1
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Kolind S, Abel S, Taylor C, Tam R, Laule C, Li DK, Garren H, Gaetano L, Bernasconi C, Clayton D, Vavasour I, Traboulsee A. Myelin water imaging in relapsing multiple sclerosis treated with ocrelizumab and interferon beta-1a. NeuroImage: Clinical 2022; 35:103109. [PMID: 35878575 PMCID: PMC9421448 DOI: 10.1016/j.nicl.2022.103109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022] Open
Abstract
2-Year change in MS myelin water fraction favored ocrelizumab over interferon. Matched healthy controls showed no change in myelin water fraction over 2 years. Ocrelizumab appears to protect against demyelination in MS white matter and lesions.
Background Myelin water imaging is a magnetic resonance imaging (MRI) technique that quantifies myelin damage and repair in multiple sclerosis (MS) via the myelin water fraction (MWF). Objective In this substudy of a phase 3 therapeutic trial, OPERA II, MWF was assessed in relapsing MS participants assigned to interferon beta-1a (IFNb-1a) or ocrelizumab (OCR) during a two-year double-blind period (DBP) followed by a two-year open label extension (OLE) with ocrelizumab treatment. Methods MWF in normal appearing white matter (NAWM), including both whole brain NAWM and 5 white matter structures, and chronic lesions, was assessed in 29 OCR and 26 IFNb-1a treated participants at weeks 0, 24, 48 and 96 (DBP), and weeks 144 and 192 (OLE), and in white matter for 23 healthy control participants at weeks 0, 48 and 96. Results Linear mixed-effects models of data from baseline to week 96 showed a difference in the change in MWF over time favouring ocrelizumab in all NAWM regions. At week 192, lesion MWF was lower for participants originally randomised to IFNb-1a compared to those originally randomised to OCR. Controls showed no change in MWF over 96 weeks in any region. Conclusion Ocrelizumab appears to protect against demyelination in MS NAWM and chronic lesions and may allow for a more permissive micro environment for remyelination to occur in focal and diffusely damaged tissue.
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2
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Rammohan KW, Halper J, Lang S, Murphy SM, Patton L, Goodman C, Li DK. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS). Int J MS Care 2021; 23:269-275. [PMID: 35035298 PMCID: PMC8745232 DOI: 10.7224/1537-2073.2021-021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although many regional multiple sclerosis (MS) databases existed in the United States and Canada, there was no single clinician-derived registry that examined this disease as a group across the North American continent. This distinction is important because information that results from such a database can potentially give perspectives about MS that cannot be derived from any single regional registry. A partnership was forged between the pharmaceutical industry and the Consortium of Multiple Sclerosis Centers (CMSC) to create a registry of patients with MS from Canada and the United States, including Puerto Rico. Case report forms were created to collect physician-derived information, and the Patient-Reported Outcomes Measurement Information System (PROMIS) was selected to capture patient-reported outcomes. As of November 2021, 754 of 1000 patients have been enrolled. Completion of recruitment is expected by the end of 2021. Twenty-five centers are participating, with an expected total of 30, including five centers from Canada. Clinical status, health economic outcomes, magnetic resonance images, and, soon, biomarkers relevant to understanding relapses and progression are collected. The short-term goal is to understand and better treat MS disease progression, and the long-term goal is its prevention. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is one of few clinician/patient-generated registries that examines MS across North America, including Puerto Rico. Information derived from the natural history studies should help physicians, the pharmaceutical industry, and regulatory bodies understand MS better and improve quality of life for patients with MS worldwide.
