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Sanchez-Somonte P, Padala S, Kolominsky J, Gul E, Pillai A, Kron J, Shepard R, Kalahasty G, Tsang B, Khaykin Y, Pantano A, Koneru J, Ellenbogen K, Verma A. INTERMEDIATE TERM PERFORMANCE AND SAFETY OF LEFT BUNDLE BRANCH AREA CONDUCTION SYSTEM PACING LEADS: A MULTICENTER PROSPECTIVE STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.110] [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: 10/20/2022] Open
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Sanchez-Somonte P, Gul E, Terricabras M, Khaykin Y, Tsang B, Pantano A, Ellenbogen K, Padala S, Verma A. ELECTROCARDIOGRAPHIC CHARACTERISTICS WITH LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER PROSPECTIVE STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.109] [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: 11/28/2022] Open
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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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Lai K, Anantha RV, Fawcett V, Tsang B, Kim M, Widder S. Early predictors of discharge to home among severely injured geriatric patients: A single-system retrospective cohort study. Trauma 2021. [DOI: 10.1177/1460408620982261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Injured geriatric patients experience significant functional decline during their hospitalization, limiting their ability to be discharged home which is a valuable outcome among this vulnerable population. We therefore sought to evaluate the clinical characteristics of injured elderly patients managed within our trauma system and identify early predictors for discharge to home. Methods In this single-system retrospective cohort study, we evaluated significantly injured (Injury Severity Score ≥12) geriatric (age ≥65 y) patients admitted from Northern Alberta between 2011 and 2016. The primary outcome was discharge disposition to home. Data was analyzed with descriptive statistics, and univariable and multivariable logistic regression modelling. P values less than 0.05 were considered statistically significant. Results We identified 1548 patients with a median age of 77. Falls accounted for 47% of injuries with median injury severity score of 22; 47% of patients were discharged home with a median hospital length of stay of 8 days. All-cause in-hospital mortality was 19%. On multivariable regression, age, injury severity score, heart rate, systolic blood pressure, and Glasgow Coma Score were independent predictors for discharge home, as well as hospital and intensive care unit length of stay. Conclusion Nearly half of severely injured geriatric trauma patients were discharged home. The identified predictors provide clues to disposition on admission that trauma providers may use to guide in-hospital care planning, disposition planning, and stimulate early goals of care discussions.
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Affiliation(s)
- Krista Lai
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Ram V Anantha
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Vanessa Fawcett
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Bonnie Tsang
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Michael Kim
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
| | - Sandy Widder
- Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
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Clement E, Yoon J, Sutherland T, Tsang B, Fawcett V, Kim M, Widder S. Effect of a mindfulness intervention on patients admitted after multisystem trauma. Trauma 2020. [DOI: 10.1177/1460408619872593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The incidence of depression, anxiety, and post-traumatic stress disorders is reported to be as high as 50% in trauma patients. The perpetual negative emotions and state of mind in these disorders predisposes patients to negative mental health outcomes. Mindfulness, on the other hand, helps people to process their experience and emotions in a non-judgmental manner, and recently, there has been increased utilization of mindfulness-based therapies for the treatment of mental health conditions. This proof-of-concept study evaluates the use of a mindfulness-based online application in patients admitted to the trauma service at a Level 1 Trauma Centre. Methods Trauma patients who were English speaking, over the age of 18, and without brain injury or pre-existing neurocognitive disorder were included. Participants completed the Depression Anxiety Stress Scale (DASS)-21 to assess level of depression, anxiety, and stress, and the Connor-Davidson Resilience Scale (CD-RISC) to assess level of resiliency. Then, after 28 consecutive days of practicing mindfulness using the app ‘Stop, Breathe, and Think,’ the questionnaires were repeated and an exit survey conducted. Results For this study, 13 participants were enrolled, 2 withdrew, and 5 were lost to follow-up. The mean DASS-21 score at time enrollment was 16.4 and was 11.2 at follow-up ( p = 0.10). There were no differences between the level of depression and stress from enrollment to follow-up, but there was significant decrease in anxiety symptoms from 7.2 to 3.0 (<0.05). CD-RISC scores at enrollment and follow-up were 77.8 and 81 ( p = 0.23), respectively. At the time of exit interview, 67% of patients continued to use the application three to four times a week and 67% responded they plan to continue using the application. In addition, 83% of patients always or often felt better after practicing mindfulness and stated they would recommend the application to others. Conclusions Mindfulness shows promising potential to decrease psychological distress in trauma patients.
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Affiliation(s)
- Elizabeth Clement
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Jenny Yoon
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Tala Sutherland
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Bonnie Tsang
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Vanessa Fawcett
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Michael Kim
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Sandy Widder
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
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Verhoeff K, Saybel R, Fawcett V, Tsang B, Mathura P, Widder S. A quality-improvement approach to effective trauma team activation. Can J Surg 2020; 62:305-314. [PMID: 31364348 DOI: 10.1503/cjs.000218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines. Methods Quality-improvement action followed a well-defined process. Baseline data collection was performed, and, in keeping with the Donabedian approach, we brought together stakeholders to collectively review and understand the reasons
behind poor TTA compliance; and root-cause analysis. This was followed by rapid change cycles that focused on structure and processes with ongoing audits to support and sustain change. Results Trauma team activation compliance improved from 58.8% to more than 90% over 2 years. Quality indicators showed a statistically significant reduction in the time to computed tomography scanner, time in the acute care region of the emergency department and total time in the emergency department, with improved TTA compliance. Conclusion Compliance with TTA protocols improved to more than 90% over a 2-year period, which shows the benefit of having a clearly outlined qualityimprovement process. This well-defined quality-improvement method provides a framework for use by other institutions that seek to improve their processes of trauma care, including activation rates.
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Affiliation(s)
- Kevin Verhoeff
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Rachelle Saybel
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Vanessa Fawcett
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Bonnie Tsang
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Pamela Mathura
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
| | - Sandy Widder
- From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura)
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Lester E, Dykstra M, Grant C, Fawcett V, Tsang B, Widder S. High-risk medications in older patients with trauma: a cross-sectional study of risk mitigation. Can J Surg 2019; 62:100-104. [PMID: 30907565 DOI: 10.1503/cjs.017117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The Beers Criteria for Potentially Inappropriate Medication Use inOlder Adults is a framework that can assess the nature of high-risk medication use. The objective of this study was to use the Beers Criteria to assess the prevalence and nature of polypharmacy, the magnitude of medication changes during the hospital stay and the impact of Beers Criteria medications on outcomes in older patients with trauma. Methods We used the Alberta Trauma Registry to conduct a retrospective review of patients aged 65 years or older with major trauma (Injury Severity Score ≥ 12) who were admitted to a level 1 trauma centre between January 2013 and December 2014. We analyzed changes in medication prescriptions during the hospital stay using descriptive statistics and assessed the association between Beers Criteria medications and relevant outcomes using multivariable regression analysis. Results There was no significant change in the number of Beers Criteria medications prescribed before and after admission. The adjusted odds ratio for 30-day mortality for each additional Beers Criteria medication prescribed was 2.02 (95% confidence interval [CI] 1.16–3.51) versus 1.24 (95% CI 1.04–1.59) for each additional medication of any type. The corresponding adjusted incidence rate ratios for length of stay were 1.15 (95% CI 1.03–1.30) versus 1.05 (95% CI 1.01–1.10). Conclusion Beers Criteria medications were not discontinued during trauma admissions. Using the Beers Criteria as a process indicator for quality improvement in trauma care may provide interdisciplinary trauma teams an opportunity to audit patient medications and stop potentially harmful medications in a vulnerable population.
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Affiliation(s)
- Erica Lester
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - Mark Dykstra
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - Chantalle Grant
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - Vanessa Fawcett
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - Bonnie Tsang
- From the Department of Surgery, University of Alberta, Edmonton, Alta
| | - Sandy Widder
- From the Department of Surgery, University of Alberta, Edmonton, Alta
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Nasralla A, Tsang B. Unusual osseous metaplasia following hernia repair with Prolene mesh: a case report. J Surg Case Rep 2019; 2019:rjz251. [PMID: 31636884 PMCID: PMC6796178 DOI: 10.1093/jscr/rjz251] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/02/2019] [Indexed: 11/14/2022] Open
Abstract
The use of Prolene mesh for repair of various hernias is very common. As with any surgical procedure, it can be associated with complications such as seroma, hematoma and wound infection. However, it is uncommon to develop heterotopic ossification following incisional hernia repair with Prolene mesh. Herein, we report a case with chronic abdominal pain secondary to heterotopic ossification occurring after incisional hernia repair with Prolene mesh. It is crucial to report uncommon reactions to the mesh in order to aid in diagnosis of unexplained abdominal pain post hernia repair, after common etiologies are ruled out.
