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Gibb J, Wall E, Fields E, Seale A, Armstrong C, Bamber A, Daubeney P, Jacobs-Pearson M, Marton T, Stals K, Low K, Kaski JP, Spentzou G. Biallelic PKP2 loss of function variants are associated with a lethal perinatal-onset biventricular dilated cardiomyopathy with excessive trabeculations and ventricular septal defects. J Med Genet 2024; 61:405-409. [PMID: 38050058 DOI: 10.1136/jmg-2023-109493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
Homozygous plakophilin-2 (PKP2) variants have been identified as a cause of a lethal form of dilated cardiomyopathy with excessive trabeculations (DCM-ET) in three cases. We report three more cases from two families with homozygous pathogenic PKP2 variants and perinatal-onset, lethal DCM-ET. Identification of the genetic abnormalities played a key role in decision-making and family counselling in these cases. This case series supports the published evidence that biallelic loss of function PKP2 variants cause a lethal, perinatal-onset cardiomyopathy.
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Affiliation(s)
- Jack Gibb
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Elizabeth Wall
- Department of Clinical Genetics, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Ella Fields
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Anna Seale
- Department of Paediatric Cardiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Catherine Armstrong
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Andrew Bamber
- Department of Cellular Pathology, Southmead Hospital, Bristol, City of Bristol, UK
| | - Piers Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Makaela Jacobs-Pearson
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Tamas Marton
- Department of Obstetrics and Gynecology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Cellular pathology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Karen Stals
- Department of Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Karen Low
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Department of Academic Child Health, University of Bristol, Bristol, UK
| | - Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Georgia Spentzou
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
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Hernandez TD, Aleman SJ, Bao-Loc-Trung M, Forte MV, Brandt W, Armstrong C, Howard J, Mosieri CN, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies. Cureus 2024; 16:e55393. [PMID: 38562326 PMCID: PMC10982833 DOI: 10.7759/cureus.55393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Atopic dermatitis (AD) is a pervasive and multifaceted dermatological disorder causing daily distress to afflicted individuals worldwide. This comprehensive review synthesizes the historical and contemporary advancements in therapeutic strategies, offering a critical analysis of their efficacy, safety profiles, and adaptability. The enduring role of topical corticosteroids in managing AD is examined, acknowledging their potent anti-inflammatory properties alongside their potential adverse side effects, particularly in extended usage. The article explores the utilization of topical calcineurin inhibitors like tacrolimus and pimecrolimus, highlighting their novel anti-inflammatory pathways while also scrutinizing concerns over potential malignancies that relegate them to second-line therapy. The present investigation features the emergence of crisaborole, a phosphodiesterase four inhibitor. Its innovative mode of action, benign safety profile, and applicability to mild and moderate AD are thoroughly evaluated. The review also includes challenges, particularly cost considerations, which constrain accessibility and necessitate nuanced implementation in therapeutic regimens. This study underscores the need for persistent investigation, teamwork, and innovations in managing AD. In this regard, AD requires a united approach between clinicians, researchers, affected individuals, and policymakers to refine patient-focused treatment and develop precise, economical strategies to address this chronic and frequently life-altering health condition.
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Affiliation(s)
- Tyler D Hernandez
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Sarah J Aleman
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Maria Bao-Loc-Trung
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Michael V Forte
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - William Brandt
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Catherine Armstrong
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Jeffrey Howard
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Chizoba N Mosieri
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
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Hanington OP, Armstrong C, Pierre G, Stuart G, Hancox JC. Left ventricular noncompaction cardiomyopathy and short QT syndrome due to primary carnitine deficiency. Ann Noninvasive Electrocardiol 2023; 28:e13077. [PMID: 37658577 PMCID: PMC10646383 DOI: 10.1111/anec.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/06/2023] [Accepted: 07/26/2023] [Indexed: 09/03/2023] Open
Abstract
We report the case of a 13-year-old female patient presenting with presyncope and palpitations. Her electrocardiogram revealed an abbreviation of the rate-corrected QT interval with imaging showing significant left ventricular dysfunction. Carnitine levels were measured as part of her diagnostic workup, discovering a rare, reversible cause of short QT syndrome (SQTS) and associated cardiomyopathy-primary carnitine deficiency (PCD) caused by a homozygous mutation in the SLC22A5 gene, leading to an in-frame deletion mutation (NP_003051.1:p.Phe23del) affecting the organic cation transporter 2 (OCTN2) protein. Following the treatment with oral carnitine supplementation, her QT interval returned to within the normal range with significant improvement in left ventricular function.
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Affiliation(s)
- Oliver P. Hanington
- Cardiovascular Research Laboratories, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | | | | | - Graham Stuart
- Bristol Heart InstituteBristolUK
- Bristol Royal Hospital for Sick ChildrenBristolUK
| | - Jules C. Hancox
- Cardiovascular Research Laboratories, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Daw R, Armstrong C. The role of the advanced clinical practitioner in arthroplasty care. Br J Nurs 2023; 32:362-366. [PMID: 37083377 DOI: 10.12968/bjon.2023.32.8.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Demand for joint arthroplasty surgery in the UK has increased significantly over the past 10 years. Advanced clinical practitioner (ACP) roles in arthroplasty care, typically fulfilled by expert nurses or physiotherapists, have been developed to alleviate service pressures and facilitate care for the growing number of patients undergoing arthroplasty surgery. There are numerous different models of ACP-led services both in the UK and internationally, driven by local service and population needs. ACPs in arthroplasty care will be involved throughout the patient journey, including pre-operative assessment, peri-operative care and long-term surveillance. ACPs in arthroplasty care will develop expertise across all four pillars of advanced clinical practice and have the potential to influence and contribute to the development of guidance and policy for the future of arthroplasty care delivery, ensuring best quality, evidence-based practice is achieved.
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Affiliation(s)
- Rachael Daw
- Senior Educationalist, Royal College of Physicians, London
| | - Catherine Armstrong
- Advanced Physiotherapy Practitioner in Orthopaedics, Liverpool University Hospitals Foundation Trust, Liverpool
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Yang L, Dempsey M, Brennan A, Whelan B, Erjiang E, Wang T, Egan R, Gorham K, Heaney F, Armstrong C, Ibarrola GM, Gsel A, Yu M, Carey JJ. Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX. Arch Osteoporos 2023; 18:43. [PMID: 36939937 PMCID: PMC10027809 DOI: 10.1007/s11657-023-01232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. PURPOSE FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. METHOD A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. RESULTS Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. CONCLUSIONS Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.
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Affiliation(s)
- Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, University of Galway, IDA Business Park, Lower Dangan, Galway, H91 AEX4, Ireland.
| | - Mary Dempsey
- School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - E Erjiang
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | | | | | - Amina Gsel
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - John J Carey
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
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O 'Sullivan D, Silke C, Whelan B, McGowan B, O 'Sullivan M, McCabe JP, Heaney F, Armstrong C, Gsel AM, Connaughton B, Carey JJ. Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals. Arch Osteoporos 2022; 18:12. [PMID: 36527534 DOI: 10.1007/s11657-022-01199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis. Hospital care represents the costliest portion of health services. We found public hospital bed days for fragility fractures in Ireland increased by 43% between 2008 and 2017 which exceeded those for other common diseases. INTRODUCTION Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases. METHODS A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50 years and older from January 2008 to December 2017. RESULTS In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection. CONCLUSION Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.
