutations had persistent anemia, worrisome for an emerging MDS. However, given the absence of thrombocytopenia, increased multinucleated megakaryocytes in this patient could be an unrelated incidental finding. Our study indicates that increased multinucleated megakaryocytes as an isolated finding is a rare phenomenon, and this sole morphologic finding is not diagnostic of myelodysplastic syndrome. Diagnostic approaches in the presence of increased multinucleated megakaryocytes are proposed based on different clinical and pathologic scenarios.
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Affiliation(s)
- Gang Zheng
- Division of Laboratory Genetics and Genomics
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Aruna Rangan
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN
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Rangan A, Savedra ME, Dergam-Larson C, Swanson KC, Szuberski J, Go RS, Porter TR, Brunker SE, Shi M, Nguyen PL, Hoyer JD, Oliveira JL. Interpreting sulfhemoglobin and methemoglobin in patients with cyanosis: An overview of patients with M-hemoglobin variants. Int J Lab Hematol 2021; 43:837-844. [PMID: 34092029 DOI: 10.1111/ijlh.13581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/29/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Methemoglobin (MetHb) and sulfhemoglobin (SHb) measurements are useful in the evaluation of cyanosis. When one or both values are elevated, additional analysis is important to establish the etiology of the disorder. Methemoglobinemia occurs from acquired or hereditary causes with diverse treatment considerations, while true sulfhemoglobinemia is only acquired and treatment is restricted to toxin removal. Some toxic exposures can result in a dual increase in MetHb and SHb. Hereditary conditions, such as M-Hemoglobin variants (M-Hbs), can result in increased MetHb and/or SHb values but are clinically compensated and do not require treatment if they are cyanotic but otherwise clinically well. METHODS Herein, we report 53 hemoglobin variant cases that have associated MetHb and SHb levels measured by an adapted Evelyn-Malloy laboratory assay method. RESULTS Our data indicate M-Hbs cause variable patterns of MetHb and SHb elevation in a fairly reproducible pattern for the particular variant. In particular, α globin chain M-Hbs can mimic acquired sulfhemoglobinemia due to an isolated increased SHb value. CONCLUSION If the patient appears clinically well other than cyanosis, M-Hbs should be considered early in the evaluation process to differentiate from acquired conditions to avoid unnecessary testing and treatment regimens and prompt genetic counseling.
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Affiliation(s)
- Aruna Rangan
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Ronald S Go
- Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Sarah E Brunker
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - James D Hoyer
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
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14
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Tsang B, McDonald D, McNamara I, Kottam L, Rangan A, Baker P. National survey of occupational advice for lower limb arthroplasty patients. Occup Med (Lond) 2021; 70:123-126. [PMID: 32009175 DOI: 10.1093/occmed/kqaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known what advice or support patients are given about return to work (RTW) after hip or knee replacement surgery. AIMS This study aims to understand the delivery, timing and content of 'RTW' advice currently delivered by surgical teams offering hip and knee replacements across the UK. METHODS National online survey exploring five specific areas relating to 'RTW' advice: (i) timings of interactions between hospital orthopaedic teams and patients prior to surgery, (ii) routine delivery of 'RTW' advice, (iii) methods used to deliver 'RTW' advice, (iv) confidence delivering advice and (v) need for an occupational 'RTW' advice intervention. RESULTS A total of 152 participants including surgeons, physiotherapists, occupational therapists and nurses from 59 different public and private health providers responded. Only 20% (n = 30) of respondents reported that working patients were identified as a specific subgroup in need of additional support. Overall, 62% (n = 92) stated that they did not routinely offer 'RTW' advice. When given, 'RTW' advice was almost always verbal, generic advice using blanket timescales and based on the respondent's anecdotal experience rather than the patients individualized needs. Overall, 116 (78%) felt an occupational advice intervention was needed. CONCLUSIONS This national survey demonstrated wide variation in the timing, content and delivery of information and advice for patients in work and intending to RTW after hip and knee replacement surgery. Current RTW advice provided to hip and knee replacement patients is inadequate.
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Affiliation(s)
- B Tsang
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK
| | - D McDonald
- Whole System Patient Flow Programme, Scottish Government, Scotland, UK.,NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - I McNamara
- Norfolk and Norwich NHS Foundation Trust, Department of Trauma & Orthopaedics, Norwich, UK
| | - L Kottam
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK
| | - A Rangan
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK.,University of York, York, UK.,University of Oxford, Oxford, UK
| | - P Baker
- South Tees Hospitals NHS Foundation Trust, Department of Trauma & Orthopaedics, Middlesbrough, UK.,University of York, York, UK
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15
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Mehta N, Johnston JM, Hein M, Kipp BR, Coon L, Savedra ME, Hoyer JD, He R, Rangan A, Shi M, Oliveira JL. Further Characterization of Hb Bronovo [α103(G10)His→Leu; HBA2: c.311A>T] and First Report of the Homozygous State. Hemoglobin 2020; 44:174-178. [PMID: 32552204 DOI: 10.1080/03630269.2020.1776322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hb Bronovo [α103(G10)His→Leu, HBA2: c.311A>T] is an α-globin variant that interferes with and decreases binding efficiency to α hemoglobin (Hb) stabilizing protein (AHSP), a chaperone molecule. The histidine residue at position 103 is integral to the AHSP hydrogen bond formation where disruption results in an increased quantity of cytotoxic free α-globin chains, thereby creating a similar pathophysiology as β-thalassemia (β-thal). We report a family with Hb Bronovo, including a homozygous proband, which resulted from maternal uniparental disomy (UPD). Although not detected by routine studies in previous reports, the variant protein is visible by intact mass spectrometry (MS).
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Affiliation(s)
- Nikita Mehta
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.,Department of Pathology, Diagnostic Molecular Genetics Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Martin Johnston
- Division of Pediatric Hematology/Oncology, Renown Children's Hospital, Reno, NV, USA
| | - Molly Hein
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Lea Coon
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Michelle E Savedra
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - James D Hoyer
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Aruna Rangan
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Oliveira
- Department of Laboratory Medicine and Pathology, Metabolic Hematology Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
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16
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Baldwin MJ, Nagra NS, Merritt N, Rees JL, Carr AJ, Rangan A, Thomas M, Beard DJ, Cooper C, Kottam L, Cook JA. The use of a patch to augment rotator cuff surgery - A survey of UK shoulder and elbow surgeons. PLoS One 2020; 15:e0230235. [PMID: 32240199 PMCID: PMC7117708 DOI: 10.1371/journal.pone.0230235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Rotator cuff tears are a common cause of shoulder pain and can result in prolonged periods of pain, disability and absence from work. Rotator cuff repair surgery is increasingly used in an attempt to resolve symptoms but has failure rates of around 40%. There is a pressing need to improve the outcome of rotator cuff repairs. Patch augmentation increasingly being used within the NHS in an attempt to reduce repair failures. The aim of this survey was to determine current UK practice and opinion relating to the factors that influence choice of patch, current patient selection and willingness to assist with generation of improved evidence. Methods An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, experience with patches, indications for patch augmentation and willingness to be involved in a randomised trial of patch augmented rotator cuff surgery. Results The response rate was 105/550 (19%). 58% of respondents had used a patch to augment rotator cuff surgery. 70% of patch users had undertaken an augmented repair within the last 6 months. A wide surgical experience in augmentation was reported (ranging 1 to 200 implants used). However, most surgeons reported low volume usage, with a median of 5 rotator cuff augmentation procedures performed. At least 10 different products had been used. Most of the patches used were constructed from human decellularised dermis tissue, although porcine derived and synthetic based patches had also been used. Only 3–5% stated they would undertake an augmented repair for small tears across ages, whereas 28–40% and 19–59% would do so for large or massive tears respectively. When assessing patient suitability, patient age seemed relevant only for those with large and massive tears. Half of the surgeons reported an interest in taking part in a randomised controlled trial (RCT) evaluating the role of patch augmentation for rotator cuff surgery, with a further 22% of respondent’s undecided. Conclusions A variety of patches have been used by surgeons to augment rotator cuff repair with a wide range of operator experience. There was substantial uncertainty about which patch to use and differing views on which patients were most suitable. There is a clear need for robust clinical evaluation and further research in this area.