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Affiliation(s)
- Awrad Nasralla
- Division of General Surgery, Department of Surgery, University of Alberta, Canada
| | - Bonnie Tsang
- Division of General Surgery, Department of Surgery, University of Alberta, Canada
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Mador B, Fuselli P, Choudhary D, Bokhari F, Tanenbaum B, Tze N, Wong TH, Grant I, Sahi S, Tanenbaum B, Figueira S, Knight H, Grant I, Beno S, Moore L, Macpherson A, Laverty C, Watson I, Watson I, Laverty C, Bérubé M, Cowan S, Homer K, Bouderba S, Soltana K, Fransblow L, Fransblow L, Bérubé M, Gonthier C, Bryson A, Bokhari F, Rados A, Courval V, Masales C, Trust MD, Hogan J, Warriner Z, Lalande A, Chung D, Tanenbaun B, Kuper T, Mckee J, Bratu I, Makish A, Versolatto A, Ramagnano S, Mehrnoush V, Kang D, Moore L, Schellenberg M, LeBreton M, Javidan AP, Schwartz G, Doucet J, Cunningham A, Clarke R, Paradis T, Beamish I, Hilsden R, Raizman I, Green R, Green R, Green R, Esmail R, Moon J(J, Cheng V, Brisson A, Beno S, Heck C, Koeck E, Schneider P, Bal C, Ko YM(D, Martinez M, Kim D, Tierney J, Emigh B, Lie J, Tierney J, MacLean A, Milton L, Bradley N, Kim M, White J, Harris I, Tekian A, Babul S, Cowle S, Turcotte K, Dhillon R, Chadha K, Fu CY, Bajan F, Welsh S, Kaminsky M, Dennis A, Starr F, Butler C, Messer T, Poulakidas S, Ramagnano S, Grushka J, Beckett A, Filteau C, Larocque J, Nadkarni N, Chua WC, Loo L, Ang ASH, Iau PTC, Goo JTT, Chan KC, Adam TN, Seow DCC, Ng YS, Malhotra R, Chan AWM, Matchar DB, Van Nguyen H, Ong MEH, Lampron J, Bougie A, Brown C, Patel A, Edwards L, Spitz K, Ramagnano S, Lampron J, Nucete M, Lindsey S, Lampron J, Figueira S, Matar M, Michael D, Rosenfield D, Harvey G, Jessa K, Tardif PA, Mercier E, Berthelot S, Lecky F, Cameron P, Archambault P, Tien H, Beckett A, Nathens A, Luz LTD, Benjamin S, Chisholm A, Benjamin S, Chisholm A, Tien H, Beckett A, Nathens A, Luz LTD, Pasquotti T, Klassen B, Brisson A, Tze N, Fawcett V, Tsang B, Kabaroff A, Verhoeff K, Turner S, Kim M, Widder S, Fung C, Widder S, Kim M, Moore L, Lecky F, Lawrence T, Soltana K, Mansour T, Moore L, Bouderba S, Turgeon A, Krouchev R, Mercier E, Friedman D, Souranis A, Slapcoff L, Friedman D, Fakir MB, Turcotte V, Valiquette MP, Bernard F, Giroux M, Côté MÈ, Gagné A, Dollé S, Gélinas C, Belcaïd A, Truchon C, Moore L, Clément J, Pelletier LP, Ivkov V, Gamble K, Constable L, Haegert J, Bajani F, Fu CY, Welsh S, Kaminsky M, Dennis A, Starr F, Messer T, Butler C, Tatebe L, Poulakidas S, Thauvette D, Engels P, Klassen B, Coates A, De Silva S, Schellenberg M, Biswas S, Inaba K, Cheng V, Warriner Z, Love B, Demetriades D, Schellenberg M, Inaba K, Trust MD, Love B, Cheng V, Strumwasser A, Demetriades D, Joos E, Dawe P, Hameed M, Evans D, Garraway N, Gawaziuk J, Cristall N, Logsetty S, Ramagnano S, Federman N, Murphy P, Parry N, Leeper R, McBeth P, Wachs J, Hamilton D, Ball C, Gillman L, Kirkpatrick A, Dulai S, Falconer C, McLachlin M, Armstrong A, Parry N, Vogt K, Shi Q, Coates A, Engels P, Rice T, Nathens A, Naidu D, Brubacher J, Chan H, Erdelyi S, Kubasiak J, Bokhari F, Kaminsky M, Lauzier F, Tardif PA, Lamontagne F, Chassé M, Stelfox HT, Kortbeek J, Lessard-Bonaventure P, Truchon C, Turgeon A, Cheng V, Inaba K, Foran C, Warriner Z, Trust MD, Clark D, Demetriades D, Levesque K, Lampron J, Nathens A, Tien H, Luz LTD, Jing R, McFarlan A, Liu M, Sander B, Fowler R, Rizoli S, Ferrada P, Murthi S, Nirula R, Edwards S, Cantrell E, Han J, Haase D, Singleton A, Birkas Y, Casola G, Coimbra R, Condron M, Schreiber M, Azarow K, Hamilton N, Long W, Maxwell B, Jafri M, Whitman L, Wilson H, Wong H, Grushka J, Razek T, Fata P, Deckelbaum D, Kawaja K, Beckett A, Razek T, Deckelbaum D, Grushka J, Fata P, Beckett A, Lund M, Leeper R, Conn LG, Strauss R, Haas B, Beckett A, Nathens A, Tien H, Callum J, Luz LTD, Higgins S, Coles J, Erdogan M, Coles J, Higgins S, Erdogan M, Erdogan M, Kureshi N, Fenerty L, Thibault-Halman G, Walling S, Clarke DB, Vis C, Nosworthy S, Razek T, Boulanger N, Deckelbaum D, Grushka J, Fata P, Beckett A, Khwaja K, Schellenberg M, Inaba K, Warriner Z, Trust MD, Matsushima K, Lam L, Demetriades D, Lakha N, Wong H, McLauchlin L, Ashe CS, Logie SA, Lenton-Brym T, Rosenfield D, McDowall D, Wales P, Principi T, Mis J, Kaminsky M, Bokhari F, Rahbar E, Cotton B, Bryan P, MacGillivray S, Thompson G, Wishart I, Hameed M, Joos E, Evans D, Garraway N, Dawe P, Wild J, Widom K, Torres D, Blansfield J, Shabahang M, Dove J, Fluck M, Hameed M, Roux L, Nicol A, Schulenberg L, Fredericks C, Messer T, Starr F, Dennis A, Bokhari F, Kaminsky M, Teixeira P, Coopwood B, Aydelotte J, Cardenas T, Ali S, Brown C, Dawe P, Fredericks C, Matta LD, Messer T, Starr F, Dennis A, Kaminsky M, Bokhari F, Jiang HY, Yoon J, Kim M, Widder S, Hameed M, Wray C, Agarwal A, Harvin J. 2019 Trauma Association of Canada Annual Scientific Meeting Abstracts. Can J Surg 2019; 62:S3-S35. [PMID: 31091053 DOI: 10.1503/cjs.008619] [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: 11/01/2022] Open
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Abstract
Introduction The oil and gas industry employs approximately 390,000 people in Canada and these workers are often exposed to substantial workplace risks. Trauma centres treat a significant number of industry-related injuries; however, studies characterizing these traumatic events are lacking. Methods A retrospective study was conducted of workers in the oil and gas industry admitted to major trauma centres in Edmonton, Alberta from January 2009 to December 2014. Patients were identified from Alberta Trauma Registry and Worker's Compensation Board data. Inclusion criteria were: age ≥16 years, trauma occurring in the oil and gas industry, and Injury Severity Score (ISS) ≥ 12 or Modified Abbreviated Injury Scale (MAIS) ≥ 3. Descriptive analysis and cost estimation were performed. Results There were 182 major traumas occurring primarily in young males. Blunt trauma was the primary mechanism (90.1%), and alcohol levels were positive in 4.8% of patients. The overall complication rate was 32.4% with a mortality rate of 6%. The majority of patients were discharged home (64.3%), however a large proportion (29.7%) required further care at another facility post-acute care. The median days missed from work were 85 (IQR 7–214.5). Total cost of injury from the societal perspective ranged from $109 965 to $332 098 USD per person. Conclusion Oil and gas industry trauma has a high economic and societal cost. Strategies to prevent injuries in this field should be undertaken including promotion and support of drug-free programmes given the rate of positive alcohol screening in this population.