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Affiliation(s)
| | - June Halper
- Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (JH)
| | - Steven Lang
- From the University of Miami, Miami, FL, USA (KWR, SL, CG)
| | | | - Lisa Patton
- Social & Scientific Systems, Silver Spring, MD, USA (SMM, LP)
| | | | - David K.B. Li
- University of British Columbia, Vancouver, BC, Canada (DKBL)
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3
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Zhu Z, Zhang B, Tang Y, Mei D, Li DK. [Peking Union Medical College Hospital and Its Training of Pharmaceutical Staff in the Republican Period]. Zhonghua Yi Shi Za Zhi 2021; 51:282-288. [PMID: 34794267 DOI: 10.3760/cma.j.cn112155-20200702-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Several training programs for the pharmacy staff in the Pharmacy Department of Beijing Union Medical College Hospital were implemented over 1910's to 1942, such as apprenticeships, prior courses on pharmaceutical sciences,vocational training, study overseas, and developing the Beiping Pharmacy Evening School in collaboration with the North China Pharmaceutical Society around the 1930's. These programs explored training models for the hospital, developed practical talent with competence ensuring the needs and requirements within the hospital, established practical education on pharmacy in Beiping and therefore contributed to promoting future pharmaceutical training systems in China.
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Affiliation(s)
- Z Zhu
- Department of Pharmacy, Peking Union Medical College Hospital,Chinese Academy Institute of Medical Sciences-Peking Union Medical College, Beijing 100730, China
| | - B Zhang
- Department of Pharmacy, Peking Union Medical College Hospital,Chinese Academy Institute of Medical Sciences-Peking Union Medical College, Beijing 100730, China
| | - Y Tang
- Department of Pharmacy, Peking Union Medical College Hospital,Chinese Academy Institute of Medical Sciences-Peking Union Medical College, Beijing 100730, China
| | - D Mei
- Department of Pharmacy, Peking Union Medical College Hospital,Chinese Academy Institute of Medical Sciences-Peking Union Medical College, Beijing 100730, China
| | - D K Li
- Department of Pharmacy, Peking Union Medical College Hospital,Chinese Academy Institute of Medical Sciences-Peking Union Medical College, Beijing 100730, China
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4
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Hernández‐Torres E, Wiggermann V, Machan L, Sadovnick AD, Li DK, Traboulsee A, Hametner S, Rauscher A. Increased mean R2* in the deep gray matter of multiple sclerosis patients: Have we been measuring atrophy? J Magn Reson Imaging 2018; 50:201-208. [DOI: 10.1002/jmri.26561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Enedino Hernández‐Torres
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
| | - Vanessa Wiggermann
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
| | - Lindsay Machan
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - A. Dessa Sadovnick
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
- Department of Medical GeneticsUniversity of British Columbia Vancouver Canada
| | - David K.B. Li
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain ResearchMedical University of Vienna Vienna Austria
- Institute of NeuropathologyUniversity Medical Center Göttingen Germany
| | - Alexander Rauscher
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- BC Children's Hospital Research InstituteUniversity of British Columbia Vancouver Canada
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5
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Vertinsky AT, Li DK, Vavasour IM, Miropolsky V, Zhao G, Zhao Y, Riddehough A, Moore GW, Traboulsee A, Laule C. Diffusely Abnormal White Matter, T2
Burden of Disease, and Brain Volume in Relapsing-Remitting Multiple Sclerosis. J Neuroimaging 2018; 29:151-159. [DOI: 10.1111/jon.12574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Alexandra T. Vertinsky
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - David K.B. Li
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Irene M. Vavasour
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Vladislav Miropolsky
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Guojun Zhao
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Andrew Riddehough
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
| | - G.R. Wayne Moore
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver British Columbia Canada
| | - Anthony Traboulsee
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver British Columbia Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
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6
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Vavasour IM, Meyers SM, Mädler B, Harris T, Fu E, Li DK, Traboulsee A, MacKay AL, Laule C. Multicenter Measurements of T1
Relaxation and Diffusion Tensor Imaging: Intra and Intersite Reproducibility. J Neuroimaging 2018; 29:42-51. [DOI: 10.1111/jon.12559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/20/2018] [Accepted: 08/26/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Irene M. Vavasour
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
| | - Sandra M. Meyers
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
| | | | - Trudy Harris
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
| | - Eric Fu
- Department of Statistics; University of British Columbia; Vancouver British Columbia Canada