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Affiliation(s)
- M. J. Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - N. S. Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - N. Merritt
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - J. L. Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - A. J. Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - A. Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - M. Thomas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - D. J. Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - C. Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - L. Kottam
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - J. A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Institute of Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Garriga C, Murphy J, Leal J, Price A, Prieto-Alhambra D, Carr A, Arden NK, Rangan A, Cooper C, Peat G, Fitzpatrick R, Barker K, Judge A. Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man". Osteoarthritis Cartilage 2019; 27:1280-1293. [PMID: 31078777 DOI: 10.1016/j.joca.2019.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/02/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to test whether a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) had an impact on patient outcomes. DESIGN Natural-experiment (April 2008-December 2016). Interrupted time-series regression assessed impact on trends before-during-after ERAS implementation. SETTING Primary operations from the UK National Joint Registry (NJR) were linked with Hospital Episode Statistics (HES) data which contains inpatient episodes undertaken in National Health Service (NHS) trusts in England, and Patient Reported Outcome Measures (PROMs). PARTICIPANTS Patients undergoing primary planned TKR aged ≥18 years. INTERVENTION ERAS implementation (April 2009-March 2011). OUTCOMES Regression coefficients of monthly means of Length of stay (LOS), bed day costs, change in Oxford knee scores (OKS) 6-months after surgery, complications (at 6 months), and rates of revision surgeries (at 5 years). RESULTS 486,579 primary TKRs were identified. Overall LOS and bed-day costs decreased from 5.8 days to 3.7 and from £7607 to £5276, from April 2008 to December 2016. Oxford knee score (OKS) change improved from 15.1 points in April 2008 to 17.1 points in December 2016. Complications decreased from 4.1 % in April 2008 to 1.7 % in March 2016. 5-year revision rates remained stable at 4.8 per 1000 implants years in April 2008 and December 2011. After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased. CONCLUSIONS Different secular trends in outcomes for patients having TKR have been observed over the last decade. Although patient outcomes are better than a decade ago ERAS did not improve them at national level.
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Affiliation(s)
- C Garriga
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - J Murphy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - J Leal
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - A Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - D Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - A Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
| | - N K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - A Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
| | - C Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
| | - G Peat
- Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | - R Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - K Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Windmill Rd, Headington, Oxford, OX3 7HE, UK.
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK; National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol NHS Foundation Trust, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
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18
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Costa ML, Achten J, Rangan A, Lamb SE, Parsons NR. Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: five-year follow-up of a randomized controlled trial. Bone Joint J 2019; 101-B:978-983. [PMID: 31362548 PMCID: PMC6681675 DOI: 10.1302/0301-620x.101b8.bjj-2018-1285.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. Patients and Methods We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. Results At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). Conclusion This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978–983.
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Affiliation(s)
- M L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Achten
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Rangan
- Health Sciences, University of York, York, UK
| | - S E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N R Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
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Watts AC, Duckworth AD, Trail IA, Rees J, Thomas M, Rangan A. Scoping review: Diagnosis and management of periprosthetic joint infection in elbow arthroplasty. Shoulder Elbow 2019; 11:282-291. [PMID: 31316589 PMCID: PMC6620798 DOI: 10.1177/1758573218789341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total elbow arthroplasty is an effective treatment for patients with painful elbow arthritis. Infection can be a serious complication. The aim of this scoping review was to document the available evidence on periprosthetic elbow infection. METHODS A search of Medline, Embase and PubMed was performed; two authors screened results independently. Systematic reviews, randomised controlled trials, cohort studies, case-control studies and case series including periprosthetic elbow infection were eligible. RESULTS A total of 46 studies were included. The median rate of periprosthetic elbow infection reported from recent published studies is 3.3%. The most commonly identified causative organisms are Staphylococcus aureus and Staphylococcus epidermidis. Risk factors include younger age, rheumatoid arthritis, obesity, previous surgery or infection to the elbow, and postoperative wound complications. Debridement, antibiotics and implant retention results in implant survival rates of 50-90%. Two-stage revision results in improved functional outcome scores, but with recurrent infection rates of 12-28%. CONCLUSIONS Total elbow arthroplasty carries a higher risk of infection when compared to other major joint replacements. The current body of literature is limited and is almost exclusively low volume retrospective case series. The best management of periprosthetic elbow infection is difficult to determine, but two-stage revision appears to be the gold standard.
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Affiliation(s)
- AC Watts
- Wrightington Hospital, Lancashire, UK,AC Watts, Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire WN6 9EP, UK.
| | | | - IA Trail
- Wrightington Hospital, Lancashire, UK
| | - J Rees
- University of Oxford, Oxford, UK
| | - M Thomas
- Frimley Health Foundation Trust, Frimley, UK
| | - A Rangan
- James Cook University Hospital, Middlesbrough, UK
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Hanchard NCA, Goodchild L, Brealey SD, Lamb SE, Rangan A. Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post operative protocols for UK FROST and inferences for wider practice. Physiotherapy 2019; 107:150-160. [PMID: 32026815 DOI: 10.1016/j.physio.2019.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility. METHODS We screened a UK Department of Health systematic review and UK evidence-based guidelines (Hanchard et al., 2012; Maund et al., 2012) for recommendations, and previous surveys of UK physiotherapists (Hanchard et al., 2011, 2013) for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post operative physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder). We proposed respectively mandating or recommending interventions with 100% and 90% positive consensus, and respectively disallowing or discouraging interventions with 90% and 80% negative consensus. Other interventions would be optional. RESULTS The systematic review and guideline recommended including steroid injection and manual mobilizations in non-operative care, and we mandated these for stand-alone physiotherapy. Consensus in the pre-existing surveys strongly favoured advice, education and home exercises, which we mandated across contexts. The Delphi survey led to recommendation of some supervised exercise modalities, plus the disallowing or discouragement-in various contexts-of immobilization and some 'higher-tech' electrotherapies and alternative therapies. CONCLUSIONS We developed physiotherapy protocols despite incomplete empirical evidence. Their clear structure enabled implementation in data-sheets designed to facilitate recording, monitoring of fidelity and reporting of interventions. Other trials involving physiotherapy may benefit from this approach.