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Affiliation(s)
- Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Erica Lester
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Warren Sun
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vanessa Fawcett
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Sandy Widder
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Bonnie Tsang
- Department of Surgery, University of Alberta, Edmonton, Canada
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Clement E, Tsang B, Fawcett VJ, Kim MJ, Widder S. Mindfulness as an Intervention in Patients Admitted after Multisystem Trauma. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Verhoeff K, Glen P, Taheri A, Min B, Tsang B, Fawcett V, Widder S. Implementation and adoption of advanced care planning in the elderly trauma patient. World J Emerg Surg 2018; 13:40. [PMID: 30202429 PMCID: PMC6127940 DOI: 10.1186/s13017-018-0201-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Geriatric trauma has high morbidity and mortality, often requiring extensive hospital stays and interventions. The number of geriatric trauma patients is also increasing significantly and accounts for a large proportion of trauma care. Specific geriatric trauma protocols exist to improve care for this complex patient population, who often have various comorbidities, pre-existing medications, and extensive injury within a trauma perspective. These guidelines for geriatric trauma care often suggest early advanced care planning (ACP) discussions and documentation to guide patient and family-centered care. Methods A provincial ACP program was implemented in April of 2012, which has since been used by our level 1 trauma center. We applied a before and after study design to assess the documentation of goals of care in elderly trauma patients following implementation of the standardized provincial ACP tool on April 1, 2012. Results Documentation of ACP in elderly major trauma patients following the implementation of this tool increased significantly from 16 to 35%. Additionally, secondary outcomes demonstrated that many more patients received goals of care documentation within 24 h of admission, and 93% of patients had goals of care documented prior to intensive care unit (ICU) admission. The number of trauma patients that were admitted to the ICU also decreased from 17 to 5%. Conclusion Early advanced care planning is crucial for geriatric trauma patients to improve patient and family-centered care. Here, we have outlined our approach with modest improvements in goals of care documentation for our geriatric population at a level 1 trauma center. We also outline the benefits and drawbacks of this approach and identify the areas for improvement to support improved patient-centered care for the injured geriatric patient. Here, we have provided a framework for others to implement and further develop. Electronic supplementary material The online version of this article (10.1186/s13017-018-0201-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Verhoeff
- 1Faculty of Medicine and Dentistry, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - P Glen
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - A Taheri
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - B Min
- 1Faculty of Medicine and Dentistry, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - B Tsang
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - V Fawcett
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
| | - S Widder
- 2Department of Surgery, 2D4.27 Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St. Edmonton, Edmonton, Alberta T6G 2B7 Canada
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Swayne A, Tjoa L, Broadley S, Dionisio S, Gillis D, Jacobson L, Woodhall MR, McNabb A, Schweitzer D, Tsang B, Vincent A, Irani SR, Wong R, Waters P, Blum S. Antiglycine receptor antibody related disease: a case series and literature review. Eur J Neurol 2018; 25:1290-1298. [PMID: 29904974 PMCID: PMC6282944 DOI: 10.1111/ene.13721] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies to glycine receptors (GlyR-Abs) were first defined in progressive encephalopathy with rigidity and myoclonus (PERM) but were subsequently identified in other clinical presentations. Our aim was to assess the clinical associations of all patients identified with GlyR-Abs in Queensland, Australia, between April 2014 and May 2017 and to compare these to cases reported in the literature. METHODS A literature review identified the clinical features of all published GlyR-Ab-positive cases through online databases. A case series was undertaken via collection of clinical information from all patients diagnosed or known to immunology, pathology or neurological services in Queensland during the study period of 3 years. RESULTS In all, 187 GlyR-Ab-positive cases were identified in the literature. The majority (47.6%) had PERM, 22.4% had epilepsy, but the remaining 30% included mixed phenotypes consisting of cerebellar ataxia, movement disorders, demyelination and encephalitis/cognitive dysfunction. By contrast, in our series of 14 cases, eight had clinical presentations consistent with seizures and epilepsy and only three cases had classical features of PERM. There was one case each of global fatiguable weakness with sustained clonus, laryngeal dystonia and movement disorder with hemiballismus and tics. The rate of response to immune therapy was similar in all groups. CONCLUSION Antibodies to glycine receptors are linked to a spectrum of neurological disease. The results of the literature review and our case series suggest a greater relationship between GlyR-Abs and epilepsy than previously reported.
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Affiliation(s)
- A Swayne
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,School of Medicine, University of Queensland, Herston, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - L Tjoa
- Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - S Broadley
- Gold Coast University Hospital, Griffith University Medical School, Griffith University, QLD, Australia
| | - S Dionisio
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - D Gillis
- Pathology Queensland, Brisbane, QLD, Australia.,Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - L Jacobson
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M R Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A McNabb
- Cairns Base Hospital, Cairns, QLD, Australia
| | - D Schweitzer
- Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - B Tsang
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - A Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - S R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - R Wong
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,Pathology Queensland, Brisbane, QLD, Australia
| | - P Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - S Blum
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,School of Medicine, University of Queensland, Herston, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
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Verhoeff K, Saybel R, Mathura P, Tsang B, Fawcett V, Widder S. Ensuring adequate vascular access in patients with major trauma: a quality improvement initiative. BMJ Open Qual 2018; 7:e000090. [PMID: 29333494 PMCID: PMC5759737 DOI: 10.1136/bmjoq-2017-000090] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 11/04/2022] Open
Abstract
Ensuring adequate vascular access in major trauma patients prior to decompensative physiological processes is crucial to patient outcomes. Most protocols suggest achieving two 18-gauge or larger intravenous lines immediately in patients with major trauma. We discuss a quality improvement approach to ensure that >90% of patients with major trauma (as defined by an injury severity score ≥12) at a level one trauma centre receive timely and adequate fluid access. Applying Donabedian principles for process improvement, we used the Alberta Trauma Registry to perform a 4-month chart audit on patients with major trauma at the University of Alberta Hospital. Background data were supported with a formal root cause analysis to outline the problems and generate plan, do, study and act (PDSA) rapid change cycles. These PDSA cycles were then implemented over the course of 2 months to alter system and personnel barriers to care, thereby ensuring that patients with major trauma received adequate vascular access for fluid resuscitation. This was followed by a 6-month sustainability assessment. The percentage of patients with major trauma who received adequate fluid access went from a mean of 55.5% to >90% in 2 months and was sustained at or greater than 90% for 6 consecutive months. The formal application of quality improvement processes is uncommon in trauma care but is much needed to ensure success and sustainability of quality initiatives. Planning including engagement and prechange awareness is crucial to staff engagement, change, and sustainment. Formal quality improvement and change management techniques can elicit rapid and sustainable changes in trauma care. We provide a framework for change to increase compliance with fluid access in patients with major trauma.
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Affiliation(s)
- Kevin Verhoeff
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachelle Saybel
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bonnie Tsang
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vanessa Fawcett
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sandy Widder
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Morrison RJM, Tsang B, Fishley W, Harper I, Joseph JC, Reed MR. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res 2017; 6:499-505. [PMID: 28851694 PMCID: PMC5579309 DOI: 10.1302/2046-3758.68.bjr-2017-0005.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 01/11/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022] Open
Abstract
Objectives We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. Methods We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates. Results A total of 1914 THA and 2537 TKA procedures were evaluated. In THA, the higher dose of TXA was associated with a significant reduction in transfusion (p = 0.02, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.58 to 0.96) and rate of re-admission (p < 0.001, RR 0.50, 95% CI 0.35 to 0.71). There were reductions in the requirement for critical care (p = 0.06, RR 0.55, 95% CI 0.31 to 1.00), and in the length of stay from 4.7 to 4.3 days (p = 0.02). In TKA, transfusion requirements (p = 0.049, RR 0.64, 95% CI 0.41 to 0.99), re-admission rate (p = 0.001, RR 0.56, 95% CI 0.39 to 0.80) and critical care requirements (p < 0.003, RR 0.34, 95% CI 0.16 to 0.72) were reduced with the higher dose. Mean length of stay reduced from 4.6 days to 3.6 days (p < 0.01). There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, gastrointestinal bleed, myocardial infarction, stroke or death in THA and TKA between cohorts. Conclusion We suggest that a single pre-operative dose of TXA, 30 mg/kg, maximum 2.5g, results in a lower transfusion requirement compared with a lower dose in patients undergoing elective primary hip and knee arthroplasty. However, these findings should be interpreted in the context of the retrospective non-randomised study design. Cite this article: R. J. M. Morrison, B. Tsang, W. Fishley, I. Harper, J. C. Joseph, M. R. Reed. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res 2017;6:499–505. DOI: 10.1302/2046-3758.68.BJR-2017-0005.R1.