| | - David K.B. Li
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Anthony Traboulsee
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Alex L. MacKay
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver British Columbia Canada
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Li DK, Yan P, Abou-Samra AB, Chung RT, Butt AA. Proton pump inhibitors are associated with accelerated development of cirrhosis, hepatic decompensation and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection: results from ERCHIVES. Aliment Pharmacol Ther 2018; 47:246-258. [PMID: 29105111 DOI: 10.1111/apt.14391] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 02/07/2017] [Revised: 03/12/2017] [Accepted: 09/30/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Proton pump inhibitors are among the most commonly prescribed medications in the United States. Their safety in cirrhosis has recently been questioned, but their overall effect on disease progression in noncirrhotic patients with chronic liver disease remains unclear. AIM To determine the impact of proton pump inhibitors on the progression of liver disease in noncirrhotic patients with hepatitis C virus (HCV) infection. METHODS Using the electronically retrieved cohort of HCV-infected veterans (ERCHIVES) database, we identified all subjects who received HCV treatment and all incident cases of cirrhosis, hepatic decompensation and hepatocellular carcinoma. Proton pump inhibitor use was measured using cumulative defined daily dose. Multivariate Cox regression analysis was performed after adjusting univariate predictors of cirrhosis and various indications for proton pump inhibitor use. RESULTS Among 11 526 eligible individuals, we found that exposure to proton pump inhibitors was independently associated with an increased risk of developing cirrhosis (hazard ratio [HR]: 1.32; 95% confidence interval: [1.17, 1.49]). This association remained robust to sensitivity analysis in which only patients who achieved sustained virologic response were analysed as well as analysis excluding those with alcohol abuse/dependence. Proton pump inhibitor exposure was also independently associated with an increased risk of hepatic decompensation (HR: 3.79 [2.58, 5.57]) and hepatocellular carcinoma (HR: 2.01 [1.50, 2.70]). CONCLUSIONS In patients with chronic HCV infection, increasing proton pump inhibitor use is associated with a dose-dependent risk of progression of chronic liver disease to cirrhosis, as well as an increased risk of hepatic decompensation and hepatocellular carcinoma.
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Affiliation(s)
- D K Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - P Yan
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - A-B Abou-Samra
- Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar
| | - R T Chung
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Gastroenterology, Department of Medicine, Liver Center, Massachusetts General Hospital, Boston, MA, USA
| | - A A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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8
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Combes AJ, Matthews L, Lee JS, Li DK, Carruthers R, Traboulsee AL, Barker GJ, Palace J, Kolind S. Cervical cord myelin water imaging shows degenerative changes over one year in multiple sclerosis but not neuromyelitis optica spectrum disorder. Neuroimage Clin 2017; 16:17-22. [PMID: 28725551 PMCID: PMC5503831 DOI: 10.1016/j.nicl.2017.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/08/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Spinal cord pathology is a feature of both neuromyelitis optica spectrum disorder (NMOSD) and relapsing-remitting multiple sclerosis (MS). While subclinical disease activity has been described in MS using quantitative magnetic resonance imaging measures, current evidence suggests that neurodegeneration is absent between relapses in NMOSD, although most evidence comes from brain studies. We aimed to assess cross-sectional differences and longitudinal changes in myelin integrity in relapse-free MS and NMOSD subjects over one year. 15 NMOSD, 15 MS subjects, and 17 healthy controls were scanned at 3 T using a cervical cord mcDESPOT protocol. A subset of 8 NMOSD, 11 MS subjects and 14 controls completed follow-up. Measures of the myelin water fraction (fM) within lesioned and non-lesioned cord segments were collected. At baseline, fM in lesioned and non-lesioned segments was significantly reduced in MS (lesioned: p = 0.002; non-lesioned: p = 0.03) and NMOSD (lesioned: p = 0.0007; non-lesioned: p = 0.002) compared to controls. Longitudinally, fM decreased within non-lesioned cord segments in the MS group (− 7.3%, p = 0.02), but not in NMOSD (+ 5.8%, p = 0.1), while change in lesioned segments fM did not differ from controls' in either patient group. These results suggest that degenerative changes outside of lesioned areas can be observed over a short time frame in MS, but not NMOSD, and support the use of longitudinal myelin water imaging for the assessment of pathological changes in the cervical cord in demyelinating diseases. MS and NMOSD subjects underwent longitudinal cervical cord myelin water imaging. Reduced myelin water fraction in MS and NMOSD normal-appearing and lesioned areas Decrease in myelin in normal-appearing tissue over 1 year in MS, but not NMOSD Further evidence that disease progression is absent between relapses in NMOSD.