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Affiliation(s)
- N C A Hanchard
- School of Health and Social Care, Teesside University, Middlesbrough TS1 3BX, United Kingdom
| | - L Goodchild
- Department of Trauma & Orthopaedic Surgery, The James Cook University Hospital, Middlesbrough TS4 3BW, United Kingdom
| | - S D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, United Kingdom
| | - S E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, United Kingdom
| | - A Rangan
- Department of Trauma & Orthopaedic Surgery, The James Cook University Hospital, Middlesbrough TS4 3BW, United Kingdom; York Trials Unit, Department of Health Sciences, University of York, York YO10 5DD, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, United Kingdom.
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21
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Beckman A, Meredith M, Rangan A, Thyagarajan B, Yohe S, Mroz P. Acute Myeloid Leukemia Characterized by Four CEBPA Mutations. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqy097.250] [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] Open
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22
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Neff JL, Rangan A, Jevremovic D, Nguyen PL, Chiu A, Go RS, Chen D, Morice WG, Shi M. Mixed-phenotype large granular lymphocytic leukemia: a rare subtype in the large granular lymphocytic leukemia spectrum. Hum Pathol 2018; 81:96-104. [PMID: 29949739 DOI: 10.1016/j.humpath.2018.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/01/2018] [Accepted: 06/09/2018] [Indexed: 01/18/2023]
Abstract
Large granular lymphocytic leukemia (LGLL) is a chronic proliferation of cytotoxic lymphocytes in which more than 70% of patients develop cytopenia(s) requiring therapy. LGLL includes T-cell LGLL and chronic lymphoproliferative disorder of natural killer (NK) cells. The neoplastic cells in LGLL usually exhibit a single immunophenotype in a patient, with CD8-positive/αβ T-cell type being the most common, followed by NK-cell, γδ T-cell, and CD4-positive/αβ T-cell types. We investigated a total of 220 LGLL cases and identified 12 mixed-phenotype LGLLs (5%): 7 cases with coexistent αβ T-cell and NK-cell clones and 5 with coexistent αβ and γδ T-cell clones. With a median follow-up of 48 months, the clinicopathological characteristics of these patients seemed similar to those of typical LGLL patients. Treatment was instituted in 9 patients, and 5 patients (55%) attained complete hematologic response or partial response. The therapeutic response rate of this cohort is comparable to the reported overall response rate of 40% to 60% in typical LGLL patients. Three patients who did not receive any treatment had progressive or persistent cytopenias. Interestingly, inverted proportions of 2 clones at disease recurrence were identified in 4 patients (36%) and stable clonal proportions in 7 patients (64%). Mixed-phenotype LGLL is rare, and this study underscores the importance of recognizing this rare type of LGLL in patients who may benefit from LGLL treatment.
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Affiliation(s)
- Jadee L Neff
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Aruna Rangan
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - April Chiu
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - William G Morice
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA.
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Anderson B, Rangan A, Sweetser S. A Large Retroperitoneal Mass in an Asymptomatic 22-Year-Old Man. Gastroenterology 2017; 153:1200-1202. [PMID: 28843956 DOI: 10.1053/j.gastro.2017.08.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/08/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Bradley Anderson
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Aruna Rangan
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Jefferson L, Brealey S, Handoll H, Keding A, Kottam L, Sbizzera I, Rangan A. Impact of the PROFHER trial findings on surgeons' clinical practice: An online questionnaire survey. Bone Joint Res 2017; 6:590-599. [PMID: 29066532 PMCID: PMC5670363 DOI: 10.1302/2046-3758.610.bjr-2017-0170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives To explore whether orthopaedic surgeons have adopted the Proximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial results routinely into clinical practice. Methods A questionnaire was piloted with six orthopaedic surgeons using a ‘think aloud’ process. The final questionnaire contained 29 items and was distributed online to surgeon members of the British Orthopaedic Association and British Elbow and Shoulder Society. Descriptive statistics summarised the sample characteristics and fracture treatment of respondents overall, and grouped them by whether they changed practice based on PROFHER trial findings. Free-text responses were analysed qualitatively for emerging themes using Framework Analysis principles. Results There were complete responses from 265 orthopaedic and trauma surgeons who treat patients with proximal humeral fractures. Around half (137) had changed practice to various extents because of PROFHER, by operating on fewer PROFHER-eligible fractures. A third (43) of the 128 respondents who had not changed practice were already managing patients non-operatively. Those who changed practice were more likely to be younger, work in a trauma unit rather than a major trauma centre, be specialist shoulder surgeons and treat fewer PROFHER-eligible fractures surgically. This group gave higher scores when assessing validity and applicability of PROFHER. In contrast, a quarter of the non-changers were critical, sometimes emphatically, of PROFHER. The strongest theme that emerged overall was the endorsement of evidence-based practice. Conclusion PROFHER has had an impact on surgeons’ clinical practice, both through changing it, and through underpinning existing non-operative practice. Although some respondents expressed reservations about the trial, evidence from such trials was found to be the most important influence on surgeons’ decisions to change practice. Cite this article: L. Jefferson, S. Brealey, H. Handoll, A. Keding, L. Kottam, I. Sbizzera, A. Rangan. Impact of the PROFHER trial findings on surgeons’ clinical practice: An online questionnaire survey. Bone Joint Res 2017;6:590–599. DOI: 10.1302/2046-3758.610.BJR-2017-0170.
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Affiliation(s)
- L Jefferson
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - S Brealey
- York Trials Unit, University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - H Handoll
- School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley TS1 3BA, UK
| | - A Keding
- York Trials Unit, University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - L Kottam
- Department of Trauma and Orthopaedics, South Tees Hospitals NHS Trust, James Cook University Hospital, Marton Road, Middlesborough, Tees Valley TS4 3BW, UK
| | - I Sbizzera
- York Trials Unit, University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - A Rangan
- York Trials Unit, University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK and School of Health and Social Care, Middlesbrough, Tees Valley TS1 3BA, UK and South Tees Hospitals NHS Trust, Marton Road, Middlesborough TS4 3BW, UK
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Rangan A, Zheng M, Olsen NJ, Rohde JF, Heitmann BL. Shorter sleep duration is associated with higher energy intake and an increase in BMI z-score in young children predisposed to overweight. Int J Obes (Lond) 2017; 42:59-64. [PMID: 28883538 DOI: 10.1038/ijo.2017.216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/14/2017] [Accepted: 08/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Inadequate sleep has been shown to be a contributor to obesity in both children and adults. Less evidence is available for toddlers and among those with higher obesity risk. The objective of this study was to examine the relationship between sleep patterns and body weight development in a group of young obesity-predisposed children, and to assess whether intakes of energy or macronutrients mediate this relationship. METHODS Participants included 368 Danish children aged 2-6 years from the Healthy Start Study, a 1.3 year randomised controlled intervention trial. Sleep habits were measured using a 7-day sleep diary. Multivariate linear regression with adjustment for confounders was used to assess the association of sleep duration and sleep variability with 1.3 year changes (Δ) in body mass index (BMI) z-score from baseline to follow-up. RESULTS The average nighttime sleep duration was 10.7 h (range 8.8-12.5 h). After controlling for potential confounders, a significant inverse association between nighttime sleep duration and ΔBMI z-score (β=-0.090, P=0.046) was observed. This relationship was mediated by energy intake, with all macronutrients contributing to this mediation effect. No associations were found for sleep variability and ΔBMI z-score but baseline intake of added sugars and sugary beverages were positively associated with sleep variability. CONCLUSION Shorter sleep duration, mediated by energy intake in early in life, seems a risk factor for weight gain among young obesity-predisposed children.