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Affiliation(s)
- D O 'Sullivan
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - C Silke
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B Whelan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B McGowan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - M O 'Sullivan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - J P McCabe
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - F Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - C Armstrong
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - A M Gsel
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - B Connaughton
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - J J Carey
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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Kufera J, Armstrong C, Wu F, Singhal A, Zhang H, Lai J, Wilkins H, Simonetti F, Siliciano J, Siliciano R. OP 3.6 – 00023 Effect of HIV-1 infection, viral particle production, and proviral integration site on CD4+ T cell proliferation. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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8
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O'Neil J, Whelan J, Armstrong C, Schroyer R. Assessing the Nutrition Knowledge, Family Activity-Eating Behaviors, and Food Accessibility of Parents with Children Diagnosed with Spina Bifida. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kaw A, Kaw K, Hostetler EM, Beleza-Meireles A, Smith-Collins A, Armstrong C, Scurr I, Cotts T, Aatre R, Bamshad MJ, Earl D, Groner A, Agre K, Raveh Y, Kwartler CS, Milewicz DM. Expanding ACTA2 genotypes with corresponding phenotypes overlapping with smooth muscle dysfunction syndrome. Am J Med Genet A 2022; 188:2389-2396. [PMID: 35567597 PMCID: PMC9283281 DOI: 10.1002/ajmg.a.62775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/13/2022] [Accepted: 04/09/2022] [Indexed: 11/07/2022]
Abstract
Pathogenic variants in ACTA2, encoding smooth muscle α-actin, predispose to thoracic aortic aneurysms and dissections. ACTA2 variants altering arginine 179 predispose to a more severe, multisystemic disease termed smooth muscle dysfunction syndrome (SMDS; OMIM 613834). Vascular complications of SMDS include patent ductus arteriosus (PDA) or aortopulmonary window, early-onset thoracic aortic disease (TAD), moyamoya-like cerebrovascular disease, and primary pulmonary hypertension. Patients also have dysfunction of other smooth muscle-dependent systems, including congenital mydriasis, hypotonic bladder, and gut hypoperistalsis. Here, we describe five patients with novel heterozygous ACTA2 missense variants, p.Arg179Gly, p.Met46Arg, p.Thr204Ile, p.Arg39Cys, and p.Ile66Asn, who have clinical complications that align or overlap with SMDS. Patients with the ACTA2 p.Arg179Gly and p.Thr204Ile variants display classic features of SMDS. The patient with the ACTA2 p.Met46Arg variant exhibits exclusively vascular complications of SMDS, including early-onset TAD, PDA, and moyamoya-like cerebrovascular disease. The patient with the ACTA2 p.Ile66Asn variant has an unusual vascular complication, a large fusiform internal carotid artery aneurysm. The patient with the ACTA2 p.Arg39Cys variant has pulmonary, gastrointestinal, and genitourinary complications of SMDS but no vascular manifestations. Identifying pathogenic ACTA2 variants associated with features of SMDS is critical for aggressive surveillance and management of vascular and nonvascular complications and delineating the molecular pathogenesis of SMDS.
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Affiliation(s)
- Anita Kaw
- Division of Medical Genetic, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kaveeta Kaw
- Division of Medical Genetic, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ellen M Hostetler
- Division of Medical Genetic, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ana Beleza-Meireles
- Bristol Regional Clinical Genetics Service, St Michael's Hospital, Bristol, UK
| | - Adam Smith-Collins
- Regional Neonatal Intensive Care Unit, St Michael's Hospital, Bristol, UK
| | | | - Ingrid Scurr
- Bristol Regional Clinical Genetics Service, St Michael's Hospital, Bristol, UK
| | - Timothy Cotts
- Division of Pediatric Cardiology, Department of Pediatrics, Michigan Medicine, University of Michigan at Ann Arbor, Ann Arbor, Michigan, USA
| | - Rajani Aatre
- Franklin Cardiovascular Center, Department of Internal Medicine, Michigan Medicine, University of Michigan at Ann Arbor, Ann Arbor, Michigan, USA
| | - Michael J Bamshad
- Division of Medical Genetics, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dawn Earl
- Division of Medical Genetics, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Abraham Groner
- Division of Cardiology, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | | | - Yehuda Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Callie S Kwartler
- Division of Medical Genetic, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dianna M Milewicz
- Division of Medical Genetic, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Murphy T, Sale SM, Gonzalez Barlatay F, Armstrong C, Parry A, Houghton E, Jerrom T, Schadenberg A. Initial results from an enhanced recovery program for pediatric cardiac surgical patients. Paediatr Anaesth 2022; 32:647-653. [PMID: 35156262 DOI: 10.1111/pan.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over recent years, a number of enhanced recovery programs have appeared in first, adult colorectal surgery, and subsequently many other adult surgical specialties. Increasing interest in this approach to perioperative management in children culminated in the recent development of the first enhanced recovery pathway for pediatric intestinal surgery, endorsed by Enhanced Recovery after Surgery Society (ERAS®). In parallel, there has been increasing interest in the refinement of perioperative management of selected pediatric cardiac surgical patients, invariably referred to as "fast track" management. Initiatives have largely focused on duration of postoperative ventilation rather than on a much wider range of perioperative interventions to optimize recovery and ensure timely discharge after surgery. In our institution, a "Level 1" pediatric cardiac surgical center, we assembled a multidisciplinary team to design a comprehensive enhanced recovery pathway, based on ERAS® methodology, for selected cardiac surgical patients. After a lengthy period of planning, staff education, and preparation, we implemented the pathway at the end of November 2019. METHODS We conducted a prospective audit of the perioperative management and outcomes of the first 88 patients managed according to this enhanced recovery pathway over a 25-month period in our institution. RESULTS The mean age of the patients was 5.8 years (range 0.5-17.9), and the mean weight was 22.4 kg (range 6.6-57.2). Sixty-eight of the 88 patients were cardiopulmonary bypass cases. A total of 54% of patients received all four defined intraoperative anesthetic interventions (intravenous paracetamol, non-steroidal anti-inflammatory drug, antiemetic if aged more than 4 years, and use of a local anesthetic technique). A total of 89% of patients met the target extubation time of 6 h after administration of protamine. Median postoperative intensive care unit length of stay was 23.5 h (range 15.2-89.5). When compared to a historic control group, this represented a 22% reduction in median intensive care unit stay, although the total hospital length of stay remained unchanged. A total of 83% of patients met the target hospital discharge target of the fifth postoperative day. CONCLUSIONS These preliminary results suggest that enhanced recovery pathway implementation for selected pediatric cardiac surgical patients is feasible, with acceptable outcomes. They suggest areas for further development and the potential for wider implementation.
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Affiliation(s)
- Tim Murphy
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Steven M Sale
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | | | | | - Andrew Parry
- Congenital Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Tom Jerrom
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - Alvin Schadenberg
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
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11
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Yang L, Carey JJ, Egan RM, Gorham KA, Heaney F, Armstrong C, Ibarrola GM, Whelan BR, Silke C, O’Sullivan M, Gsel A, Brennan A, Dempsey M. Agreement between Ireland DXA FRAX® and Web FRAX®: Preliminary Results of the DXA-HIP Study. Bone Rep 2022. [DOI: 10.1016/j.bonr.2022.101551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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12
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Carey JJ, Yang L, Erjiang E, Wang T, Gorham K, Egan R, Brennan A, Dempsey M, Armstrong C, Heaney F, McCabe E, Yu M. Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project. Calcif Tissue Int 2021; 109:534-543. [PMID: 34085087 PMCID: PMC8484104 DOI: 10.1007/s00223-021-00868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was - 1.4 and mean total hip T-scores was - 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40-49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.
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Affiliation(s)
- John J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
| | - Lan Yang
- School of Engineering, National University of Ireland Galway, Galway, Ireland
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - E Erjiang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Eva McCabe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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13
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Ferguson R, Shortland J, Gonzalez C, Armstrong C, Stuart AG. B-PO05-207 PAEDIATRIC COMPLETE HEART BLOCK SECONDARY TO RESTRICTIVE CARDIOMYOPATHY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Armstrong C, Best G, Marcus S. P.123 Peripartum spontaneous coronary artery dissection. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Bondy GS, Curran IHC, Coady LC, Armstrong C, Bourque C, Bugiel S, Caldwell D, Kwong K, Lefebvre DE, Maurice C, Marchetti F, Pantazopoulos PP, Ross N, Gannon AM. A one-generation reproductive toxicity study of the mycotoxin ochratoxin A in Fischer rats. Food Chem Toxicol 2021; 153:112247. [PMID: 33951485 DOI: 10.1016/j.fct.2021.112247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/08/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Ochratoxin A (OTA) is a mycotoxin produced by Aspergillus and Penicillium molds. Grain-based foods account for most human dietary exposures to OTA. OTA is a teratogen, but its reproductive and developmental effects are poorly understood. A one-generation reproductive toxicity study was conducted with groups of 16 male and 16 female Fischer rats exposed to 0, 0.026, 0.064, 0.16, 0.4 or 1.0 mg OTA/kg in diet. Dams exposed to 1.0 mg OTA/kg diet had statistically significant F1 pup losses between implantation and postnatal day (PND 4). Delays in preputial separation (PPS) and vaginal opening (VO) were indicative of delayed puberty in F1 rats. Mild renal lesions in nursing pups indicated that exposure prior to weaning impacted the kidneys. The developing kidney was more susceptible to OTA than the adult kidney. Significant increases in multi-oocyte follicles (MOFs) and proportional changes in resting and growing follicles were observed in F1 female ovaries. Plasma testosterone was reduced in F0 males, and there were negative effects on sperm quality in F0 and F1 male rats. The results confirm that continuous dietary exposure to OTA causes post-implantation fetotoxicity in dams, and renal and reproductive toxicity in their male and female offspring.