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Affiliation(s)
- Anna J.E. Combes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Corresponding author at: Centre for Neuroimaging Sciences, P089, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jimmy S. Lee
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David K.B. Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Anthony L. Traboulsee
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Gareth J. Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shannon Kolind
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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9
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Hedderson MM, Ferrara A, Avalos LA, Van den Eeden SK, Gunderson EP, Li DK, Altschuler A, Woo S, Rowell S, Choudhary V, Xu F, Flanagan T, Schaefer C, Croen LA. The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics. BMC Pregnancy Childbirth 2016; 16:381. [PMID: 27899076 PMCID: PMC5129213 DOI: 10.1186/s12884-016-1150-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children’s short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women’s and children’s health. Recruitment is integrated into routine clinical prenatal care at KPNC, an integrated health care delivery system. We detail the study design, data collection, and methodologies for establishing this cohort. We also describe the baseline characteristics and the cohort’s representativeness of the underlying pregnant population in KPNC. Methods While recruitment is ongoing, as of October 2014, the RPGEH pregnancy cohort included 16,977 pregnancies (53 % from racial and ethnic minorities). RPGEH pregnancy cohort participants consented to have blood samples obtained in the first trimester (mean gestational age 9.1 weeks ± 4.2 SD) and second trimester (mean gestational age 18.1 weeks ± 5.5 SD) to be stored for future use. Women were invited to complete a questionnaire on health history and lifestyle. Information on women’s clinical and health assessments before, during and after pregnancy and women and children’s health outcomes are available in the health system’s electronic health records, which also allows long-term follow-up. Discussion This large, racially- and ethnically-diverse cohort of pregnancies with prenatal biospecimens and clinical data is a valuable resource for future studies on in utero environmental exposures and maternal and child perinatal and long term health outcomes. The baseline characteristics of RPGEH Pregnancy Cohort demonstrate that it is highly representative of the underlying population living in the broader community in Northern California. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1150-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M M Hedderson
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - A Ferrara
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - L A Avalos
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - S K Van den Eeden
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - E P Gunderson
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - D K Li
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - A Altschuler
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - S Woo
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - S Rowell
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - V Choudhary
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - F Xu
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - T Flanagan
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - C Schaefer
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - L A Croen
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
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10
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Ljungberg E, Vavasour I, Tam R, Yoo Y, Rauscher A, Li DK, Traboulsee A, MacKay A, Kolind S. Rapid myelin water imaging in human cervical spinal cord. Magn Reson Med 2016; 78:1482-1487. [DOI: 10.1002/mrm.26551] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/23/2016] [Accepted: 10/20/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Emil Ljungberg
- Division of Neurology, Department of Medicine; University of British Columbia; Vancouver BC Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver BC Canada
| | - Irene Vavasour
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Roger Tam
- Division of Neurology, Department of Medicine; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Youngjin Yoo
- Department of Electrical and Computer Engineering; University of British Columbia; Vancouver BC Canada
| | - Alexander Rauscher
- Department of Pediatrics; University of British Columbia; Vancouver BC Canada
| | - David K.B. Li
- Division of Neurology, Department of Medicine; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine; University of British Columbia; Vancouver BC Canada
| | - Alex MacKay
- Department of Physics and Astronomy; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
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11
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Meyers SM, Tam R, Lee JS, Kolind SH, Vavasour IM, Mackie E, Zhao Y, Laule C, Mädler B, Li DK, MacKay AL, Traboulsee AL. Does hydration status affect MRI measures of brain volume or water content? J Magn Reson Imaging 2016; 44:296-304. [DOI: 10.1002/jmri.25168] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/11/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sandra M. Meyers