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Affiliation(s)
- A Rangan
- Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - M Zheng
- Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - N J Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark
| | - J F Rohde
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - B L Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospitals, the Capital Region, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Boden Institute of Obesity, Nutrition, Exercise & Eating disorders, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Institute of Public Health, Section for General Medicine, University of Copenhagen, Copenhagen, Denmark
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Zheng J, Wu J, Louie J, Flood V, Gill T, Rangan A. Changes in portion sizes of commonly consumed core and discretionary foods among Australian adults from 1995 to 2011-12. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.107] [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: 11/26/2022] Open
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27
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Wong T, Sui Z, Rangan A, Louie J. Different preferences towards coffee type and additive usages reflect variations in dietary pattern. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.053] [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: 12/01/2022] Open
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Handoll HH, Keding A, Corbacho B, Brealey SD, Hewitt C, Rangan A. Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Joint J 2017; 99-B:383-392. [PMID: 28249980 PMCID: PMC5404240 DOI: 10.1302/0301-620x.99b3.bjj-2016-1028] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
Aims The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Patients and Methods Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and economic analyses, consistent with those of the main trial were
applied. Results OSS data were available for 164, 155 and 149 participants at
three, four and five years, respectively. There were no statistically
or clinically significant differences between operative and non-operative
treatment at each follow-up point. No participant had secondary
shoulder surgery for a new complication. Analyses of EQ-5D-3L data
showed no significant between-group differences in quality of life
over time. Conclusion These results confirm that the main findings of the PROFHER trial
over two years are unchanged at five years. Cite this article: Bone Joint J 2017;99-B:383–92.
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Affiliation(s)
- H H Handoll
- Teesside University, Middlesbrough, Tees Valley TS1 3BA, UK
| | - A Keding
- University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - B Corbacho
- University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - S D Brealey
- University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - C Hewitt
- University of York, Lower Ground Floor, ARRC Building, Heslington, York YO10 5DD, UK
| | - A Rangan
- James Cook University Hospital, South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
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Handoll HHG, Brealey SD, Jefferson L, Keding A, Brooksbank AJ, Johnstone AJ, Candal-Couto JJ, Rangan A. Defining the fracture population in a pragmatic multicentre randomised controlled trial: PROFHER and the Neer classification of proximal humeral fractures. Bone Joint Res 2016; 5:481-489. [PMID: 27756739 PMCID: PMC5086839 DOI: 10.1302/2046-3758.510.bjr-2016-0132.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/24/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. METHODS The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons. RESULTS Two or more baseline radiographic views were obtained for each participant. The independent raters confirmed that all fractures would have been considered for surgery in contemporaneous practice. A full description of the fracture population based on the Neer classification was obtained. The agreement between the categorisation at baseline (tuberosity involvement) and Neer classification as assessed by the two raters was only fair (kappa 0.29). However, this disparity did not appear to affect trial findings, specifically in terms of influencing the effect of treatment on the primary outcome of the trial. CONCLUSIONS A key reporting requirement, namely the description of the fracture population, was achieved within the context of a pragmatic multicentre randomised clinical trial. This article provides important guidance for researchers designing similar trials on fracture management.Cite this article: H. H. G. Handoll, S. D. Brealey, L. Jefferson, A. Keding, A. J. Brooksbank, A. J. Johnstone, J. J. Candal-Couto, A. Rangan. Defining the fracture population in a pragmatic multicentre randomised controlled trial: PROFHER and the Neer classification of proximal humeral fractures.Bone Joint Res 2016;5:481-489. DOI: 10.1302/2046-3758.510.BJR-2016-0132.R1.
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Affiliation(s)
- H H G Handoll
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, TS1 3BA, UK
| | - S D Brealey
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - L Jefferson
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - A Keding
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - A J Brooksbank
- Department of Orthopaedics and Trauma, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - A J Johnstone
- Orthopaedic Trauma Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | - J J Candal-Couto
- Northumbria Healthcare NHS Trust, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK
| | - A Rangan
- Department of Trauma and Orthopaedics, James Cook University Hospital, South Tees Hospitals NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
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Rangan A, Feldman A. Nodular Lymphocyte Predominant Hodgkin Lymphoma in the Ileum: A Rare Presentation. Am J Clin Pathol 2016. [DOI: 10.1093/ajcp/aqw151.012] [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: 11/13/2022] Open
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Abstract
A system is subject to shocks; each shock at time t increases the cumulative damage λ (t) by a constant amount, while the system is subject to repair in between the shocks which brings down λ (t) at a constant rate. The shock arrival process is an inhomogeneous Poisson process with intensity function λ (t) and each shock weakens the system making it more expensive to run. The long-run expected cost per unit time of running the system is obtained as well as the variance of the cost which are used to get optimal times of replacement of the system.
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Rangan A, Grace RE. On the replacement of systems subject to shocks and wear-dependent failure. ADV APPL PROBAB 2016. [DOI: 10.2307/1427211] [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: 11/10/2022]
Abstract
A system is discussed which is subject to a conditional Poisson stream of failures, whose intensity function representing the cumulative damage level is a Markov chain.
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Abstract
A system is repaired on failure. With probability p, it is returned to the ‘good as new' state (perfect repair) and with probability 1 – p, it is returned to the functioning state, but is only as good as a system of age equal to its age at failure (imperfect repair). In this article, we develop replacement policies for a deteriorating system with imperfect maintenance. The successive survival times and consecutive repair times form a geometric process which is stochastically non-increasing or non-decreasing respectively. Explicit expressions are obtained for the long-run expected cost under two kinds of replacement policies based on the working age of the system and the number of imperfect repairs before a replacement.