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Affiliation(s)
- G S Bondy
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - I H C Curran
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - L C Coady
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - C Armstrong
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - C Bourque
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - S Bugiel
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - D Caldwell
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - K Kwong
- Ontario Food Laboratory, Laboratories Directorate, Regulatory Operations and Enforcement Branch, Toronto, Ontario, M1P 4R7, Canada
| | - D E Lefebvre
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - C Maurice
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - F Marchetti
- Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - P P Pantazopoulos
- Ontario Food Laboratory, Laboratories Directorate, Regulatory Operations and Enforcement Branch, Toronto, Ontario, M1P 4R7, Canada
| | - N Ross
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada
| | - A M Gannon
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, K1A 0K9, Canada.
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16
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Kelly MA, McCabe E, Bergin D, Kearns SR, McCabe JP, Armstrong C, Heaney F, Carey JJ. Osteoporotic Vertebral Fractures are Common in Hip Fracture Patients and are Under-recognized. J Clin Densitom 2021; 24:183-189. [PMID: 32546345 DOI: 10.1016/j.jocd.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The vertebrae are the most common site for osteoporotic fracture. While they can result in disability and increased mortality, only one-third present clinically. People with multiple fractures are at greater risk of future fractures. Most hip fracture patients are neither diagnosed nor treated for their underlying osteoporosis. Computed tomography (CT) studies are often performed on hospitalised patients, can be used to diagnose osteoporosis and are gaining popularity for opportunistic osteoporosis screening by measuring BMD and other bone strength indices. The aim of this study was to assess the prevalence of vertebral fractures on CT pulmonary angiograms (CTPA) in a cohort of hip fracture patients and whether this increased their diagnosis and treatment rates. METHODS We retrospectively identified all hip fractures admitted to our institution between 2010 and 2017 to identify those who underwent CTPA scans. An independent, blinded consultant musculoskeletal radiologist reviewed the images for vertebral fractures and quantified severity using Genant criteria. Results were compared to the original radiology report, discharge diagnoses and treatment rates for osteoporosis. RESULTS Eleven percent (225/2122) of patients had CTPA images available. Seventy percent (158) were female with a mean age of 78 years (SD: 11). The median length of stay for all patients was 16 days (1-301). Forty percent (90) of patients had at least one vertebral fracture present and 20% (46) had more than one fracture. Only one in 5 radiology reports noted the fractures. 24% of subjects had osteoporosis treatment recorded at hospital discharge and there was no difference between those with vertebral fractures to those without. CONCLUSION Many hip fracture patients have undiagnosed spine fractures. A screening strategy which evaluates CT scans for fractures has potential to increase diagnosis and treatment rates of osteoporosis. However, more work is needed to increase awareness.
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Affiliation(s)
- Michael A Kelly
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland
| | - Eva McCabe
- Department of Rheumatology, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland.
| | - Diane Bergin
- Department of Radiology, Galway University Hospitals, Ireland
| | - Stephen R Kearns
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Ireland
| | - John J Carey
- Department of Rheumatology, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
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17
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Robinson HK, Zaklyazminskaya E, Povolotskaya I, Surikova Y, Mallin L, Armstrong C, Mabin D, Benke PJ, Chrisant MR, McDonald M, Marboe CC, Agre KE, Deyle DR, McWalter K, Douglas G, Balashova MS, Kaimonov V, Shirokova N, Pomerantseva E, Turner CL, Ellard S. Biallelic variants in PPP1R13L cause paediatric dilated cardiomyopathy. Clin Genet 2020; 98:331-340. [PMID: 32666529 DOI: 10.1111/cge.13812] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/12/2020] [Accepted: 06/29/2020] [Indexed: 12/21/2022]
Abstract
Childhood dilated cardiomyopathy (DCM) is a leading cause of heart failure requiring cardiac transplantation and approximately 5% of cases result in sudden death. Knowledge of the underlying genetic cause can aid prognostication and clinical management and enables accurate recurrence risk counselling for the family. Here we used genomic sequencing to identify the causative genetic variant(s) in families with children affected by severe DCM. In an international collaborative effort facilitated by GeneMatcher, biallelic variants in PPP1R13L were identified in seven children with severe DCM from five unrelated families following exome or genome sequencing and inheritance-based variant filtering. PPP1R13L encodes inhibitor of apoptosis-stimulating protein of p53 protein (iASPP). In addition to roles in apoptosis, iASPP acts as a regulator of desmosomes and has been implicated in inflammatory pathways. DCM presented early (mean: 2 years 10 months; range: 3 months-9 years) and was progressive, resulting in death (n = 3) or transplant (n = 3), with one child currently awaiting transplant. Genomic sequencing technologies are valuable for the identification of novel and emerging candidate genes. Biallelic variants in PPP1R13L were previously reported in a single consanguineous family with paediatric DCM. The identification here of a further five families now provides sufficient evidence to support a robust gene-disease association between PPP1R13L and severe paediatric DCM. The PPP1R13L gene should be included in panel-based genetic testing for paediatric DCM.
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Affiliation(s)
- H K Robinson
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - E Zaklyazminskaya
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow, Russia.,NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - I Povolotskaya
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - Y Surikova
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - L Mallin
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - C Armstrong
- Paediatric Cardiac Service, Bristol Royal Hospital for Children, Bristol, UK
| | - D Mabin
- Paediatrics Service, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - P J Benke
- Clinical Genetics Dpt, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - M R Chrisant
- Clinical Genetics Dpt, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - M McDonald
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina, USA
| | - C C Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Centre, New York, New York, USA
| | - K E Agre
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - D R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - K McWalter
- Clinical Genomics, GeneDx Inc, Gaithersburg, Maryland, USA
| | - G Douglas
- Clinical Genomics, GeneDx Inc, Gaithersburg, Maryland, USA
| | - M S Balashova
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia.,Chair of Genetics, I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V Kaimonov
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - N Shirokova
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - E Pomerantseva
- NGS Laboratory
- Genotyping Laboratory
- Genetic Counseling Department, Centre of Genetics and Reproductive Medicine "Genetico", Moscow, Russia
| | - C L Turner
- Peninsula Clinical Genetics Service, Department of Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Ellard
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, Exeter, UK
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18
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Vergnano S, Alders N, Armstrong C, Bamber AR, Bandi S, Evans JA, Hajiani N, Kenny J, Kucera F, Tometzki A, Uzun O, Wilkinson N, Ramanan AV. Severe refractory Kawasaki disease in seven infants in the COVID-19 era. Lancet Rheumatol 2020; 2:e520. [PMID: 32838312 PMCID: PMC7351415 DOI: 10.1016/s2665-9913(20)30231-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Stefania Vergnano
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Nele Alders
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Catherine Armstrong
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Andrew R Bamber
- Department of Paediatrics, North Bristol NHS Trust, Bristol, UK
| | - Srini Bandi
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Jennifer A Evans
- Department of Paediatrics, Cardiff and Vale University Health Board-Child Health, Cardiff, UK
| | - Nadia Hajiani
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Julia Kenny
- Department of Paediatric Infectious Diseases, Evelina London Children's Healthcare, London, UK
| | - Filip Kucera
- Department of Paediatric Cardiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Andrew Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Orhan Uzun
- Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
| | - Nick Wilkinson
- Department of Paediatric Rheumatology, Evelina London Children's Healthcare, London, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
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19
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McCabe E, Ibrahim A, Singh R, Kelly M, Armstrong C, Heaney F, Bergin D, McCabe JP, Carey JJ. A systematic review of the Irish osteoporotic vertebral fracture literature. Arch Osteoporos 2020; 15:34. [PMID: 32124074 DOI: 10.1007/s11657-020-0704-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Vertebral fractures (VF) are the most common osteoporotic fracture. They are associated with significant morbidity and mortality and are an important predictor of future fractures. The epidemiology of VF in Ireland is limited and a greater understanding of their scale and impact is needed. Therefore, we conducted a systematic review of publications on osteoporotic VF in Ireland. METHODS Systematic searches were conducted using PubMed, Medline, Embase, Scopus and Cochrane electronic databases to identify eligible publications from Ireland addressing osteoporotic VF. RESULTS Twenty studies met the inclusion criteria out of 1558 citations. All studies were published since 2000. Data was obtained on 182,771 patients with fractures. Nine studies included more than 100 subjects and three included more than 1000. Females accounted for 70% with an overall mean age of 65.2 years (30-94). There was significant heterogeneity in study design, methods and outcome measures including the following: use of administrative claims data on public hospital admissions, surgical and medical interventions, the impact of a fracture liaison service and the osteoporosis economic burden. The prevalence of VF was difficult to ascertain due to definitions used and differences in the study populations. Only two studies systematically reviewed spine imaging using blinded assessors and validated diagnostic criteria to assess the prevalence of fractures in patient cohorts. CONCLUSIONS Several studies show that VF are common when addressed systematically and the prevalence may be rising. However, there is a deficit of large studies systematically addressing the epidemiology and their importance in Ireland.