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Affiliation(s)
- R J M Morrison
- Trauma & Orthopaedics Department, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - B Tsang
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - W Fishley
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - I Harper
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - J C Joseph
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
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Stothers L, Tsang B, Nigro M, Lazare D, Macnab A. An integrative review of standardized clinical evaluation tool utilization in anticholinergic drug trials for neurogenic lower urinary tract dysfunction. Spinal Cord 2016; 54:1114-1120. [PMID: 27241452 PMCID: PMC5308214 DOI: 10.1038/sc.2016.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN To review prospective and randomized trials studying anticholinergic therapy for neurogenic bladder in SCI to identify whether trials included standardized clinical evaluation tools and reporting measures now recognized to enhance clinical trial data. METHODS A systematic search via EMBASE, MEDLINE, CENTRAL, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HTA (Health Technology Assessment), CMR (Comprehensive Microbial Resource), HAPI (Health and Psychosocial Instruments) and PsycINFO using the key term spinal cord injury crossed with oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, trospium chloride, propiverine, propantheline and anticholinergic(s) for 1946-2015 inclusive. We then collated whether standardized clinical tools, measures and descriptors were used within each study identified: American Spine Injury Association (ASIA) impairment scale; symptom scores validated in SCI; technical methodology for urodynamics/video urodynamics; urinary diaries; and standardized urologic terminology. RESULTS A total of 1225 entries with 610 unique articles were identified, 14 randomized and 16 prospective studies. In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. Classification using the ASIA impairment scale was used in <10% of studies; none used symptom scores validated in SCI; <50% reported urodynamic test methodology fully, incorporated urinary diaries or used International Continence Society Standardization Subcommittee urinary tract terminology. CONCLUSION Integrative review of trials from 1946 to 2015 identified infrequent use of standardized clinical evaluation tools and reporting measures. Data from future trials evaluating therapies for neurogenic bladder would likely be more applicable to specific SCI patients if current standardized classification and descriptors now available were used consistently: for example, the ASIA scale, symptom scores validated in SCI, standardized urodynamic methodology, urinary diaries and urinary tract terminology. Studies recruiting SCI patients exclusively would also provide additional benefit.
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Affiliation(s)
- L Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Associate Member Department of Obstetrics and Gynaecology and School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - B Tsang
- St Andrews University, Fife, Scotland, UK
| | - M Nigro
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - A Macnab
- Department of Urologic Sciences and Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Virani S, Sharma V, McCann M, Koehler J, Tsang B, Zieroth S. INTEGRATED DIAGNOSTICS FOR HEART FAILURE: THE TRIAGE-HF STUDY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.227] [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: 10/20/2022] Open
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18
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Virani S, Sharma V, McCann M, Koehler J, Tsang B, Zieroth S. TRIAGE HF STUDY: SYMPTOMS AND DEVICE PARAMETERS ASSOCIATED WITH HIGH HEART FAILURE RISK STATUS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.276] [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: 11/25/2022] Open
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19
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Kochhaeuser S, Dechering D, Trough K, Hache P, Haig-Carter T, Khaykin Y, Wulffhart Z, Pantano A, Tsang B, Eckardt L, Verma A. PROGRESSION OF PAROXYSMAL TO PERSISTENT AF IN PATIENTS AWAITING AF ABLATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.468] [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: 10/22/2022] Open
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20
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Tsang B, Stothers L, Macnab A, Lazare D, Nigro M. A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder. Neurourol Urodyn 2015; 35:354-64. [PMID: 25620137 DOI: 10.1002/nau.22720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/26/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Abstract
AIMS Validated questionnaires are increasingly the preferred method used to obtain historical information. Specialized questionnaires exist validated for patients with neurogenic disease including neurogenic bladder. Those currently available are systematically reviewed and their potential for clinical and research use are described. METHODS A systematic search via Medline and PubMed using the key terms questionnaire(s) crossed with Multiple Sclerosis (MS) and Spinal Cord Injury (SCI) for the years 1946 to January 22, 2014 inclusive. Additional articles were selected from review of references in the publications identified. Only peer reviewed articles published in English were included. RESULTS 18 questionnaires exist validated for patients with neurogenic bladder; 14 related to MS, 3 for SCI, and 1 for neurogenic bladder in general; with 4 cross-validated in both MS and SCI. All 18 are validated for both male and female patients; 59% are available only in English. The domains of psychological impact and physical function are represented in 71% and 76% of questionnaires, respectively. None for the female population included elements to measure symptoms of prolapse. CONCLUSION The last decade has seen an expansion of validated questionnaires to document bladder symptoms in neurogenic disease. Disease specific instruments are available for incorporation into the clinical setting for MS and SCI patients with neurogenic bladder. The availability of caregiver and interview options enhances suitability in clinical practice as they can be adapted to various extents of disability. Future developments should include expanded language validation to the top 10 global languages reported by the World Health Organization.
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Affiliation(s)
- B Tsang
- St. Andrews University, United Kingdom
| | - L Stothers
- Department of Urological Sciences, University of British Columbia
| | - A Macnab
- Department of Urological Sciences, University of British Columbia
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia
| | - M Nigro
- Department of Urological Sciences, University of British Columbia
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Proietti R, Essebag V, Beardsall J, Hache P, Pantano A, Wulffhart Z, Juta R, Tsang B, Joza J, Nascimento T, Pegoraro V, Khaykin Y, Verma A. Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome. Europace 2014; 17:461-7. [DOI: 10.1093/europace/euu326] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gregorio B, Beardsall M, Gallagher L, McNamara M, Tsang B. CASE ROUNDS: AN INTERDISCIPLINARY PATIENT QUALITY AND SAFETY INITIATIVE. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.700] [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: 11/27/2022] Open
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Tsang B, McKee J, Engels PT, Paton-Gay D, Widder SL. Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting. World J Emerg Surg 2013; 8:39. [PMID: 24088362 PMCID: PMC3851478 DOI: 10.1186/1749-7922-8-39] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/27/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Advanced Trauma Life Support (ATLS) protocols provide a common approach for trauma resuscitations. This was a quality review assessing compliance with ATLS protocols at a Level I trauma center; specifically whether the presence or absence of a trauma team leader (TTL) influenced adherence. METHODS This retrospective study was conducted on adult major trauma patients with acute injuries over a one-year period in a Level I Canadian trauma center. Data were collected from the Alberta Trauma Registry, and adherence to ATLS protocols was determined by chart review. RESULTS The study identified 508 patients with a mean Injury Severity Score of 24.5 (SD 10.7), mean age 39.7 (SD 17.6), 73.8% were male and 91.9% were involved in blunt trauma. The overall compliance rate was 81.8% for primary survey and 75% for secondary survey. The TTL group compared to non-TTL group was more likely to complete the primary survey (90.9% vs. 81.8%, p = 0.003), and the secondary survey (100% vs. 75%, p = 0.004). The TTL group was more likely than the non-TTL group to complete the following tasks: insertion of two large bore IVs (68.2% vs. 57.7%, p = 0.014), digital rectal exam (64.6% vs. 54.7%, p = 0.023), and head to toe exam (77% vs. 67.1%, p = 0.013). Mean times from emergency department arrival to diagnostic imaging were also significantly shorter in the TTL group compared to the non-TTL group, including times to pelvis xray (mean 68min vs. 107min, p = 0.007), CT chest (mean 133min vs. 172min, p = 0.005), and CT abdomen and pelvis (mean 136min vs. 173min, p = 0.013). Readmission rates were not significantly different between the TTL and non-TTL groups (3.5% vs. 4.5%, p = 0.642). CONCLUSIONS While many studies have demonstrated the effectiveness of trauma systems on outcomes, few have explored the direct influence of the TTL on ATLS compliance. This study demonstrated that TTL involvement during resuscitations was associated with improved adherence to ATLS protocols, and increased efficiency (compared to non TTL involvement) to diagnostic imaging. Findings from this study will guide future quality improvement and education for early trauma management.