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Zheng M, Wu J, Louie J, Flood V, Gill T, Thomas B, Cleanthous X, Neal B, Rangan A. Typical portion size of core foods among Australian adults: The 2011–12 National Nutrition and Physical Activity Survey. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.235] [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: 10/21/2022] Open
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He R, Greipp PT, Rangan A, Mai M, Chen D, Reichard KK, Nelsen LL, Pardanani A, Hanson CA, Viswanatha DS. BCR-JAK2 fusion in a myeloproliferative neoplasm with associated eosinophilia. Cancer Genet 2016; 209:223-8. [PMID: 27134074 DOI: 10.1016/j.cancergen.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
Janus kinase 2 (JAK2) is located on chromosome 9 at band p24 and JAK2V617F is the most common mutation in Philadelphia chromosome-negative myeloproliferative neoplasms (Ph-MPN). However, rearrangement of JAK2 is a rare event. We report a case of myeloproliferative neoplasm, unclassifiable (MPN-U) with BCR-JAK2 fusion confirmed by molecular studies. Conventional chromosome analysis (CC) revealed t(9;22)(p24;q11.2) and fluorescence in situ hybridization (FISH) showed a JAK2 gene rearrangement in 88% of interphase nuclei. The BCR-JAK2 fusion was confirmed by multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and demonstrated two in-frame 5'BCR/3'JAK2 transcripts with BCR exon 1 juxtaposed to JAK2 exon 15 and exon 17, respectively. Our results, together with literature review, reveal BCR-JAK2 fusions as oncogenic genetic alterations that are associated with myeloid or lymphoid neoplasms and are frequently characterized by eosinophilia. Further, patients with BCR-JAK2 are candidates for JAK2 inhibitor therapy. Given the distinct clinical and pathological characteristics, we believe that hematological neoplasms harboring BCR-JAK2 should be included as an additional distinct entity to the current WHO category of "myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB, or FGFR", and testing for a JAK2 fusion should be pursued in neoplasms with a karyotypic 9p24 abnormality.
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Affiliation(s)
- Rong He
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Patricia T Greipp
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Aruna Rangan
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ming Mai
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dong Chen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kaaren K Reichard
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura L Nelsen
- Department of Pathology, Maine General Hospital, Augusta, ME, USA
| | - Animesh Pardanani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Curtis A Hanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David S Viswanatha
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Corbacho B, Duarte A, Keding A, Handoll H, Chuang LH, Torgerson D, Brealey S, Jefferson L, Hewitt C, Rangan A. Cost effectiveness of surgical versus non-surgical treatment of adults with displaced fractures of the proximal humerus. Bone Joint J 2016; 98-B:152-9. [DOI: 10.1302/0301-620x.98b2.36614] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aims A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals to evaluate the clinical effectiveness and cost effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults. Methods A cost utility analysis from the NHS perspective was performed. Differences between surgical and non-surgical treatment groups in costs and quality adjusted life years (QALYs) at two years were used to derive an estimate of the cost effectiveness of surgery using regression methods. Results Patients randomised to receive surgical intervention accumulated mean greater costs and marginally lower QALYs than patients randomised to non-surgery. The surgical intervention cost a mean of £1758 more per patient (95% confidence intervals (CI) £1126 to £2389). Total QALYs for the surgical group were smaller than those for non-surgery -0.0101 (95% CI -0.13 to 0.11). The probability of surgery being cost effective was less than 10% given the current NICE willingness to pay at a threshold of £20 000 for an additional QALY. The results were robust to sensitivity analyses. Discussion The results suggest that current surgical treatment is not cost effective for the majority of displaced fractures of the proximal humerus involving the surgical neck in the United Kingdom’s NHS. Take home message: The results of this trial do not support the trend of increased surgical treatment for patients with displaced fractures of the proximal humerus involving the surgical neck within the United Kingdom NHS. Cite this article: Bone Joint J 2016;98-B:152–9.
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Affiliation(s)
- B. Corbacho
- University of York, Heslington, York, YO10
5DD, UK
| | - A. Duarte
- Centre for Health Economics, University
of York, Alcuin Block A, University
of York, York, YO10 5DD, UK
| | - A. Keding
- University of York, Heslington, York, YO10
5DD, UK
| | - H. Handoll
- Teesside University, Middlesbrough, Tees
Valley, TS1 3BA, UK
| | - L. H. Chuang
- Pharmerit Europe, Marten
Meesweg 107, 3068 AV Rotterdam, The
Netherlands
| | - D. Torgerson
- University of York, Heslington, York, YO10
5DD, UK
| | - S. Brealey
- University of York, Heslington, York, YO10
5DD, UK
| | - L. Jefferson
- University of York, Heslington, York, YO10
5DD, UK
| | - C. Hewitt
- University of York, Heslington, York, YO10
5DD, UK
| | - A. Rangan
- James
Cook University Hospital, Marton Road, Middlesbrough, TS4
3BW, UK
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Tubeuf S, Yu G, Achten J, Parsons NR, Rangan A, Lamb SE, Costa ML. Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial. Bone Joint J 2015. [PMID: 26224825 DOI: 10.1302/0301-620x.97b8.35234] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius. The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care. There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of £714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of £89,322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than £30,000. Compared with locking-plate fixation, K-wire fixation is a 'cost saving' intervention, with similar health benefits.
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Affiliation(s)
- S Tubeuf
- University of Leeds, 101 Clarendon Road, Leeds LS6 9LJ, UK
| | - G Yu
- University of Leeds, 101 Clarendon Road, Leeds LS6 9LJ, UK
| | - J Achten
- University of Oxford John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - N R Parsons
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - A Rangan
- The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - S E Lamb
- University of Oxford, Windmill Road, Headington Oxford, OX3 7LD, UK
| | - M L Costa
- University of Oxford John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Hebden L, Chan HN, Louie JC, Rangan A, Allman-Farinelli M. You are what you choose to eat: factors influencing young adults' food selection behaviour. J Hum Nutr Diet 2015; 28:401-8. [DOI: 10.1111/jhn.12312] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Hebden
- School of Molecular Bioscience; Faculty of Science; The University of Sydney; Sydney NSW Australia
| | - H. N. Chan
- School of Molecular Bioscience; Faculty of Science; The University of Sydney; Sydney NSW Australia
| | - J. C. Louie
- School of Molecular Bioscience; Faculty of Science; The University of Sydney; Sydney NSW Australia
| | - A. Rangan
- School of Molecular Bioscience; Faculty of Science; The University of Sydney; Sydney NSW Australia
| | - M. Allman-Farinelli
- School of Molecular Bioscience; Faculty of Science; The University of Sydney; Sydney NSW Australia
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Rankin KS, Sprowson AP, McNamara I, Akiyama T, Buchbinder R, Costa ML, Rasmussen S, Nathan SS, Kumta S, Rangan A. The orthopaedic research scene and strategies to improve it. Bone Joint J 2015; 96-B:1578-85. [PMID: 25452358 DOI: 10.1302/0301-620x.96b12.33990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Trauma and orthopaedics is the largest of the surgical specialties and yet attracts a disproportionately small fraction of available national and international funding for health research. With the burden of musculoskeletal disease increasing, high-quality research is required to improve the evidence base for orthopaedic practice. Using the current research landscape in the United Kingdom as an example, but also addressing the international perspective, we highlight the issues surrounding poor levels of research funding in trauma and orthopaedics and indicate avenues for improving the impact and success of surgical musculoskeletal research.