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Affiliation(s)
- Eva McCabe
- School of Medicine, National University of Ireland, Galway, Ireland. .,Department of Rheumatology, Galway University Hospital, Galway, Ireland.
| | - Ammar Ibrahim
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Rajneet Singh
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Michael Kelly
- Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Catherine Armstrong
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Fiona Heaney
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Diane Bergin
- Department of Radiology, Galway University Hospital, Galway, Ireland
| | - John P McCabe
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
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20
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Gunning AC, Strucinska K, Muñoz Oreja M, Parrish A, Caswell R, Stals KL, Durigon R, Durlacher-Betzer K, Cunningham MH, Grochowski CM, Baptista J, Tysoe C, Baple E, Lahiri N, Homfray T, Scurr I, Armstrong C, Dean J, Fernandez Pelayo U, Jones AW, Taylor RW, Misra VK, Yoon WH, Wright CF, Lupski JR, Spinazzola A, Harel T, Holt IJ, Ellard S. Recurrent De Novo NAHR Reciprocal Duplications in the ATAD3 Gene Cluster Cause a Neurogenetic Trait with Perturbed Cholesterol and Mitochondrial Metabolism. Am J Hum Genet 2020; 106:272-279. [PMID: 32004445 PMCID: PMC7010973 DOI: 10.1016/j.ajhg.2020.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/10/2020] [Indexed: 11/16/2022] Open
Abstract
Recent studies have identified both recessive and dominant forms of mitochondrial disease that result from ATAD3A variants. The recessive form includes subjects with biallelic deletions mediated by non-allelic homologous recombination. We report five unrelated neonates with a lethal metabolic disorder characterized by cardiomyopathy, corneal opacities, encephalopathy, hypotonia, and seizures in whom a monoallelic reciprocal duplication at the ATAD3 locus was identified. Analysis of the breakpoint junction fragment indicated that these 67 kb heterozygous duplications were likely mediated by non-allelic homologous recombination at regions of high sequence identity in ATAD3A exon 11 and ATAD3C exon 7. At the recombinant junction, the duplication allele produces a fusion gene derived from ATAD3A and ATAD3C, the protein product of which lacks key functional residues. Analysis of fibroblasts derived from two affected individuals shows that the fusion gene product is expressed and stable. These cells display perturbed cholesterol and mitochondrial DNA organization similar to that observed for individuals with severe ATAD3A deficiency. We hypothesize that the fusion protein acts through a dominant-negative mechanism to cause this fatal mitochondrial disorder. Our data delineate a molecular diagnosis for this disorder, extend the clinical spectrum associated with structural variation at the ATAD3 locus, and identify a third mutational mechanism for ATAD3 gene cluster variants. These results further affirm structural variant mutagenesis mechanisms in sporadic disease traits, emphasize the importance of copy number analysis in molecular genomic diagnosis, and highlight some of the challenges of detecting and interpreting clinically relevant rare gene rearrangements from next-generation sequencing data.
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21
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Donovan G, Brown A, Von Hatten E, Armstrong C, Hardisty J. Introducing pharmacy students to the structure and function of general practice through undergraduate placements. Curr Pharm Teach Learn 2019; 11:1055-1064. [PMID: 31685176 DOI: 10.1016/j.cptl.2019.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/04/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to design and evaluate the introduction of a sustainable and feasible structure of placements in general practice for third-year pharmacy students at the University of Sunderland. The national agenda in the United Kingdom (UK) calls for an increased presence of pharmacists within general practice; therefore, development of placements in this is setting is aligned to the development of these new roles. EDUCATIONAL ACTIVITY AND SETTING The placements were located in general practice surgeries in the North East of England in the UK. Students engaged in activities which introduced them to the structure and function of general practice and familiarise them with the role of pharmacists and other practice staff. Two cohorts undertook the education activity during the development process. The first cohort was comprised of 213 students, with 193 students the following year. FINDINGS An action research approach was taken to evaluate and revise the design of the placement. The final design and delivery have been shown to have a positive impact on student learning experience, be feasible and sustainable. The placement was also successful at introducing students to potential future roles in general practice for pharmacists. SUMMARY This model of general practice placement provision was found to be a feasible and sustainable delivery model, which was well received by undergraduate students.
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Affiliation(s)
- Gemma Donovan
- School of Pharmacy and Pharmaceutical Sciences, Faculty of Health Sciences and Wellbeing, University of Sunderland, Dale Building, Pasteur 153, Sciences Complex, Wharncliffe Street, Sunderland SR1 3SD, United Kingdom.
| | - Andrew Brown
- CBC Health Ltd, Building 7, Queens Park, Queensway North, Team Valley, Gateshead, Tyne and Wear NE11 0QD, United Kingdom.
| | - Emily Von Hatten
- School of Pharmacy and Pharmaceutical Sciences, Faculty of Health Sciences and Wellbeing, University of Sunderland, Dale Building, Sciences Complex, Wharncliffe Street, Sunderland SR1 3SD, United Kingdom.
| | - Catherine Armstrong
- CBC Health Ltd, Building 7, Queens Park, Queensway North, Team Valley, Gateshead, Tyne and Wear NE11 0QD, United Kingdom.
| | - Jessica Hardisty
- School of Pharmacy and Pharmaceutical Sciences, Faculty of Health Sciences and Wellbeing, University of Sunderland, Dale Building, Pasteur 153, Sciences Complex, Wharncliffe Street, Sunderland SR1 3SD, United Kingdom.
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22
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Kiran M, Donnelly TD, Armstrong C, Kapoor B, Kumar G, Peter V. Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. Bone Joint J 2019; 101-B:910-914. [PMID: 31362552 DOI: 10.1302/0301-620x.101b8.bjj-2018-0929.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.
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Affiliation(s)
- M Kiran
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - T D Donnelly
- Trauma and Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK
| | - C Armstrong
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - B Kapoor
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - G Kumar
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - V Peter
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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23
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Kiran M, Makridis KG, Armstrong C, Kapoor B, Kumar G, Peter V. Withdrawn: A Randomized Controlled Trial Comparing Modular and Nonmodular Neck Versions of a Titanium Stem. J Arthroplasty 2018:S0883-5403(18)30820-9. [PMID: 30316623 DOI: 10.1016/j.arth.2018.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/01/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Manish Kiran
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Konstantinos G Makridis
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Catherine Armstrong
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Birender Kapoor
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Gunasekaran Kumar
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Viju Peter
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
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24
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Kiran M, Lacey A, Awad M, Armstrong C, Airey N, Peter V. Enhanced recovery protocol in total hip replacement does not increase general practitioner visits. Br J Anaesth 2018; 121:682-683. [PMID: 30115274 DOI: 10.1016/j.bja.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/02/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022] Open
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O’Callaghan BM, Hancox JC, Stuart AG, Armstrong C, Williams MM, Hills A, Pearce H, Dent CL, Gable M, Walsh MA. A unique triadin exon deletion causing a null phenotype. HeartRhythm Case Rep 2018; 4:514-518. [PMID: 30479949 PMCID: PMC6241331 DOI: 10.1016/j.hrcr.2018.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Jules C. Hancox
- School of Physiology and Pharmacology, Cardiovascular Research Laboratories, University of Bristol, Bristol, United Kingdom
| | - Alan G. Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Maggie M. Williams
- Genomic Diagnostics Laboratory, University Hospital Bristol, Bristol, United Kingdom
| | - Alison Hills
- Genomic Diagnostics Laboratory, University Hospital Bristol, Bristol, United Kingdom
| | - Hazel Pearce
- Genomic Diagnostics Laboratory, University Hospital Bristol, Bristol, United Kingdom
| | - Carolyn L. Dent
- Genomic Diagnostics Laboratory, University Hospital Bristol, Bristol, United Kingdom
| | - Mary Gable
- Genomic Diagnostics Laboratory, University Hospital Bristol, Bristol, United Kingdom
| | - Mark A. Walsh
- Bristol Royal Hospital for Children, Bristol, United Kingdom
- Address reprint requests and correspondence: Dr Mark A. Walsh, Our Lady's Children's Hospital, Crumlin, Cooley Road, Drimnagh, Dublin, Ireland.