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Affiliation(s)
- Bonnie Tsang
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D WMC, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada
| | - Jessica McKee
- Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Paul T Engels
- Department of Surgery and Division of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Damian Paton-Gay
- Department of Surgery and Division of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sandy L Widder
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D WMC, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada
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Kao R, Rajagopalan A, Beckett A, Beckett A, Rex R, Shah S, Waddell J, Boitano M, Faidi S, Babatunde O, Lawson F, Grant A, Sudarshan M, Sudarshan M, Takashashi M, Waggott M, Lampron J, Post A, Beale E, Bobrovitz N, Zakrison T, Smith A, Bawazeer M, Evans C, Leeper T, Kagedan D, Grenier T, Rezendo-Neto J, Roberts D, Roberts D, Stark P, Berg R, Mehta S, Gardner P, Moore L, Vassilyadi M, Moore L, Moore L, Hoshizaki B, Rezende-Neto J, Slaba I, Ramesh A, Grigorovich A, Parry N, Pajak C, Rosenbloom B, Grunfeld A, van Heest R, Fernandes J, Doucet J, Schooler S, Ali J, Klassen B, Santana M, McFarlan A, Ball C, Blackmore C, Rezende-Neto J, Kidane B, Hicks C, Brennan M, Brennan M, Harrington A, Sorvari A, Stewart TC, Biegler N, Chaubey V, Tsang B, Benjamin S, Hogan A, Fraser J, Martin M, Bridge J, Faidi S, Waligora M, Hsiao M, Sharma S, Sankarankutty A, Mckee J, Mckee J, Mckee J, Snider C, Szpakowski J, Brown R, Shah S, Shiu M, Chen M, Bell N, Besserer F, Bell N, Trudeau MO, Alhabboubi M, Rezende-Neto J, Rizoli S, Hill A, Joseph B, Lawless B, Jiao X, Xenocostas A, Rui T, Parry N, Driman D, Martin C, Stewart TC, Walsh J, Parry N, Merritt N, Elster E, Tien H, Phillips L, Bratu I, Nascimento B, Pinto R, Callum J, Tien H, Rizoli S, McMullan J, McGlasson R, Mahomed N, Flannery J, Bir C, Baillie F, Coates A, Asiri S, Foster P, Baillie F, Bhandari M, Phillips L, Bratu I, Schuurman N, Oliver L, Nathens A, Yazdani A, Alhabboubi M, St. Louis E, Tan X, Fata P, Deckelbaum D, Chughtai T, Razek T, Khwaja K, St. Louis E, Alhabboubi M, Tan X, Fata P, Deckelbaum D, Chughtai T, Razek T, Khwaja K, Takada M, Sawano M, Ito H, Tsutsumi H, Keenan A, Waggott M, Hoshizaki B, Brien S, Gilchrist M, Janis J, Phelan H, Minei J, Santana M, Stelfox H, McCredie V, Leung E, Garcia G, Rizoli S, Nathens A, Dixon E, Niven D, Kirkpatrick A, Feliciano D, D’Amours S, Ball C, Ahmed N, Izadi H, McFarlan A, Nathens A, Pavenski K, Nathens A, Bridge J, Tallon J, Leeper W, Vogt K, Stewart TC, Gray D, Parry N, Ameer A, Alhabboubi M, Alzaid S, Deckelbaum D, Fata P, Khwaja K, Razek T, Deckelbaum D, Drudi L, Boulva K, Rodrigue N, Khwaja K, Chughtai T, Fata P, Razek T, Rizoli S, Carreiro P, Lisboa T, Winter P, Ribeiro E, Cunha-Melo J, Andrade M, Zygun D, Grendar J, Ball C, Robertson H, Ouellet JF, Cheatham M, Kirkpatrick A, Ball C, Ouellet JF, McBeth P, Kirkpatrick A, Dixon E, Groff P, Inaba K, Okoye O, Pasley J, Demetriades D, Al-Harthi F, Cheng A, Lalani A, Mikrogianakis A, Cayne S, Knittel-Keren D, Gomez M, Stelfox H, Turgeon A, Lapointe J, Bourgeois G, Karton C, Rousseau P, Hoshizaki B, Stelfox H, Turgeon A, Bourgeois G, Lapointe J, Stelfox H, Turgeon A, Bourgeois G, Lapointe J, Rousseau P, Braga B, Faleiro R, Magaldi M, Cardoso G, Lozada W, Duarte L, Rizoli S, Ball C, Oddone-Paolucci E, Doig C, Kortbeek J, Gomez M, Fish J, Leach L, Leelapattana P, Fleming J, Bailey C, Nolan B, DeMestral C, McFarlan A, Zakirova R, Nathens A, Dabbs J, Duff D, Michalak A, Mitchell L, Nathens A, Singh M, Topolovec-Vranic J, Tymianski D, Yetman L, Canzian S, MacPhail I, Constable L, van Heest R, Tam A, Mahadevan P, Kim D, Bansal V, Casola G, Coimbra R, Gladwin C, Misra M, Kumar S, Gautam S, Sorvari A, Blackwood B, Coates A, Baillie F, Stelfox H, Nathens A, Wong C, Straus S, Haas B, Lenartowicz M, Parkovnick M, Parry N, Inaba K, Dixon E, Salim A, Pasley J, Kirkpatrick A, Ouellet JF, Niven D, Kirkpatrick A, Ball C, Neto C, Nogueira G, Fernandes M, Almeida T, de Abreu EMS, Rizoli S, Abrantes W, Taranto V, Parry N, Forbes T, Knight H, Keenan A, Yoxon H, Macpherson A, Bridge J, Topolovec-Vranic J, Mauceri J, Butorac E, Ahmed N, Holmes J, Gilliland J, Healy M, Tanner D, Polgar D, Fraser D, McBeth P, Crawford I, Tiruta C, Ball C, Kirkpatrick A, Roberts D, Ferri M, Bobrovitz N, Khandwala F, Stelfox H, Widder S, Mckee J, Hogan A, Benjamin S, Atkinson P, Benjamin S, Watson I, Hogan A, Benjamin S, Woodford S, Jaramillo DG, Nathens A, Alonazi N, Coates A, Baillie F, Zhang C, McFarlan A, Sorvari A, Chalklin K, Canzian S, Nathens A, DeMestral C, Hill A, Langer J, Nascimento B, Alababtain I, Fung SY, Passos E, Luz L, Brnjac E, Pinto R, Rizoli S, Widder S, Widder S, Widder S, Nathens A, Van Heest R, Constable L, Mancini F, Heidary B, Bell N, Appleton L, Hennecke P, Taunton J, Khwaja K, O’Connor M, Hameed M, Garraway N, Simons R, Evans D, Taulu T, Quinn L, Kuipers D, Rizoli S, Rogers C, Geerts W, Rhind S, Rizoli S, George K, Quinn L, Babcock C, Hameed M, Simons R, Caron N, Hameed M, Simons R, Prévost F, Razek T, Khwaja K, Sudarshan M, Razek T, Fata P, Deckelbaum D, Khwaja K, de Abreu EMS, Neto C, Almeida T, Pastore M, Taranto V, Fernandes M, Rizoli S, Nascimento B, Sankarankutty A, Pinto R, Callum J, Tremblay L, Tien H, Fowler R, Pinto R, Nathens A, Sadoun M, Harris J, Friese R, Kulvantunyou N, O’Keeffe T, Wynne J, Tang A, Green D, Rhee P, Trpkovski J, Blount V. Trauma Association of Canada Annual Scientific Meeting abstractsErythroopoietin resuscitated with normal saline, Ringer’s lactate and 7.5% hypertonic saline reduces small intestine injury in a hemorrhagic shock and resuscitation rat model.Analgesia in the management of pediatric trauma in the resuscitative phase: the role of the trauma centre.Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.Does computed tomography for penetrating renal injury reduce renal exploration? An 8-year review at a Canadian level 1 trauma centre.The other side of pediatric trauma: violence and intent injury.Upregulation of activated protein C leads to factor V deficiency in early trauma coagulopathy.A provincial integrated model of improved care for patients following hip fracture.Sports concussion: an Olympic boxing model comparing sex with biomechanics and traumatic brain injury.A multifaceted quality improvement strategy to optimize monitoring and management of delirium in trauma patients: results of a clinician survey.Risk factors for severe all-terrain vehicle injuries in Alberta.Evaluating potential spatial access to trauma centre care by severely injured patients.Incidence of brain injury in facial fractures.Surgical outcomes and the acute care surgery service.The acute care general surgery population and prognostic factors for morbidity and mortality.Disaster preparedness of trauma.What would you like to know and how can we help you? Assessing the needs of regional trauma centres.Posttraumatic stress disorder screening for trauma patients at a level 1 trauma centre.Physical and finite element model reconstruction of a subdural hematoma event.Abdominal wall reconstruction in the trauma patient with an open abdomen.Development and pilot testing of a survey to measure patient and family experiences with injury care.Occult shock in trauma: What are Canadian traumatologists missing?Timeliness in obtaining emergent percutaneous procedures for the severely injured patient: How long is too long?97% of massive transfusion protocol activations do not include a complete hemorrhage panel.Trauma systems in Canada: What system components facilitate access to definitive care?The role of trauma team leaders in missed injuries: Does specialty matter?The adverse consequences of dabigatran among trauma and acute surgical patients.A descriptive study of bicycle helmet use in Montréal.Factor XIII, desmopressin and permissive hypotension enhance clot formation compared with normotensive resuscitation: uncontrolled hemorrhagic shock model.Negative pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review.The “weekend warrior:” Fact or fiction for major trauma?Canadian injury preventon curriculum: a means to promote injury prevention.Penetrating splenic trauma: Safe for nonoperative management?The pediatric advanced trauma life support course: a national initiative.The effectiveness of a psycho-educational program among outpatients with burns or complex trauma.Trauma centre performance indicators for nonfatal