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Affiliation(s)
- K S Rankin
- Newcastle University, Musculoskeletal Research Group, Level 4 Cookson Building, The Medical School, Newcastle, NE2 4HH, UK
| | - A P Sprowson
- University of Warwick , Clinical Sciences Building, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - I McNamara
- Norfolk and Norwich University Hospitals Foundation NHS Trust, NR4 7UY, UK
| | - T Akiyama
- Jichi Medical University, Department of Orthopaedic Surgery, Saitama Medical Centre, Saitama, Japan
| | - R Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M L Costa
- University of Warwick, Clinical Trials Unit, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - S Rasmussen
- Aalborg University Hospital, Research and Innovation Centre, 15 Soendre Skovvej, DK-9000, Aalborg, Denmark
| | - S S Nathan
- National University of Singapore, Yong Loo Lin School of Medicine, 1E Kent Ridge Road, 119228, Singapore
| | - S Kumta
- The Chinese University of Hong Kong, Prince of Wales University Hospital, Shatin, Hong Kong
| | - A Rangan
- Durham University, School of Medicine & Health, Queen's Campus, University Boulevard, Teesside TS17 6BH, UK
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Handoll HHG, Goodchild L, Brealey SD, Hanchard NCA, Jefferson L, Keding A, Rangan A. Developing, delivering and documenting rehabilitation in a multi-centre randomised controlled surgical trial: experiences from the ProFHER trial. Bone Joint Res 2014; 3:335-40. [PMID: 25519445 PMCID: PMC4286698 DOI: 10.1302/2046-3758.312.2000364] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives A rigorous approach to developing, delivering and documenting
rehabilitation within randomised controlled trials of surgical interventions
is required to underpin the generation of reliable and usable evidence.
This article describes the key processes used to ensure provision
of good quality and comparable rehabilitation to all participants
of a multi-centre randomised controlled trial comparing surgery
with conservative treatment of proximal humeral fractures in adults. Methods These processes included the development of a patient information
leaflet on self-care during sling immobilisation, the development
of a basic treatment physiotherapy protocol that received input
and endorsement by specialist physiotherapists providing patient
care, and establishing an expectation for the provision of home
exercises. Specially designed forms were also developed to facilitate
reliable reporting of the physiotherapy care that patients received. Results All three initiatives were successfully implemented, alongside
the measures to optimise the documentation of physiotherapy. Thus,
all participating sites that recruited patients provided the sling
immobilisation leaflet, all adhered to the physiotherapy protocol
and all provided home exercises. There was exemplary completion
of the physiotherapy forms that often reflected a complex patient
care pathway. These data demonstrated equal and high access to and
implementation of physiotherapy between groups, including the performance
of home exercises. Conclusion In order to increase the validity and relevance of the evidence
from trials of surgical interventions and meet international reporting
standards, careful attention to study design, conduct and reporting
of the intrinsic rehabilitation components is required. The involvement
of rehabilitation specialists is crucial to achieving this. Cite this article: Bone Joint Res 2014;3:335–40.
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Affiliation(s)
- H H G Handoll
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough TS1 3BA, UK
| | - L Goodchild
- James Cook University Hospital, South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - S D Brealey
- York Trials Unit, Lower Ground Floor, ARRC Building, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - N C A Hanchard
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough TS1 3BA, UK
| | - L Jefferson
- York Trials Unit, Lower Ground Floor, ARRC Building, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - A Keding
- York Trials Unit, Lower Ground Floor, ARRC Building, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
| | - A Rangan
- James Cook University Hospital, South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
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Khan SK, Jameson SS, Sims A, A'Court J, Reed MR, Rangan A, Muller SD. Cemented Thompson's hemiarthroplasty in patients with intracapsular neck of femur fractures: survival analysis of 1,670 procedures. Eur J Orthop Surg Traumatol 2014; 25:655-60. [PMID: 25260576 DOI: 10.1007/s00590-014-1521-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Abstract
Cemented Thompson's prostheses have been used to treat elderly patients with displaced intracapsular hip fractures at our two units for the last 15 years, amid growing support for the use of newer implant designs for hip hemiarthroplasty. This provided us with an opportunity to investigate survival of the Thompson's stem in our patients. A retrospective cohort study was set up to review previously collected data on patients who underwent Thompson's hemiarthroplasty over a 7-year period. These were linked to surgical notes, clinical letters and radiographs to record post-operative course and subsequent admissions and procedures. The identifiers were then linked to mortality data from the Office of 'National Statistics. Kaplan-Meier survival analyses were done for implants and patients. A total of 1,632 patients (mean age 82.7 years) underwent 1,670 procedures. Five-year implant survival was 95.4 %. A total of 36 stems were revised, including 14 revisions to total hip arthroplasty and 22 excision arthroplasties. Reasons for revision included infection (2.1 %), dislocation (1.1 %) and aseptic loosening (0.5 %). Symptomatic aseptic loosening and acetabular erosion occurred late (mean time 3.2 and 5.7 years, respectively following surgery). Aseptic loosening and erosion following hemiarthroplasty are relatively late complications.
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Affiliation(s)
- S K Khan
- Northumbria Healthcare NHS Foundation Trust, Ashington, NE63 9JJ, UK,
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Abstract
The aim of this study was to review the role
of clinical trial networks in orthopaedic surgery. A total of two
electronic databases (MEDLINE and EMBASE) were searched from inception
to September 2013 with no language restrictions. Articles related
to randomised controlled trials (RCTs), research networks and orthopaedic
research, were identified and reviewed. The usefulness of trainee-led
research collaborations is reported and our knowledge of current
clinical trial infrastructure further supplements the review. Searching
yielded 818 titles and abstracts, of which 12 were suitable for
this review. Results are summarised and presented narratively under
the following headings: 1) identifying clinically relevant research
questions; 2) education and training; 3) conduct of multicentre
RCTs and 4) dissemination and adoption of trial results. This review
confirms growing international awareness of the important role research
networks play in supporting trials in orthopaedic surgery. Multidisciplinary
collaboration and adequate investment in trial infrastructure are crucial
for successful delivery of RCTs. Cite this article: Bone Joint Res 2014;3:169–74.