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Liu H, Liao GQ, Zhang YH, Zhu BJ, Zhang Z, Li YT, Scott GG, Rusby DR, Armstrong C, Zemaityte E, Carroll DC, Astbury S, Bradford P, Woolsey NC, McKenna P, Neely D. Cherenkov radiation-based optical fibre diagnostics of fast electrons generated in intense laser-plasma interactions. Rev Sci Instrum 2018; 89:083302. [PMID: 30184626 DOI: 10.1063/1.5024872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/21/2018] [Indexed: 06/08/2023]
Abstract
Diagnosing fast electrons is important to understand the physics underpinning intense laser-produced plasmas. Here, we demonstrate experimentally that a Cherenkov radiation-based optical fibre can serve as a reliable diagnostic to characterize the fast electrons escaping from solid targets irradiated by ultra-intense laser pulses. Using optical fibre loops, the number and angular distributions of the escaping electrons are obtained. The data agree well with measurements made using image plate stacks. The optical fibre can be operated at high-repetition rates and is insensitive to x-rays and ion beams, which makes it advantageous over other routinely used fast electron diagnostics in some aspects.
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Affiliation(s)
- H Liu
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - G-Q Liao
- Key Laboratory for Laser Plasmas (MoE) and School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Y-H Zhang
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - B-J Zhu
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Z Zhang
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - Y-T Li
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - G G Scott
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D R Rusby
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - C Armstrong
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - E Zemaityte
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - D C Carroll
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - S Astbury
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
| | - P Bradford
- Department of Physics, York Plasma Institute, University of York, Heslington York YO10 5DD, United Kingdom
| | - N C Woolsey
- Department of Physics, York Plasma Institute, University of York, Heslington York YO10 5DD, United Kingdom
| | - P McKenna
- Department of Physics, SUPA, University of Strathclyde, Glasgow G4 0NG, United Kingdom
| | - D Neely
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0QX, United Kingdom
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Ryu S, Moon A, Youn C, Howland A, Armstrong C, Song P. 1176 Mechanistic analysis of B16F10 melanoma cell death induced by treatment with recombinant TRAIL and bortezomib. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1191] [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: 11/17/2022]
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Yourshaw J, Armstrong C, Mishra P, Steinberg D, Ramu B, Craig M, Van Bakel A, Tedford R, Houston B. Effects of Percutaneous LVAD Support on Right Ventricular Load and Adaptation Acutely and Over Time. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.096] [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: 11/30/2022] Open
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Mccarron A, Xu J, Armstrong C, Glynn G, Millar BC, Mcclurg RB, Han L, Goldsmith CE, Rooney PJ, Moore JE. Comparison of the identification of Acinetobacter spp. with API20NE and 16S rRNA gene sequencing techniques. Br J Biomed Sci 2018; 68:94-7. [DOI: 10.1080/09674845.2011.11978233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A.J. Mccarron
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine, Northern Ireland
| | - J. Xu
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
- Department of Immunology and Pathogenic Biology, Molecular Bacteriology Laboratory, Key Laboratory of Environment and Genes related to Diseases of Chinese Ministry of Education, School of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China, Northern Ireland
| | - C. Armstrong
- Department of Microbiology, Craigavon Area Hospital, Craigavon, Co. Armagh, Northern Ireland
| | - G. Glynn
- Department of Microbiology,, Altnagelvin Hospital, Glenshane Road, Londonderry, Co. Londonderry, Northern Ireland
| | - B. C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
| | - R. B. Mcclurg
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
| | - L. Han
- Department of Immunology and Pathogenic Biology, Molecular Bacteriology Laboratory, Key Laboratory of Environment and Genes related to Diseases of Chinese Ministry of Education, School of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China, Northern Ireland
| | - C. E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
| | - P. J. Rooney
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
| | - J. E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, Northern Ireland
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine, Northern Ireland
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Kiran M, Armstrong C, Shivarathre D, Peter VK. Blood Metal Ion Levels Have Limited Utility in the Surveillance of Asymptomatic Large-Head Metal-on-Metal Total Hip Arthroplasties. J Arthroplasty 2017; 32:3685-3688. [PMID: 28781016 DOI: 10.1016/j.arth.2017.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Blood cobalt (Co) and chromium (Cr) ion levels have been used as surveillance tools for adverse reaction to metal debris (ARMD) in metal-on-metal (MoM) articulations with varying thresholds in different countries. The aim of our study is to present the serial 12-year blood Co and Cr levels in a cohort of MoM total hip arthroplasties (THAs) with femoral head size ≥36 mm and analyze their utility in asymptomatic patients at current thresholds. METHODS A total of 256 patients with unilateral MoM THA with femoral head size ≥36 mm were included in this study with data collected prospectively. The implants used were Birmingham hip resurfacing cup-Freeman stem (BHR-F) or an Articular Surface Resurfacing cup-Corail/S-ROM stem. Annual follow-up with blood Co and Cr measurements was done as per Medicines and Healthcare Products Regulatory Agency (MHRA) of the United Kingdom guidelines. Receiver operating characteristic curve was plotted based on the sensitivity and specificity of blood metal ion values to detect ARMD. The metal ion levels in asymptomatic patients were analyzed separately. RESULTS Receiver operating characteristic curves showed poor discriminatory ability for both Co and Cr values in predicting ARMD at 7 μg/L. The sensitivity of Co and Cr was 82.1% and 53.5%, respectively, and their positive predictive values were 43.8% and 67.6%, respectively. After 7 years, there was no significant change in Co values, and there was a decline in Cr value after 9 years in asymptomatic patients. CONCLUSION To the best of our knowledge, this is the first study to describe the behavior of serial blood metal ion levels in asymptomatic large-diameter MoM THA. We suggest that annual blood Co and Cr have limited discriminant capacity in diagnosing the occurrence of metallosis and their measurement beyond 7 years is of limited utility in asymptomatic patients.
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Affiliation(s)
- Manish Kiran
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Catherine Armstrong
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Deepak Shivarathre
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
| | - Viju K Peter
- Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool, United Kingdom
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Maxwell P, Labonte M, McKechnie M, Duddy O, Armstrong C, Ong C, Zoubeidi A, Worthington J, Waugh D. Treatment-induced hypoxia attenuates enzalutamide response and promotes resistance in pre-clinical models of prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.028] [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: 11/12/2022] Open
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32
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Reynolds TD, Armstrong C, Ramanan AV. Cardiac involvement as a presenting feature of eosinophilic granulomatosis with polyangiitis in childhood. Clin Exp Rheumatol 2017; 35 Suppl 103:225. [PMID: 28339359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Timothy D Reynolds
- Department of Rheumatology/Medical Education, North Bristol NHS Trust, Bristol, UK.
| | - Catherine Armstrong
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol & Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK
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O'connor P, O'dea A, Lydon S, Offiah G, Scott J, Flannery A, Lang B, Hoban A, Armstrong C, Byrne D. A mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses. Int J Qual Health Care 2016; 28:339-45. [PMID: 27090400 DOI: 10.1093/intqhc/mzw036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aimed to collect and analyse examples of poor teamwork between junior doctors and nurses; identify the teamwork failures contributing to poor team function; and ascertain if particular teamwork failures are associated with higher levels of risk to patients. DESIGN Critical Incident Technique interviews were carried out with junior doctors and nurses. SETTING Two teaching hospitals in the Republic of Ireland. PARTICIPANTS Junior doctors (n = 28) and nurses (n = 8) provided descriptions of scenarios of poor teamwork. The interviews were coded against a theoretical framework of healthcare team function by three psychologists and were also rated for risk to patients by four doctors and three nurses. RESULTS A total of 33 of the scenarios met the inclusion criteria for analysis. A total of 63.6% (21/33) of the scenarios were attributed to 'poor quality of collaboration', 42.4% (14/33) to 'poor leadership' and 48.5% (16/33) to a 'lack of coordination'. A total of 16 scenarios were classified as high risk and 17 scenarios were classified as medium risk. Significantly more of the high-risk scenarios were associated with a 'lack of a shared mental model' (62.5%, 10/16) and 'poor communication' (50.0%, 8/16) than the medium-risk scenarios (17.6%, 3/17 and 11.8%, 2/17, respectively). CONCLUSION Poor teamwork between junior doctors and nurses is common and places patients at considerable risk. Addressing this problem requires a well-designed complex intervention to develop the team skills of doctors and nurses and foster a clinical environment in which teamwork is supported.