outcomes: a scoping review.The evaluation of short track speed skating helmet performance.Complication rates as a trauma care performance indicator: a systematic review.Unplanned readmission following admission for traumatic injury: When, where and why?Reconstructions of concussive impacts in ice hockey.How does head CT correlate with ICP monitoring and impact monitoring discontinuation in trauma patients with a Marshall CT score of I–II?Impact of massive transfusion protocol and exclusion of plasma products from female donors on outcome of trauma patients in Calgary region of Alberta Health Services.Primary impact arthrodesis for a neglected open Weber B ankle fracture dislocation.Impact of depression on neuropsychological functioning in electrical injury patients.Predicting the need for tracheostomy in patients with cervical spinal cord injury.Predicting crumping during computed tomography imaging using base deficit.Feasibility of using telehomecare technology to support patients with an acquired brain injury and family care-givers.Program changes impact the outcomes of severely injured patients.Do trauma performance indicators accurately reflect changes in a maturing trauma program?One-stop falls prevention information for clinicians: a multidisciplinary interactive algorithm for the prevention of falls in older adults.Use of focused assessment with sonography for trauma (FAST) for combat casualties in forward facilities.Alberta All-terrain Vehicle Working Group: a call to action.Observations and potential role for the rural trauma team development course (RTTDC) in India.An electronic strategy to facilitate information-sharing among trauma team leaders.Development of quality indicators of trauma care by a consensus panel.An evaluation of a proactive geriatric trauma consultation service.Celebrity injury-related deaths: Is a gangster rapper really gangsta?Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?Intra-abdominal injury in patients who sustain more than one gunshot wound to the abdomen: Should non-operative management be used?Retrospective review of blunt thoracic aortic injury management according to current treatment recommendations.Telemedicine for trauma resuscitation: developing a regional system to improve access to expert trauma care in Ontario.Comparing trauma quality indicator data between a pediatric and an adult trauma hospital.Using local injury data to influence injury prevention priorities.Systems saving lives: a structured review of pediatric trauma systems.What do students think of the St. Michael’s Hospital ThinkFirst Injury Prevention Strategy for Youth?An evidence-based method for targeting a shaken baby syndrome prevention media campaign.The virtual mentor: cost-effective, nurse-practitioner performed, telementored lung sonography with remote physician guidance.Quality indicators used by teaching versus nonteaching international trauma centres.Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting.Closing the quality improvement loop: a collaborative approach.National Trauma Registry: “collecting” it all in New Brunswick.Does delay to initial reduction attempt affect success rates for anterior shoulder dislocation (pilot study)?Use of multidisciplinary, multi-site morbidity and mortality rounds in a provincial trauma system.Caring about trauma care: public awareness, knowledge and perceptions.Assessing the quality of admission dictation at a level 1 trauma centre.Trauma trends in older adults: a decade in review.Blunt splenic injury in patients with hereditary spherocytosis: a population-based analysis.Analysis of trauma team activation in severe head injury: an institutional experience.ROTEM results correlate with fresh frozen plasma transfusion in trauma patients.10-year trend of assault in Alberta.10-year trend in alcohol use in major trauma in Alberta.10-year trend in major trauma injury related to motorcycles compared with all-terrain vehicles in Alberta.Referral to a community program for youth injured by violence: a feasibility study.New impaired driving laws impact on the trauma population at level 1 and 3 trauma centres in British Columbia, Canada.A validation study of the mobile medical unit/polyclinic team training for the Vancouver 2010 Winter Games.Inferior vena cava filter use in major trauma: the Sunny-brook experience, 2000–2011.Relevance of cellular microparticles in trauma-induced coagulopathy: a systemic review.Improving quality through trauma centre collaboratives.Predictors of acute stress response in adult polytrauma patients following injury.Patterns of outdoor recreational injury in northern British Columbia.Risk factors for loss-to-follow up among trauma patients include functional, socio-economic, and geographic determinants: Would mandating opt-out consent strategies minimize these risks?Med-evacs and mortality rates for trauma from Inukjuak, Nunavik, Quebec.Review of open abdomens in McGill University Health Centre.Are surgical interventions for trauma associated with the development of posttraumatic retained hemothorax and empyema?A major step in understanding the mechanisms of traumatic coagulopathy: the possible role of thrombin activatable fibrinolysis inhibitor.Access to trauma centre care for patients with major trauma.Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted.Improving trauma system governance. Can J Surg 2012. [DOI: 10.1503/cjs.006312] [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: 11/01/2022] Open
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Khaykin Y, Friedlander D, Zarnett L, Seabrook C, Beardsall M, Feltham S, Tsang B, Wulffhart Z, Pantano A, Verma A. Risk of Arrhythmia Recurrence After Successful Ablation of Lone Atrial Fibrillation. J Atr Fibrillation 2012; 4:428. [PMID: 28496728 PMCID: PMC5153194 DOI: 10.4022/jafib.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/12/2011] [Accepted: 12/23/2012] [Indexed: 06/07/2023]
Affiliation(s)
- Y Khaykin
- Department of medicine, university of toronto
| | | | - L Zarnett
- Department of medicine, university of toronto
| | - C Seabrook
- Department of medicine, university of toronto
| | - M Beardsall
- Department of medicine, university of toronto
| | - S Feltham
- Department of medicine, university of toronto
| | - B Tsang
- Department of medicine, university of toronto
| | - Z Wulffhart
- Department of medicine, university of toronto
| | - A Pantano
- Department of medicine, university of toronto
| | - A Verma
- Department of medicine, university of toronto
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Russotto P, Acosta L, Adamczyk M, Al-Ajlan A, Al-Garawi M, Al-Homaidhi S, Amorini F, Auditore L, Aumann T, Ayyad Y, Baran V, Basrak Z, Benlliure J, Boiano C, Boisjoli C, Boretzky K, Brzychczyk J, Budzanowski A, Cardella G, Cammarata P, Cavallaro S, Chajecki Z, Chartier M, Chbihi A, Colonna M, Czech B, De Filippo E, Di Toro M, Famiano M, Le Fevre A, Gašsparić A, Geraci E, Grassi L, Greco V, Guazzoni C, Guazzoni P, Heil M, Heilborn L, Introzzi R, Isobe T, Kezzar K, Kiš M, Kupny S, Kurz N, La Guidara E, Lanzalone G, Lasko P, Leifels Y, Lemmon R, Li Q, Lombardo I, Loria D, Lukasik J, Lynch W, Marini P, Matthews Z, May L, Minniti T, Mostazo M, Pagano A, Papa M, Pawlowski P, Petrovici M, Pirrone S, Politi G, Porto F, Reifarth R, Reisdorf W, Riccio F, Rizzo F, Rosato E, Rossi D, Santoro S, Simon H, Skwirczynska I, Sosin Z, Trautmann W, Trifirò A, Trimarchi M, Tsang B, Veselsky M, Verde G, Vigilante M, Wieloch A, Wigg P, Wilczynski J, Wolter H, Wu P, Yennello S, Zambon P, Zetta L, Zoric M. ASY-EOS experiment at GSI. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20123100012] [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: 11/15/2022] Open
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George AM, Love DR, Hayes I, Tsang B. Recurrent Transmission of a 17q12 Microdeletion and a Variable Clinical Spectrum. Mol Syndromol 2011; 2:72-75. [PMID: 22511894 DOI: 10.1159/000335344] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2011] [Indexed: 12/16/2022] Open
Abstract
The relatively rare proximal microdeletion of 17q12 (including deletion of the HNF1B gene) is associated with the renal cysts and diabetes syndrome. Recent reports have suggested that there may also be an association between this microdeletion and learning difficulties/autism. This case report describes one of only a few reported families segregating the 17q12 microdeletion, but which highlights the nonpenetrance and variable expressivity of multiple features of this condition.