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Affiliation(s)
- A Rangan
- The James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, UK
| | - L Jefferson
- University of York, York Trials Unit, Department of Health Sciences, York, YO10 5DD, UK
| | - P Baker
- The James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, UK
| | - L Cook
- University of York, York Trials Unit, Department of Health Sciences, York, YO10 5DD, UK
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Bjornson LK, Rangan A, Fenster TB, Magotra M, Nimaroff M. Clinical and laboratory issues associated with persistent low-level elevations of hCG in a female of childbearing age. Clin Chim Acta 2014; 430:22-3. [PMID: 24378284 DOI: 10.1016/j.cca.2013.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/04/2013] [Accepted: 12/20/2013] [Indexed: 11/15/2022]
Abstract
Persistent low-level elevations of serum concentrations of hCG in a non-pregnant female of childbearing age were investigated by a number of laboratory techniques including heterophile blocking reagents, polyethylene glycol precipitation, serial dilutions and hCG measurements on several different instrument/reagent systems. The results of these studies indicated that this patient had immunoreactive hCG in her serum that was not the intact hCG molecule but primarily the free β-hCG subunit. Differential diagnoses are discussed along with recommendation for continued surveillance of serum hCG concentrations.
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Affiliation(s)
- Loring K Bjornson
- Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Department of Pathology and Laboratory Medicine, 300 Community Dr., Manhasset, NY 11030, United States.
| | - Aruna Rangan
- Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Department of Pathology and Laboratory Medicine, 300 Community Dr., Manhasset, NY 11030, United States
| | - Tamatha B Fenster
- Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Department of Obstetrics and Gynecology, 300 Community Dr., Manhasset, NY 11030, United States
| | - Minoti Magotra
- Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Department of Pathology and Laboratory Medicine, 300 Community Dr., Manhasset, NY 11030, United States
| | - Michael Nimaroff
- Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Department of Obstetrics and Gynecology, 300 Community Dr., Manhasset, NY 11030, United States
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Zheng M, Allman-Farinelli M, Heitmann BL, Toelle B, Marks G, Cowell C, Rangan A. Liquid versus solid energy intake in relation to body composition among Australian children. J Hum Nutr Diet 2014; 28 Suppl 2:70-9. [PMID: 24548259 DOI: 10.1111/jhn.12223] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The debate about whether energy consumed in liquid form is more obesogenic than energy consumed in solid form remains equivocal. We aimed to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in childhood adiposity. METHODS Our analyses included 8-year-old Australian children (n = 158) participating in the Childhood Asthma Prevention Study. Dietary information was collected using three 24-h recalls at age 9 years. Multivariate linear regression was used to evaluate the effects of liquid versus solid energy intake and different beverage types on changes in body mass index (BMI) Z-score from ages 8 to 11.5 years (△BMIz(8-11.5y)) and percentage body fat (%BF) at age 11.5 years (%BF(11.5y)). Substitution models were used to evaluate the effects of substituting other beverage types for sugar-sweetened beverages (SSB). RESULTS Liquid energy intake (1 MJ day(-1)) was more closely associated with both △BMIz(8-11.5y) (β = 0.23, P = 0.02) and %BF(11.5y) (β = 2.31%, P = 0.01) than solid energy intake (△BMIz(8-11.5y): β = 0.12, P = 0.01 and %BF(11.5y): β = 0.80%, P = 0.07). SSB consumption (100 g day(-1)) was directly associated with △BMIz(8-11.5y) (β = 0.08, P = 0.02) and %BF(11.5y) (β = 0.92%, P = 0.004),whereas diet drinks (100 g day(-1) ) were inversely associated with △BMIz(8-11.5y) (β = 0.18, P = 0.02). Substitution of 100 g of SSB by 100 g of water or diet drink, but not other beverages, was inversely associated with both △BMIz(8-11.5y) and %BF(11.5y) (P < 0.01). CONCLUSIONS Our findings indicate that liquid energy is more obesogenic than solid energy. In particular, SSB, but not other beverage types, are a significant predictor of childhood adiposity and replacing SSB with water can have long-term beneficial effects on childhood adiposity.
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Affiliation(s)
- M Zheng
- School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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Abstract
The peer review process for the evaluation of manuscripts for publication needs to be better understood by the orthopaedic community. Improving the degree of transparency surrounding the review process and educating orthopaedic surgeons on how to improve their manuscripts for submission will help improve both the review procedure and resultant feedback, with an increase in the quality of the subsequent publications. This article seeks to clarify the peer review process and suggest simple ways in which the quality of submissions can be improved to maximise publication success. Cite this article: Bone Joint Res 2013;2:245-7.
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Affiliation(s)
- A P Sprowson
- Warwick Medical School, Clinical SciencesBuilding, Warwick University, CliffordBridge Road, Coventry CV2 2DX, UK
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46
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Rangan A, Allman-Farinelli M, Donohoe E, Gill T. Misreporting of energy intake in the 2007 Australian Children's Survey: differences in the reporting of food types between plausible, under- and over-reporters of energy intake. J Hum Nutr Diet 2013; 27:450-8. [PMID: 24206056 DOI: 10.1111/jhn.12182] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Misreporting is common when collecting dietary intake data, although relatively little is known about the types of foods misreported among children. The present study aimed to identify differences in the reporting of food types between plausible and misreporters of energy intake in a national nutrition survey of Australian children. METHODS Dietary data were collected using a 24-h recall from 4826 children aged 2-16 years who were participating in the 2007 Australian National Children's Nutrition and Physical Activity Survey. Misreporters of energy intake were classified using the Goldberg criteria. Differences in the reporting of a range of food types were examined between plausible, under- and over-reporters. RESULTS Compared with plausible reporters, under-reporters reported less frequent consumption and smaller quantities of consumption of both core and noncore foods. Older children (self-report) under-reported a larger selection of noncore foods than younger children (parental report). Over-reporters reported similar percentages of consumption of many core and noncore foods, with some exceptions. The quantities consumed by over-reporters were generally much larger and this was evident in younger and older children. Compared with plausible reporters, under-reporters had significantly higher intakes of protein and starch but lower intakes of sugar and fat, as percentage energy, than plausible reporters, whereas over-reporters had higher fat and lower carbohydrate intakes. CONCLUSIONS Differences in the reporting of food types were common between plausible, under- and over-reporters of energy intake by children (or their parents) and were not restricted to noncore foods.
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Affiliation(s)
- A Rangan
- School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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Vaiphei K, Rangan A, Singh R. Aberrant crypt focus and fragile histidine triad protein in sporadic colorectal carcinoma. World J Gastrointest Oncol 2012; 4:250-8. [PMID: 23443232 PMCID: PMC3581850 DOI: 10.4251/wjgo.v4.i12.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 10/31/2012] [Accepted: 11/20/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To characterize aberrant crypt focus (ACF) in adjoining mucosa in sporadic colorectal carcinoma and to evaluate fragile histidine triad (Fhit) protein and Ki67.
METHODS: ACF was identified grossly and classified histologically in 75 resected specimens. ACF was typed into hyperplastic ACF (HACF) and dysplastic ACF (DACF). Sections of ACF, carcinoma and normal colonic mucosa as control were studied for Fhit and Ki67 expressions by immunohistochemistry and were grouped according to staining intensity and the number of positive stained cells observed in different histological groups. Comparison was done between the different groups by Pearson’s χ2 test and γ test for the ordinal data. P value < 0.05 was considered as significant.