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Affiliation(s)
- Paul O'connor
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - Angela O'dea
- West North West Intern Training Network, Galway, Ireland
| | - Sinéad Lydon
- School of Psychology, Trinity College, Dublin, Ireland
| | | | | | | | | | | | | | - Dara Byrne
- Saolta Healthcare Group, Galway, Ireland
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Mccarron A, Armstrong C, Glynn G, Millar B, Rooney P, Goldsmith C, Xu J, Moore J. Antibacterial effects on Acinetobacter species of commonly employed antineoplastic agents used in the treatment of haematological malignancies: an in vitro laboratory evaluation. Br J Biomed Sci 2016; 69:14-7. [DOI: 10.1080/09674845.2012.11669916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A.J. Mccarron
- Northern Ireland Public Health Laboratory, Department of Bacteriology Belfast City Hospital
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine
| | - C. Armstrong
- Department of Microbiology, Altnagelvin Hospital, Glenshane Road, Londonderry Northern Ireland
| | - G. Glynn
- Department of Microbiology, Altnagelvin Hospital, Glenshane Road, Londonderry Northern Ireland
| | - B.C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology Belfast City Hospital
| | - P.J. Rooney
- Northern Ireland Public Health Laboratory, Department of Bacteriology Belfast City Hospital
| | - C.E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology Belfast City Hospital
| | - J. Xu
- Department of Immunology and Pathogenic Biology, Molecular Bacteriology Laboratory, School of Medicine, Xi’an Jiaotong University, People’s Republic of China
| | - J.E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology Belfast City Hospital
- School of Biomedical Sciences, Centre for Molecular Biosciences, University of Ulster, Coleraine
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Armstrong C, Hamilton L, Shenkin SD. 26 * FACTORS PREDICTIVE OF NURSING HOME ADMISSION DIRECTLY FROM HOSPITAL: A SYSTEMATIC REVIEW. Age Ageing 2015. [DOI: 10.1093/ageing/afv029.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Solomon PM, Bryce BA, Kuroda MA, Keech R, Shetty S, Shaw TM, Copel M, Hung LW, Schrott AG, Armstrong C, Gordon MS, Reuter KB, Theis TN, Haensch W, Rossnagel SM, Miyazoe H, Elmegreen BG, Liu XH, Trolier-McKinstry S, Martyna GJ, Newns DM. Pathway to the piezoelectronic transduction logic device. Nano Lett 2015; 15:2391-2395. [PMID: 25793915 DOI: 10.1021/nl5046796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The piezoelectronic transistor (PET) has been proposed as a transduction device not subject to the voltage limits of field-effect transistors. The PET transduces voltage to stress, activating a facile insulator-metal transition, thereby achieving multigigahertz switching speeds, as predicted by modeling, at lower power than the comparable generation field effect transistor (FET). Here, the fabrication and measurement of the first physical PET devices are reported, showing both on/off switching and cycling. The results demonstrate the realization of a stress-based transduction principle, representing the early steps on a developmental pathway to PET technology with potential to contribute to the IT industry.
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Affiliation(s)
- P M Solomon
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - B A Bryce
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - M A Kuroda
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
- ‡Department of Physics, Auburn University, Auburn, Alabama 36849, United States
| | - R Keech
- §Department of Materials Science and Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - S Shetty
- §Department of Materials Science and Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - T M Shaw
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - M Copel
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - L-W Hung
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - A G Schrott
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - C Armstrong
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - M S Gordon
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - K B Reuter
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - T N Theis
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - W Haensch
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - S M Rossnagel
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - H Miyazoe
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - B G Elmegreen
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - X-H Liu
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - S Trolier-McKinstry
- §Department of Materials Science and Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, United States
| | - G J Martyna
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
| | - D M Newns
- †IBM T. J. Watson Research Center, Yorktown Heights, New York 10598, United States
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Patrick K, Lau W, Gassas A, McDougall E, Doyle J, Ali M, Krueger J, Courtney S, Armstrong C, Egeler RM, Schechter T. Major ABO incompatible BMT in children: determining what residual volume of donor red cells can safely be infused following red cell depletion. Bone Marrow Transplant 2015; 50:536-9. [PMID: 25621802 DOI: 10.1038/bmt.2014.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/03/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
Abstract
Major ABO incompatible BM transplantation carries a risk of acute haemolysis. Red cell depletion reduces this risk but not all incompatible RBC (iRBCs) are removed and in children the residual volume can be significant relative to body weight. We sought to determine the volume of iRBCs that can be safely given to children. All patients receiving fresh BM from a donor with a major ABO blood group mismatch between January 2000 and July 2013 at the Hospital for Sick Children, Toronto, were included. Seventy-eight patients were identified. The median volume of iRBCs transfused was 1.6 mL/kg (range 0.1-10.6 mL/kg). Thirty-five patients had minor haemolytic events and five patients had clinically significant adverse events. Two patients, who received 3.66 and 3.9 mL iRBCs/kg, developed renal impairment and in one case hypoxia and hyperbilirubinaemia. One patient had mild hypotension that resolved with i.v. fluid. Two patients developed hypotension secondary to sepsis and unrelated to BM infusion. Although signs of haemolysis occur, with appropriate hydration and monitoring of renal function, clinically significant adverse events related to the infusion of ABO incompatible BM are rare, and, in this study, were only seen in patients receiving >3 mL/kg of iRBCs per kg.
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Affiliation(s)
- K Patrick
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - W Lau
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - A Gassas
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - E McDougall
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Doyle
- Division of Paediatric Haematology/Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - M Ali
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - J Krueger
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Courtney
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - C Armstrong
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - R M Egeler
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - T Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kunheri B, Arjunan A, Krishnan P, Pillai B, Prasad S, Bernier-Chastagner V, Desandes E, Carrie C, Alapetite C, Hankinson T, Jones D, Handler M, Foreman N, Liu A, Smiley NP, Alden T, Hartsell W, Fangusaro J, Hill-Kayser CE, Lustig RA, Minturn JE, Both S, Waanders AJ, Belasco JB, Armstrong C, Phillips PC, Fisher MJ, Hill-Kayser CE, Paltin I, Lustig RA, Fisher MJ, Both S, Belasco JB, Cole KA, Waanders AJ, Phillips PC, Minturn JE, Wells E, Vezina G, Kilburn L, Rood B, Crozier F, Hwang E, Packer R, Janssens GO, van den Bosch S, van Kollenburg PG, Gidding CE, Schieving JH, Kaanders JH, van Lindert EJ, Kramer K, Pandit-Taskar N, Souweidane MM, Wolden S, DeSelm C, Cheung NKV, Lassen-Ramshad Y, Hansen J, Seiersen K, Petersen JBB, Mahajan A, Grosshans D, Ris D, Chintagumpala M, Okcu F, McAleer MF, Moore B, Stancel H, Minard C, Guffey D, Kahalley L, Blomgren K, Zhou K, Xie C, Zhu C, McAleer MF, Zhao Z, Weinberg J, Sandberg D, Hughes D, Mahajan A, Anderson P, Guha-Thakurta N, Muller K, Hoffmann M, Seidel C, Warmuth-Metz M, Pietsch T, Kordes U, Sander A, Rossler J, Graf N, Scheithauer H, Kortmann RD, Kramm CM, von Bueren AO, Gunther J, Sato M, Chintagumpala M, Jo E, Paulino A, Adesina A, Ketonen L, Jones J, Su J, Okcu F, Khatua S, Dauser R, Whitehead W, Weinberg J, Mahajan A, Gandola L, Pecori E, Biassoni V, Chiruzzi C, Schiavello E, Meroni S, Spreafico F, Pignoli E, Massimino M, Jalali R, Krishna U, Gupta T, Goswami S, Deodhar J, Dutta D, Kannan S, Goel A, Sarin R, Sastry J, Ronghe M, Murphy D, Forbes K, Jones R, Cowie F, Brown J, Indelicato D, Goksel EO, Tezcanli E, Bilge H, Yasemin, Yarar Y, Sato M, Gunther J, Mahajan A, Jo E, Paulino A, Adesina A, Jones J, Ketonen L, Su J, Okcu M, Khatua S, Dauser R, Whitehead W, Weinberg J, Chintagumpala M, Paulino A, Jo E, Sato M, Su J, Okcu MF, Mahajan A, Dauser R, Whitehead W, Adesina A, Chintagumpala M, Danielsson A, Tisell M, Rydenhag B, Caren H. RADIATION ONCOLOGY. Neuro Oncol 2014; 16:i117-i122. [PMCID: PMC4046296 DOI: 10.1093/neuonc/nou080] [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: 09/10/2023] Open