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Affiliation(s)
- A M George
- Diagnostic Genetics, LabPlus, Auckland, New Zealand
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Khaykin Y, Zarnett L, Friedlander D, Seabrook C, Beardsall M, Feltham S, O'Boyle M, Tsang B, Wulffhart Z, Verma A. 266 Quantification of AF burden before and up to 12 months following pulmonary vein antrum isolation. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Alkhatib H, Stenbeck J, Tedeschi D, Tsang B, Oves S, Neglia W, Higgins P, Alaei P, Bzdusek K. SU-E-J-03: The Modeling of Cone Beam Computed Tomography in a Treatment Planning System. Med Phys 2011. [DOI: 10.1118/1.3611771] [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: 11/07/2022] Open
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Stenbeck J, Tedeschi D, Tsang B, Alaei P, Higgins P, Alkhatib H. SU-GG-I-23: A Dosimetric Evaluation of Cone Beam CT Imaging in an Anthropomorphic Phantom. Med Phys 2010. [DOI: 10.1118/1.3468056] [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: 11/07/2022] Open
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McPhail LT, Borisoff JF, Tsang B, Hwi LPR, Kwiecien JM, Ramer MS. Protracted myelin clearance hinders central primary afferent regeneration following dorsal rhizotomy and delayed neurotrophin-3 treatment. Neurosci Lett 2007; 411:206-11. [PMID: 17123713 DOI: 10.1016/j.neulet.2006.09.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Revised: 09/08/2006] [Accepted: 09/08/2006] [Indexed: 01/05/2023]
Abstract
Regeneration within or into the CNS is thwarted by glial inhibition at the site of a spinal cord injury and at the dorsal root entry zone (DREZ), respectively. At the DREZ, injured axons and their distal targets are separated by degenerating myelin and an astrocytic glia limitans. The different glial barriers to regeneration following dorsal rhizotomy are temporally and spatially distinct. The more peripheral astrocytic barrier develops first, and is surmountable by neurotrophin-3 (NT-3) treatment; the more central myelin-derived barrier, which prevents dorsal horn re-innervation by NT-3-treated axons, becomes significant only after the onset of myelin degeneration. Here we test the hypothesis that in the presence of NT-3, axonal regeneration is hindered by myelin degeneration products. To do so, we used the Long Evans Shaker (LES) rat, in which oligodendrocytes do not make CNS myelin, but do produce myelin-derived inhibitory proteins. We show that delaying NT-3 treatment for 1 week in normal (LE) rats, while allowing axonal penetration of the glia limitans and growth within degenerating myelin, results in misdirected regeneration with axons curling around presumptive degenerating myelin ovoids within the CNS compartment of the dorsal root. In contrast, delaying NT-3 treatment in LES rats resulted in straighter, centrally-directed regenerating axons. These results indicate that regeneration may be best optimized through a combination of neurotrophin treatment plus complete clearance of myelin debris.
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Affiliation(s)
- Lowell T McPhail
- ICORD (International Collaboration on Repair Discoveries), The University of British Columbia, 6270 University Boulevard, Vancouver, BC, Canada V6T 1Z4
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Abstract
In the central nervous system, regeneration of injured axons and sprouting of intact axons are suppressed by myelin-derived molecules that bind to the Nogo receptor (NgR). We used a soluble form of the NgR (sNgR), constructed as an IgG of the human NgR extracellular domain, to manipulate plasticity of uninjured primary afferent and descending monoaminergic projections to the rat spinal cord following dorsal rhizotomy. Rats with quadruple dorsal rhizotomies were treated with intrathecal sNgR or saline, or were left untreated for 2 weeks. Rhizotomy alone resulted in sprouting of serotonergic axons and to a lesser extent, tyrosine-hydroxylase (TH)-expressing axons, while axons expressing dopamine-beta-hydroxylase (DbetaH) were unaffected. Human IgG immunohistochemistry revealed that sNgR infused into the intrathecal space penetrated approximately 300 microm into spinal white and grey matter. Separate axonal populations differed in their responses to intrathecal sNgR: TH-expressing and DbetaH-expressing axons responded most and least vigorously, respectively. Serotonergic axons were identified by serotonin (5-HT) or serotonin transporter (SERT) immunohistochemistry. Interestingly, a large increase in 5-HT compared to SERT-positive axons density in both saline and sNgR-treated rats indicated that serotonergic axons both sprouted and increased their transmitter content in response to rhizotomy and sNgR treatment. Calcitonin gene-related peptide-positive axons were largely depleted ipsilaterally by rhizotomy, and sNgR increased axon density only in deeper contralateral laminae (III-V). GAP-43 immunohistochemistry revealed a small increase in axon density following dorsal rhizotomy that was further augmented by sNgR treatment. These results reveal a differential effect of myelin antagonism on distinct populations of spinally projecting axons.
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Affiliation(s)
- V E MacDermid
- International Collaboration on Repair Discoveries, University of British Columbia, 2469-6270 University Blvd, Vancouver, British Columbia, Canada V6T 1Z4
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Abbott G, Farmer K, Grimwood K, Hill S, Lennon D, Moyes C, Reid S, Stanley T, Teele D, Tsang B, Voss L. Childhood immunisation in Rotorua. N Z Med J 1999; 112:454-5. [PMID: 10678248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Li Q, Zhang L, Tsang B, Gardner K, Bostick-Bruton F, Reed E. Phorbol ester exposure activates an AP-1-mediated increase in ERCC-1 messenger RNA expression in human ovarian tumor cells. Cell Mol Life Sci 1999; 55:456-66. [PMID: 10228559 DOI: 10.1007/s000180050302] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/28/2022]
Abstract
ERCC-1 is an essential gene in the nucleotide excision repair pathway, and may be essential for life. However, the mechanism of transcriptional activation and regulation of ERCC-1 gene expression is unclear. We therefore investigated the effect of the phorbol ester 12-O-tetradecanoyl-phorbol-13-acetate (TPA) on the expression of the ERCC-1 gene in A2780/CP70 human ovarian carcinoma cells. TPA induced a four- to sixfold increase in steady-state ERCC-1 messenger RNA (mRNA) levels that was time- and concentration-dependent. Nuclear run-on experiments demonstrated that the rate of transcription of ERCC-1 was approximately 2.8-fold higher in TPA-treated cells than in the controls. TPA stimulation of A2780/CP70 cells also resulted in a rapid but transient induction of c-jun and c-fos as determined by Northern and Western blot analyses, which peaked about 2 h before the peak in ERCC-1 expression. Electrophoretic mobility shift assays of nuclear extracts from TPA-treated cells revealed an increase in DNA-binding activity specific for the AP-1-like binding site in the 5'-flanking region of ERCC-1. c-Jun and c-Fos proteins were confirmed to be the components of the activated AP-1 complex by supershift analysis. The increase in AP-1 activity occurs immediately before the increase in ERCC-1 transcription. The increase in AP-1 DNA-binding activity and the increase in ERCC-1 mRNA expression were prevented by pretreatment with cycloheximide. These data suggest that AP-1 may contribute to the upregulation of ERCC-1 in response to TPA in human ovarian cancer cells.
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Affiliation(s)
- Q Li
- Developmental Therapeutics Department, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Li Q, Tsang B, Bostick-Bruton F, Reed E. Modulation of excision repair cross complementation group 1 (ERCC-1) mRNA expression by pharmacological agents in human ovarian carcinoma cells. Biochem Pharmacol 1999; 57:347-53. [PMID: 9933022 DOI: 10.1016/s0006-2952(98)00291-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Excision repair cross complementation group 1 (ERCC-1) is a DNA repair gene that is essential for life, and it appears to be a marker gene for nucleotide excision repair activity. Overexpression of ERCC-1 during cisplatin-based chemotherapy is associated with clinical and cellular drug resistance. We therefore began to assess the influence of various pharmacological agents on the induction of ERCC-1 mRNA in A2780/CP70 human ovarian carcinoma cells. Cisplatin exposure in culture resulted in a 4- to 6-fold induction for the steady-state level of ERCC-1 mRNA in A2780/CP70 cells. ERCC-1 mRNA induction was concentration and time dependent. Cyclosporin A and herbimycin A, which suppress c-fos and c-jun gene expressions, respectively, blocked the cisplatin-induced increase in ERCC-1 mRNA. This effect of cyclosporin A or herbimycin A on the down-regulation of ERCC-1 correlates with enhanced cytotoxicity of cisplatin in this system. The products of c-fos and c-jun are components of the transcription factor AP-1 (activator protein 1). 12-O-Tetradecanoylphorbol 13-acetate (TPA), a known AP-1 agonist, induced ERCC-1 mRNA to the same extent as cisplatin, but did not synergize with cisplatin in this regard. The TPA effect was biphasic, with an initial increase during the first 1-6 hr, followed by decreasing mRNA levels at 24-72 hr. These data suggest that the effects of these pharmacological agents on ERCC-1 gene expression may be mediated through the modulation of AP-1 activities.
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Affiliation(s)
- Q Li
- Medical Ovarian Cancer Section, Developmental Therapeutics Department, Medicine Branch, Division of Clinical Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Li Q, Tsang B, Ding L, Ji-Hong W. Infection with the human immunodeficiency virus type 2: epidemiology and transmission (Review). Int J Mol Med 1998; 2:573-6. [PMID: 9858654 DOI: 10.3892/ijmm.2.5.573] [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: 11/06/2022] Open
Abstract
Human immunodeficiency virus type 2 (HIV-2) is known to be one of the agents that causes acquired immunodeficiency syndrome (AIDS). It has been present in West Africa since the 1960s and is currently epidemic there. Compared with human immunodeficiency virus type 1 (HIV-1), HIV-2 is genomically different. Furthermore, it is less prevalent worldwide than HIV-1. In West Africa, seropositive rates of HIV-2 are higher in urban versus rural communities, however, there are no gender differences. Sexual contact and vertical transmission are known modes of infectivity, though HIV-2 is less contagious than HIV-1.