- Physics and Astronomy; University of British Columbia; Vancouver BC Canada
| | - Roger Tam
- MS/MRI Research Group; University of British Columbia; Vancouver BC Canada
- Radiology; University of British Columbia; Vancouver BC Canada
| | - Jimmy S. Lee
- Radiology; University of British Columbia; Vancouver BC Canada
| | | | | | - Emilie Mackie
- Medicine; University of British Columbia; Vancouver BC Canada
| | - Yinshan Zhao
- Medicine; University of British Columbia; Vancouver BC Canada
| | - Cornelia Laule
- Radiology; University of British Columbia; Vancouver BC Canada
- Pathology & Laboratory Medicine; University of British Columbia; Vancouver BC Canada
- International Collaboration on Repair Discoveries; University of British Columbia; Vancouver BC Canada
| | | | - David K.B. Li
- MS/MRI Research Group; University of British Columbia; Vancouver BC Canada
- Radiology; University of British Columbia; Vancouver BC Canada
- Medicine; University of British Columbia; Vancouver BC Canada
| | - Alex L. MacKay
- Physics and Astronomy; University of British Columbia; Vancouver BC Canada
- Radiology; University of British Columbia; Vancouver BC Canada
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12
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Li DK, Traboulsee AL, Truffinet P, O’connor PW, Pelletier J, Clavelou P, Edan G. Données IRM à long terme des patients sous tériflunomide : résultats de l’extension de l’étude de phase II. Rev Neurol (Paris) 2015. [DOI: 10.1016/j.neurol.2015.01.167] [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]
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13
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Yoo Y, Prasloski T, Vavasour I, MacKay A, Traboulsee AL, Li DK, Tam RC. Fast computation of myelin maps from MRI T2relaxation data using multicore CPU and graphics card parallelization. J Magn Reson Imaging 2014; 41:700-7. [DOI: 10.1002/jmri.24604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/05/2014] [Indexed: 12/19/2022] Open
Affiliation(s)
- Youngjin Yoo
- Department of Electrical and Computer Engineering; University of British Columbia; Vancouver BC Canada
- Division of Neurology; University of British Columbia; Vancouver BC Canada
| | - Thomas Prasloski
- Department of Physics and Astronomy; University of British Columbia; Vancouver BC Canada
| | - Irene Vavasour
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Alexander MacKay
- Department of Physics and Astronomy; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | | | - David K.B. Li
- Division of Neurology; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
| | - Roger C. Tam
- Division of Neurology; University of British Columbia; Vancouver BC Canada
- Department of Radiology; University of British Columbia; Vancouver BC Canada
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Kovanecz I, Gelfand R, Masouminia M, Gharib S, Segura D, Vernet D, Rajfer J, Li DK, Kannan K, Gonzalez-Cadavid NF. Oral Bisphenol A (BPA) given to rats at moderate doses is associated with erectile dysfunction, cavernosal lipofibrosis and alterations of global gene transcription. Int J Impot Res 2013; 26:67-75. [PMID: 24305612 PMCID: PMC4098849 DOI: 10.1038/ijir.2013.37] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/08/2013] [Accepted: 10/15/2013] [Indexed: 12/15/2022]
Abstract
Introduction Bisphenol A (BPA), a suspected reproductive biohazard and endocrine disruptor released from plastics is associated with erectile dysfunction (ED) in occupationally exposed workers. However, in rats, despite the induction of hypogonadism, apoptosis of the penile corporal smooth muscle, fat infiltration into the cavernosal tissue, and changes in global gene expression with the intraperitoneal administration of high dose BPA, ED was not observed. Aims We investigated whether BPA administered orally rather than intraperitoneally to rats for longer periods and lower doses will lead to ED. Main Outcomes Measures ED, histological, and biochemical markers in rat penile tissues. Methods 2.5-month old rats were given drinking water daily without and with BPA at 1 and 0.1 mg/kg/day. Two months later, erectile function was determined by cavernosometry (DIC) and electrical field stimulation (EFS) and serum levels of testosterone (T), estradiol (E2), and BPA were measured. Penile tissue sections were assayed by Masson (smooth muscle (SM)/collagen), Oil Red O (fat), TUNEL (apoptosis), immunohistochemistry for Oct 4 (stem cells), and α-SM actin/ calponin (SM and myofibroblasts), applying quantitative image analysis. Other markers were assayed by western blots. DNA microarrays/microRNA assays defined transcription profiles. Results Orally administered BPA did not affect body weight, but: 1) decreased serum T and E2; 2) reduced the EFS response and increased the DIC drop rate; 3) increased within the corporal tissue the presence of fat, myofibroblasts and apoptosis; 4) lowered the contents of SM and stem cells, but not nerve terminals; and 5) caused alterations of the transcriptional profiles for both mRNA and microRNAs within the penile shaft. Conclusions Long-term exposure of rats to oral BPA,caused a moderate corporal veno-occlusive dysfunction (CVOD), possibly due to alterations within the corporal tissue that pose gene transcriptional changes related to inflammation, fibrosis and epithelial/ mesenchymal transition (EMT).