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Huber GM, Blok HP, Butuceanu C, Gaskell D, Horn T, Mack DJ, Abbott D, Aniol K, Anklin H, Armstrong C, Arrington J, Assamagan K, Avery S, Baker OK, Barrett B, Beise EJ, Bochna C, Boeglin W, Brash EJ, Breuer H, Chang CC, Chant N, Christy ME, Dunne J, Eden T, Ent R, Fenker H, Gibson EF, Gilman R, Gustafsson K, Hinton W, Holt RJ, Jackson H, Jin S, Jones MK, Keppel CE, Kim PH, Kim W, King PM, Klein A, Koltenuk D, Kovaltchouk V, Liang M, Liu J, Lolos GJ, Lung A, Margaziotis DJ, Markowitz P, Matsumura A, McKee D, Meekins D, Mitchell J, Miyoshi T, Mkrtchyan H, Mueller B, Niculescu G, Niculescu I, Okayasu Y, Pentchev L, Perdrisat C, Pitz D, Potterveld D, Punjabi V, Qin LM, Reimer PE, Reinhold J, Roche J, Roos PG, Sarty A, Shin IK, Smith GR, Stepanyan S, Tang LG, Tadevosyan V, Tvaskis V, van der Meer RLJ, Vansyoc K, Van Westrum D, Vidakovic S, Volmer J, Vulcan W, Warren G, Wood SA, Xu C, Yan C, Zhao WX, Zheng X, Zihlmann B. Separated response function ratios in exclusive, forward π(±) electroproduction. Phys Rev Lett 2014; 112:182501. [PMID: 24856691 DOI: 10.1103/physrevlett.112.182501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Indexed: 06/03/2023]
Abstract
The study of exclusive π(±) electroproduction on the nucleon, including separation of the various structure functions, is of interest for a number of reasons. The ratio RL=σL(π-)/σL(π+) is sensitive to isoscalar contamination to the dominant isovector pion exchange amplitude, which is the basis for the determination of the charged pion form factor from electroproduction data. A change in the value of RT=σT(π-)/σT(π+) from unity at small -t, to 1/4 at large -t, would suggest a transition from coupling to a (virtual) pion to coupling to individual quarks. Furthermore, the mentioned ratios may show an earlier approach to perturbative QCD than the individual cross sections. We have performed the first complete separation of the four unpolarized electromagnetic structure functions above the dominant resonances in forward, exclusive π(±) electroproduction on the deuteron at central Q(2) values of 0.6, 1.0, 1.6 GeV(2) at W=1.95 GeV, and Q(2)=2.45 GeV(2) at W=2.22 GeV. Here, we present the L and T cross sections, with emphasis on RL and RT, and compare them with theoretical calculations. Results for the separated ratio RL indicate dominance of the pion-pole diagram at low -t, while results for RT are consistent with a transition between pion knockout and quark knockout mechanisms.
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Affiliation(s)
- G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H P Blok
- VU university, NL-1081 HV Amsterdam, The Netherlands and NIKHEF, Postbus 41882, NL-1009 DB Amsterdam, The Netherlands
| | - C Butuceanu
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Horn
- Catholic University of America, Washington, DC 20064, USA
| | - D J Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D Abbott
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Aniol
- California State University Los Angeles, Los Angeles, California 90032, USA
| | - H Anklin
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Florida International University, Miami, Florida 33119, USA
| | - C Armstrong
- College of William and Mary, Williamsburg, Virginia 23187, USA
| | - J Arrington
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - K Assamagan
- Hampton University, Hampton, Virginia 23668, USA
| | - S Avery
- Hampton University, Hampton, Virginia 23668, USA
| | - O K Baker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Hampton University, Hampton, Virginia 23668, USA
| | - B Barrett
- Saint Mary's University, Halifax, Nova Scotia B3H 3C3 Canada
| | - E J Beise
- University of Maryland, College Park, Maryland 20742, USA
| | - C Bochna
- University of Illinois, Champaign, Illinois 61801, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33119, USA
| | - E J Brash
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Breuer
- University of Maryland, College Park, Maryland 20742, USA
| | - C C Chang
- University of Maryland, College Park, Maryland 20742, USA
| | - N Chant
- University of Maryland, College Park, Maryland 20742, USA
| | - M E Christy
- Hampton University, Hampton, Virginia 23668, USA
| | - J Dunne
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Eden
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Norfolk State University, Norfolk, Virginia 23504, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - H Fenker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - E F Gibson
- California State University, Sacramento, California 95819, USA
| | - R Gilman
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - K Gustafsson
- University of Maryland, College Park, Maryland 20742, USA
| | - W Hinton
- Hampton University, Hampton, Virginia 23668, USA
| | - R J Holt
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - H Jackson
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S Jin
- Kyungpook National University, Daegu 702-701, Republic of Korea
| | - M K Jones
- College of William and Mary, Williamsburg, Virginia 23187, USA
| | - C E Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Hampton University, Hampton, Virginia 23668, USA
| | - P H Kim
- Kyungpook National University, Daegu 702-701, Republic of Korea
| | - W Kim
- Kyungpook National University, Daegu 702-701, Republic of Korea
| | - P M King
- University of Maryland, College Park, Maryland 20742, USA
| | - A Klein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - D Koltenuk
- University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - V Kovaltchouk
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - M Liang
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Liu
- University of Maryland, College Park, Maryland 20742, USA
| | - G J Lolos
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - A Lung
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D J Margaziotis
- California State University Los Angeles, Los Angeles, California 90032, USA
| | - P Markowitz
- Florida International University, Miami, Florida 33119, USA
| | | | - D McKee
- New Mexico State University, Las Cruces, New Mexico 88003-8001, USA
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Mitchell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | | | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory, Yerevan 0036, Armenia
| | - B Mueller
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - G Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - I Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | | | - L Pentchev
- College of William and Mary, Williamsburg, Virginia 23187, USA
| | - C Perdrisat
- College of William and Mary, Williamsburg, Virginia 23187, USA
| | - D Pitz
- DAPNIA/SPhN, CEA/Saclay, F-91191 Gif-sur-Yvette, France
| | - D Potterveld
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - V Punjabi
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - L M Qin
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - P E Reimer
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J Reinhold
- Florida International University, Miami, Florida 33119, USA
| | - J Roche
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - P G Roos
- University of Maryland, College Park, Maryland 20742, USA
| | - A Sarty
- Saint Mary's University, Halifax, Nova Scotia B3H 3C3 Canada
| | - I K Shin
- Kyungpook National University, Daegu 702-701, Republic of Korea
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Stepanyan
- A.I. Alikhanyan National Science Laboratory, Yerevan 0036, Armenia
| | - L G Tang
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and Hampton University, Hampton, Virginia 23668, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory, Yerevan 0036, Armenia
| | - V Tvaskis
- VU university, NL-1081 HV Amsterdam, The Netherlands and NIKHEF, Postbus 41882, NL-1009 DB Amsterdam, The Netherlands
| | | | - K Vansyoc
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - D Van Westrum
- University of Colorado, Boulder, Colorado 80309, USA
| | - S Vidakovic
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - J Volmer
- VU university, NL-1081 HV Amsterdam, The Netherlands and DESY, Hamburg, Germany
| | - W Vulcan
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G Warren
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C Xu
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - C Yan
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - W-X Zhao
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - X Zheng
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - B Zihlmann
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA and University of Virginia, Charlottesville, Virginia 22901, USA
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Copel M, Kuroda MA, Gordon MS, Liu XH, Mahajan SS, Martyna GJ, Moumen N, Armstrong C, Rossnagel SM, Shaw TM, Solomon PM, Theis TN, Yurkas JJ, Zhu Y, Newns DM. Giant piezoresistive on/off ratios in rare-earth chalcogenide thin films enabling nanomechanical switching. Nano Lett 2013; 13:4650-4653. [PMID: 24016226 DOI: 10.1021/nl401710f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sophisticated microelectromechanical systems for device and sensor applications have flourished in the past decade. These devices exploit piezoelectric, capacitive, and piezoresistive effects, and coupling between them. However, high-performance piezoresistivity (as defined by on/off ratio) has primarily been observed in macroscopic single crystals. In this Letter, we show for the first time that rare-earth monochalcogenides in thin film form can modulate a current by more than 1000 times due to a pressure-induced insulator to metal transition. Furthermore, films as thin as 8 nm show a piezoresistive response. The combination of high performance and scalability make these promising candidates for nanoscale applications, such as the recently proposed piezoelectronic transistor (PET). The PET would mechanically couple a piezoelectric thin film with a piezoresistive switching layer, potentially scaling to higher speeds and lower powers than today's complementary metal-oxide-semiconductor technology.