RESULTS: Age range was 40 to 86 years in males (mean = 43.36) and 45 to 70 years in females (mean = 56). HACF was identified in all cases studied in the non-tumorous colonic mucosa; ACF was observed as non-contiguous scattered foci, which supports the hypothesis of acquisition of single focus monoclonality by colonic epithelial cells in tumor generation. Twenty-four (32%) had DACF and were observed as closure to carcinoma foci. Intensity of Fhit expression: (1) HACF - 40% exhibited strong intensity, similar to normal, moderate in 36% and weak in 24%; (2) DACF - strong in 25%, moderate in 37.5% and weak in 37.5%; and (3) carcinoma - negative in 16%, strong in 43% and moderate and weak in 28.5% each. Significant difference was observed in intensity of the Fhit protein expressions by HACF and DACF (P < 0.05). Tumor in older patients showed a stronger Fhit intensity compared to younger patients (P = 0.036). Vegetarian diet intake and non-smokers showed stronger Fhit intensities. Advanced stage tumor, non-vegetarian diet and younger age was associated with loss of Fhit protein. Ki67 positivity was an extended crypt pattern in HACF and DACF showed extension up to the neck region of the crypts and surface epithelium. Carcinomas showed a marked increase in Ki67 expression (P < 0.05). Fhit protein had an inverse association with Ki67 expression.
CONCLUSION: Weaker Fhit intensity was associated with smoking, non-vegetarian diet intake and increasing Ki67 expression. Loss of Fhit protein expression is possibly influenced by environmental factors like smoking and non-vegetarian diet intake.
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Affiliation(s)
- Kim Vaiphei
- Kim Vaiphei, Aruna Rangan, Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Pin 160012, India
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49
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Maund E, Craig D, Suekarran S, Neilson A, Wright K, Brealey S, Dennis L, Goodchild L, Hanchard N, Rangan A, Richardson G, Robertson J, McDaid C. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16:1-264. [PMID: 22405512 DOI: 10.3310/hta16110] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Frozen shoulder is condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of treatments for primary frozen shoulder, identify the most appropriate intervention by stage of condition and highlight any gaps in the evidence. DATA SOURCES A systematic review was conducted. Nineteen databases and other sources including the Cumulative Index to Nursing and Allied Health (CINAHL), Science Citation Index, BIOSIS Previews and Database of Abstracts of Reviews of Effects (DARE) were searched up to March 2010 and EMBASE and MEDLINE up to January 2011, without language restrictions. MEDLINE, CINAHL and PsycINFO were searched in June 2010 for studies of patients' views about treatment. REVIEW METHODS Randomised controlled trials (RCTs) evaluating physical therapies, arthrographic distension, steroid injection, sodium hyaluronate injection, manipulation under anaesthesia, capsular release or watchful waiting, alone or in combination were eligible for inclusion. Patients with primary frozen shoulder (with or without diabetes) were included. Quasi-experimental studies were included in the absence of RCTs and case series for manipulation under anaesthesia (MUA) and capsular release only. Full economic evaluations meeting the intervention and population inclusion criteria of the clinical review were included. Two researchers independently screened studies for relevance based on the inclusion criteria. One reviewer extracted data and assessed study quality; this was checked by a second reviewer. The main outcomes of interest were pain, range of movement, function and disability, quality of life and adverse events. The analysis comprised a narrative synthesis and pair-wise meta-analysis. A mixed-treatment comparison (MTC) was also undertaken. An economic decision model was intended, but was found to be implausible because of a lack of available evidence. Resource use was estimated from clinical advisors and combined with quality-adjusted life-years obtained through mapping to present tentative cost-effectiveness results. RESULTS Thirty-one clinical effectiveness studies and one economic evaluation were included. The clinical effectiveness studies evaluated steroid injection, sodium hyaluronate, supervised neglect, physical therapy (mainly physiotherapy), acupuncture, MUA, distension and capsular release. Many of the studies identified were at high risk of bias. Because of variation in the interventions and comparators few studies could be pooled in a meta-analysis. Based on single RCTs, and for some outcomes only, short-wave diathermy may be more effective than home exercise. High-grade mobilisation may be more effective than low-grade mobilisation in a population in which most patients have already had treatment. Data from two RCTs showed that there may be benefit from adding a single intra-articular steroid injection to home exercise in patients with frozen shoulder of < 6 months' duration. The same two trials showed that there may be benefit from adding physiotherapy (including mobilisation) to a single steroid injection. Based on a network of nine studies the MTC found that steroid combined with physiotherapy was the only treatment showing a statistically and clinically significant beneficial treatment effect compared with placebo for short-term pain (standardised mean difference -1.58, 95% credible interval -2.96 to -0.42). This analysis was based on only a subset of the evidence, which may explain why the findings are only partly supportive of the main analysis. No studies of patients' views about the treatments were identified. Average costs ranged from £36.16 for unguided steroid injections to £2204 for capsular release. The findings of the mapping suggest a positive relationship between outcome and European Quality of Life-5 Dimensions (EQ-5D) score: a decreasing visual analogue scale score (less pain) was accompanied by an increasing (better) EQ-5D score. The one published economic evaluation suggested that low-grade mobilisation may be more cost-effective than high-grade mobilisation. Our tentative cost-effectiveness analysis suggested that steroid alone may be more cost-effective than steroid plus physiotherapy or physiotherapy alone. These results are very uncertain. LIMITATIONS The key limitation was the lack of data available. It was not possible to undertake the planned synthesis exploring the influence of stage of frozen shoulder or the presence of diabetes on treatment effect. As a result of study diversity and poor reporting of outcome data there were few instances where the planned quantitative synthesis was possible or appropriate. Most of the included studies had a small number of participants and may have been underpowered. The lack of available data made the development of a decision-analytic model implausible. We found little evidence on treatment related to stage of condition, treatment pathways, the impact on quality of life, associated resource use and no information on utilities. Without making a number of questionable assumptions modelling was not possible. CONCLUSIONS There was limited clinical evidence on the effectiveness of treatments for primary frozen shoulder. The economic evidence was so limited that no conclusions can be made about the cost-effectiveness of the different treatments. High-quality primary research is required.
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Affiliation(s)
- E Maund
- Centre for Reviews and Dissemination, University of York, York, UK
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50
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Abstract
A new stochastic model for the repair of radiation-induced cell damage based on enzyme kinetics is proposed. The model not only accounts for the depletion of enzyme level with successive repairs but also takes into account the synthesis of new enzymes in response to repairs. The cell survival probability is explicitly calculated, using which comparisons with related models are made.
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Affiliation(s)
- A. Rangan
- Dept. of Mathematics, Indian Institute of Technology, Madras 600 036, India
- Dept. of Cell Research and Immunology, Tel Aviv University, Ramat Aviv 69978, Tel Aviv, Israel
| | - V. Arunachalam
- Dept. of Cell Research and Immunology, Tel Aviv University, Ramat Aviv 69978, Tel Aviv, Israel
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