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Affiliation(s)
- Q Li
- Developmental Therapeutics Department, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Li Q, Ding L, Yu JJ, Mu C, Tsang B, Bostick-Bruton F, Reed E. Cisplatin and phorbol ester independently induce ERCC-1 protein in human ovarian carcinoma cells. Int J Oncol 1998; 13:987-92. [PMID: 9772291 DOI: 10.3892/ijo.13.5.987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nucleotide excision repair (NER) is the DNA repair pathway by which cisplatin-induced damage is removed from DNA in human cells. ERCC-1 is one of the essential proteins in NER, and is essential for life. Enhanced ERCC-1 expression has been associated with clinical and cellular resistance to cisplatin. We therefore carried out this study to investigate the effect of cisplatin on ERCC-1 protein expression in A2780/CP70 human ovarian cancer cells. Western blot analysis showed that ERCC-1 protein levels were increased to more than 3 times control after a 1 h cisplatin exposure to A2780/CP70 cells in culture. This increase was time- and concentration-dependent. The effect of cisplatin was maximal at 40 mM and peaked 24-48 h after exposure to the drug. These results extend our previous observations that ERCC-1 mRNA expression is induced by cisplatin in this system. TPA, a known AP-1 activator and tumor-promoting phorbol ester, also induced ERCC-1 protein to the same extent as cisplatin, but did not synergize with cisplatin in this regard. These findings suggest that ERCC-1 gene up-regulation in these cells can result through a DNA damage-response pathway, or through the induction of AP-1 activity, independent of the occurrence of DNA damage.
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Affiliation(s)
- Q Li
- Medical Ovarian Cancer Section, Developmental Therapeutics Department, Medicine Branch, Division of Clinical Sciences, National Cancer Institute, Bethesda, MD 20892, USA
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Li Q, Gardner K, Zhang L, Tsang B, Bostick-Bruton F, Reed E. Cisplatin induction of ERCC-1 mRNA expression in A2780/CP70 human ovarian cancer cells. J Biol Chem 1998; 273:23419-25. [PMID: 9722577 DOI: 10.1074/jbc.273.36.23419] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [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: 11/06/2022] Open
Abstract
ERCC-1 is a critical gene within the nucleotide excision repair pathway, and cells without a functional ERCC-1 do not perform cisplatin-DNA adduct repair. We therefore investigated the cisplatin effect on ERCC-1 mRNA expression in vitro. In response to a 1-h cisplatin exposure, A2780/CP70 human ovarian cancer cells showed a 6-fold increase in steady-state level of ERCC-1 mRNA. This rise was attributable to increased transcription as measured by nuclear run-on assays and a 60% increase in ERCC-1 mRNA half-life. The increase in ERCC-1 mRNA was preceded by a 4-5-fold rise in mRNA expressions of c-fos and c-jun, a 14-fold increase in c-Jun protein phosphorylation, and an increase in in vitro nuclear extract binding activity to the AP-1-like site of ERCC-1. These data suggest that the induction of ERCC-1 expression in A2780/CP70 cells exposed to cisplatin results from two major factors: (a) an increase in the expression of transactivating factors that bind the AP-1-like site in the 5'-flanking region of ERCC-1 and (b) an increase in the level of c-Jun phosphorylation that enhances its transactivation property.
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Affiliation(s)
- Q Li
- Medical Ovarian Cancer Section, Department of Developmental Therapeutics, Medicine Branch, Division of Clinical Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Li Q, Tsang B, Ding L, Ding ZR. Vertical transmission of human immunodeficiency virus type 1: frequency and correlation of transmission (review). Int J Mol Med 1998; 1:589-91. [PMID: 9852268 DOI: 10.3892/ijmm.1.3.589] [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: 11/05/2022] Open
Abstract
Child bearing age women constitute the fastest growing subset of the human immunodeficiency virus (HIV) infected population. Consistent with this fact is the increasing number of HIV infected children. Vertical transmission from mother to child is the most common route of infection. Because of the nature of the virus, it is difficult to determine the timing of infection. There are three time periods during which infection can occur: prenatally, perinatally, or postnatally. Evidence for each is presented within this review.
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Affiliation(s)
- Q Li
- Medicine Branch, National Cancer Institute, National Institutes of Health, Building 10, Room 13N248, Bethesda, MD 20892, USA
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Cunningham JM, Pliskin NH, Cassisi JE, Tsang B, Rao SM. Relationship between confabulation and measures of memory and executive function. J Clin Exp Neuropsychol 1997; 19:867-77. [PMID: 9524881 DOI: 10.1080/01688639708403767] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Confabulation has traditionally been attributed to a combination of memory impairment and executive dysfunction, but recent models propose that confabulation can result from executive dysfunction alone. One hundred and ten patients with diverse neurologic and psychiatric diagnoses were subdivided into high-, low-, and non-confabulator groups based upon the ratio of confabulations to total responses produced during story recall. Consistent with the combined deficit model, high-confabulators performed significantly worse than the low- and non-confabulators on measures of memory and measures of executive function that assess sustained attention, mental tracking, and set-shifting ability. However, there were no differences between groups on measures of problem-solving, concept formation, and verbal fluency, suggesting a dissociation in executive functions that contribute to confabulation.
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Affiliation(s)
- J M Cunningham
- Department of Neurology, Medical College of Wisconsin, Milwaukee 53226, USA
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Abstract
We report on an infant with severe Noonan syndrome, chylothoraces, and hepatosplenomegaly who suffered two episodes of cerebral infarction before age 6 months. No underlying cause for these events was found. The presentation is discussed in relationship to other reports of stroke in Noonan syndrome which have previously been associated with underlying vascular malformations.
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Affiliation(s)
- S Robertson
- Starship Children's Hospital, Auckland, New Zealand
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Farmer K, Grimwood K, Hill S, Holdaway D, Moyes C, Stanley T, Teele D, Tsang B, Voss L, Reid S, Lennon D. Measles control. N Z Med J 1997; 110:195. [PMID: 9201209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Collison G, Hindle R, Kennedy M, Tsang B, Tuck R. Tuberculosis in Northland. N Z Med J 1993; 106:43-4. [PMID: 8464592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Single intracranial injections of the peptide analogues of angiotensin and the enzyme renin induced drinking of water and 1.8% NaCl solution in prepubertal female pigs maintained ad libitum on a sodium-free diet with unrestricted access to both fluids. Over the dose range 10(-12)-10(-9) mol angiotensin (AI), angiotensin II (AII), angiotensin III (AIII), and renin substrate (RS), the volumes of water and salt solution ingested were dose-dependent. As in other vertebrates, AII was the most potent and rapidly acting dipsogen. However, unlike in the rat, dog and pigeon, AIII was highly effective in stimulating both water intake and salt appetite, whereas AI and RS were relatively weak. Pretreatment of intracranial sites with 10(-9) mol of the AII competitive antagonist, Sar1-Ala8-angiotensin, had no effect on the volume of water or 1.8% NaCl ingested after 10(-10) mol AIII, suggesting that in the pig AIII can exert its dipsogenic effects without acting on central AII receptors. Single microinjections of 1 and 10 mU of renin also elicited dose-dependent drinking of water and 1.8% NaCl, but compared with the peptide analogues of angiotensin the responses had a longer latency and duration and were more variable between individual animals.
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Tsang B. Teenage pregnancy: the Hong Kong experience. Concern (Anaheim) 1980:4-5. [PMID: 12278545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Whitfield JF, Boynton AL, MacManus JP, Rixon RH, Sikorska M, Tsang B, Walker PR, Swierenga SH. The roles of calcium and cyclic AMP in cell proliferation. Ann N Y Acad Sci 1980; 339:216-40. [PMID: 6249140 DOI: 10.1111/j.1749-6632.1980.tb15980.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Merali Z, Tsang B, Singhal RL, Hrdina PD. Effect of narcotic dependence and withdrawal on striatal dopamine-sensitive adenylate cyclase and synaptosomal cyclic AMP metabolism. Res Commun Chem Pathol Pharmacol 1976; 14:29-37. [PMID: 180579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In rats rendered tolerant to the dependent on morphine, striatal cyclic AMP metabolism was significantly enhanced as reflected by elevated cyclic AMP levels and adenylate cyclase activity. Following withdrawal from morphine treatment, whereas the activity of straital adenylate cyclase was significantly reduced when compared to morphine-dependent rats, the drop in cyclic AMP was not significant. Although addition of dopamine (40 muM) stimulated equally well the striatal adenylate cyclase from control or morphine-dependent animals, the activity of dopamine-stimulated enzyme was blocked in animals undergoing withdrawal. The crude synaptosomal fraction of the whole brain obtained from morphine-dependent rats exhibited an even more pronounced increase in cyclic AMP which was accompanied by elevated adenylate cyclase and protein kinase activity. Naloxone administration suppressed this rise in cyclic AMP and reversed the morphine-stimulated increases in adenylate cyclase and protein kinase. Following the withdrawal of morphine treatment, alterations in cyclic AMP metabolism were similar to those noted for the morphine-naloxone group.
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