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Affiliation(s)
- M Copel
- IBM Research Division, T. J. Watson Research Center , P.O. Box 218, Yorktown Heights, New York 10598, United States
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Connolly GM, Armstrong C, Caputo M, Morgan GJ. Staged interventional and surgical management for complex low birthweight tetralogy of Fallot: another imperfect but legitimate strategy. BMJ Case Rep 2013; 2013:bcr2013201085. [PMID: 24081599 PMCID: PMC3794286 DOI: 10.1136/bcr-2013-201085] [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: 11/03/2022] Open
Abstract
Management of spelling low weight infants with complex tetralogy of Fallot is often fraught. We present a 2.8-kg infant with DiGeorge syndrome and spelling tetralogy with non-confluent pulmonary arteries, the left pulmonary artery being supplied by an aberrant ductus arteriosus from the left common carotid artery. We performed stenting of the outflow tract and the ductus to allow this patient to achieve a successful elective surgical correction.
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Affiliation(s)
| | - Catherine Armstrong
- Department of Paediatric Cardiology, Bristol Royal Hospital For Children, Bristol, UK
| | - Massimo Caputo
- Department of Congenital Heart Disease, Bristol Heart Institute, Bristol, Alabama, UK
| | - Gareth J Morgan
- Department of Paediatric Cardiology, Guy's Hospital, London, UK
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Newton AW, Ranganath L, Armstrong C, Peter V, Roberts NB. Differential distribution of cobalt, chromium, and nickel between whole blood, plasma and urine in patients after metal-on-metal (MoM) hip arthroplasty. J Orthop Res 2012; 30:1640-6. [PMID: 22447496 DOI: 10.1002/jor.22107] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 03/01/2012] [Indexed: 02/04/2023]
Abstract
Evidence shows that raised cobalt (Co), chromium (Cr), and nickel (Ni) whole blood concentrations correlate with poor device outcome in patients following metal-on-metal (MoM) hip arthroplasty. To understand the local and systemic pathological effects of these raised metal concentrations it is important to define their distribution between whole blood, plasma, and urine. The metals were measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS). Two hundred and five plasma, 199 whole blood, and 24 sets of urine samples were analyzed from 202 patients with Co-Cr alloy MoM hip prostheses implanted between 8 months to 12 years (mean 6.0 years) prior to analysis. Plasma Co (median 39.1 nmol/L) showed significantly positive 1:1 correlation with whole blood Co (median 45.9 nmol/L; R(2) = 0.98, p < 0.001, slope = 1.0). Plasma Cr (median 53.8 nmol/L) and whole blood Cr (median 40.3 nmol/L) were also correlated; however, concentrations were significantly higher in plasma indicating relatively little blood cell uptake (R(2) = 0.96, p < 0.001, slope = 1.6). Urinary Co was up to threefold higher than Cr (median 334.0 vs. 97.3 nmol/L respectively). Nickel concentrations in whole blood, plasma, and urine were low relative to Co and Cr. The analysis shows fundamental differences in the physiological handling of these metals: Co is distributed approximately equally between blood cells and plasma, whereas Cr is mainly in plasma, despite which, Cr had far less renal excretion than Co.
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Affiliation(s)
- Ashley W Newton
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, University of Liverpool, Prescot Street, Liverpool L7 8XP, United Kingdom.
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Sherry N, Qin J, Fuller MS, Xie Y, Mola O, Bauer M, McIntyre NS, Maxwell D, Liu D, Matias E, Armstrong C. Remote Internet access to advanced analytical facilities: a new approach with Web-based services. Anal Chem 2012; 84:7283-91. [PMID: 22894172 DOI: 10.1021/ac301513b] [Citation(s) in RCA: 9] [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: 11/30/2022]
Abstract
Over the past decade, the increasing availability of the World Wide Web has held out the possibility that the efficiency of scientific measurements could be enhanced in cases where experiments were being conducted at distant facilities. Examples of early successes have included X-ray diffraction (XRD) experimental measurements of protein crystal structures at synchrotrons and access to scanning electron microscopy (SEM) and NMR facilities by users from institutions that do not possess such advanced capabilities. Experimental control, visual contact, and receipt of results has used some form of X forwarding and/or VNC (virtual network computing) software that transfers the screen image of a server at the experimental site to that of the users' home site. A more recent development is a web services platform called Science Studio that provides teams of scientists with secure links to experiments at one or more advanced research facilities. The software provides a widely distributed team with a set of controls and screens to operate, observe, and record essential parts of the experiment. As well, Science Studio provides high speed network access to computing resources to process the large data sets that are often involved in complex experiments. The simple web browser and the rapid transfer of experimental data to a processing site allow efficient use of the facility and assist decision making during the acquisition of the experimental results. The software provides users with a comprehensive overview and record of all parts of the experimental process. A prototype network is described involving X-ray beamlines at two different synchrotrons and an SEM facility. An online parallel processing facility has been developed that analyzes the data in near-real time using stream processing. Science Studio and can be expanded to include many other analytical applications, providing teams of users with rapid access to processed results along with the means for detailed discussion of their significance.
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Affiliation(s)
- N Sherry
- Faculty of Science, The University of Western Ontario, London, ON, Canada
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Armstrong C, Pollock-BarZiv S, Doyle J, Egeler M, Gassas A, Schechter T. A Prospective Comparison of Self Reported Quality of Life of Children and Their Parents After Pediatric Hematopoietic Stem-Cell Transplantation. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.226] [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: 10/14/2022]
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Ingles J, Sarina T, Evans A, Yeates L, Kawa J, Hunt L, Connell V, Gray B, Armstrong C, Ogden K, Davis A, Weintraub R, Vohra J, McTaggart D, Winship I, McGaughran J, Atherton J, Semsarian C. The National Genetic Heart Disease Registry: An Update. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.667] [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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Ebreo D, Khan A, El-Meligy M, Armstrong C, Peter V. Metal ion levels decrease after revision for metallosis arising from large-diameter metal-on-metal hip arthroplasty. Acta Orthop Belg 2011; 77:777-781. [PMID: 22308623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Concerns have been renewed regarding the possible long-term effects of elevated circulating levels of cobalt and chromium as a direct result of implantation of large femoral head diameter metal-on-metal bearings. In order to establish whether metal ion levels remain persistently elevated, we compared metal ion levels before and after revision surgery in patients with large head diameter (greater than 38 mm) metal-on-metal total hip arthroplasty or hip resurfacing arthroplasty. At greater than one year post removal of a large-diameter metal-on-metal hip implant for the indication of symptomatic metallosis, metal ion levels were found to fall to almost normal levels.
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Affiliation(s)
- Darren Ebreo
- Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
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Abstract
Prediction of biliary excretion is a challenge for drug discovery scientists due to the lack of in vitro assays. This study explores the possibility of establishing a simple assay to predict in vivo biliary excretion via the mrp2 transport system. In vitro mrp2 activity was determined by measuring the ATP-dependent uptake of 5(6)-carboxy-2',7'-dichlorofluorescein (CDCF) in canalicular plasma membrane vesicles (cLPM) from rat livers. The CDCF uptake was time- and concentration-dependent (K(m) of 2.2 ± 0.3 µM and V(max) of 115 ± 26 pmol/mg/min) and strongly inhibited by the mrp2 inhibitors, benzbromarone, MK-571, and cyclosporine A, with IC(50) values ≤ 1.1 µM. Low inhibition of CDCF uptake by taurocholate (BSEP inhibitor; 57 µM) and digoxin (P-gp inhibitor; 101 µM) demonstrated assay specificity towards mrp2. A highly significant correlation (r(2) = 0.959) between the in vitro IC(50) values from the described mrp2 assay and in vivo biliary excretion in rats was observed using 10 literature compounds. This study demonstrated, for the first time, that a high throughput assay could be established with the capability of predicting biliary excretion in the rat using CDCF as a substrate.
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Affiliation(s)
- Federico Colombo
- Biological Sciences, Boehringer Ingelheim (Canada) Ltd., Laval, Québec, Canada
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Flinn F, Armstrong C. Junior doctors' extended work hours and the effects on their performance: the Irish case. Int J Qual Health Care 2011; 23:210-7. [DOI: 10.1093/intqhc/mzq088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Armstrong C, McTaggart D, Ogden K, DeSilva D. Hypertrophic Cardiomyopathy in a Northern Tasmanian Population: A Pilot Study. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.119] [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]
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Ingles J, Yeates L, Kawa J, Armstrong C, Thompson T, Connell V, DeSilva D, Davis A, Weintraub R, Vohra J, Winship I, McTaggart D, McGaughran J, Atherton J, Semsarian C. The Australian National Genetic Heart Disease Registry: An Update. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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