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Affiliation(s)
- I Kovanecz
- 1] Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA [2] Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Gelfand
- 1] Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA [2] Division of Endocrinology, Charles Drew University of Medicine and Science, Los Angeles, CA, USA
| | - M Masouminia
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - S Gharib
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - D Segura
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - D Vernet
- 1] Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA [2] Division of Endocrinology, Charles Drew University of Medicine and Science, Los Angeles, CA, USA
| | - J Rajfer
- 1] Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA [2] Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - D K Li
- 1] Department of Health Research and Policy, Stanford University, Stanford, CA, USA [2] Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - K Kannan
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - N F Gonzalez-Cadavid
- 1] Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Torrance, CA, USA [2] Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA [3] Division of Endocrinology, Charles Drew University of Medicine and Science, Los Angeles, CA, USA
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Meyers SM, Vavasour IM, Mädler B, Harris T, Fu E, Li DK, Traboulsee AL, MacKay AL, Laule C. Multicenter measurements of myelin water fraction and geometric mean T2: Intra- and intersite reproducibility. J Magn Reson Imaging 2013; 38:1445-53. [DOI: 10.1002/jmri.24106] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/11/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sandra M. Meyers
- Physics and Astronomy; University of British Columbia; Vancouver BC Canada
| | | | | | - Trudy Harris
- UBC MRI Research Centre; University of British Columbia; Vancouver BC Canada
| | - Eric Fu
- Centre for Health Evaluation and Outcome Sciences; St Paul's Hospital; BC Canada
| | - David K.B. Li
- Radiology; University of British Columbia; Vancouver BC Canada
- UBC MRI Research Centre; University of British Columbia; Vancouver BC Canada
- Medicine, University of British Columbia; Vancouver BC Canada
| | | | - Alex L. MacKay
- Physics and Astronomy; University of British Columbia; Vancouver BC Canada
- Radiology; University of British Columbia; Vancouver BC Canada
- UBC MRI Research Centre; University of British Columbia; Vancouver BC Canada
| | - Cornelia Laule
- Radiology; University of British Columbia; Vancouver BC Canada
- UBC MRI Research Centre; University of British Columbia; Vancouver BC Canada
- Pathology and Laboratory Medicine; University of British Columbia; Vancouver BC Canada
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Vavasour IM, Laule C, Li DK, Traboulsee AL, MacKay AL. Response. J Magn Reson Imaging 2011. [DOI: 10.1002/jmri.22709] [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: 11/09/2022] Open
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Sormani MP, Li DK, Bruzzi P, Stubinski B, Cornelisse P, Rocak S, De Stefano N. Combined MRI lesions and relapses as a surrogate for disability in multiple sclerosis. Neurology 2011; 77:1684-90. [PMID: 21975200 DOI: 10.1212/wnl.0b013e31823648b9] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE In multiple sclerosis (MS), the aim of therapies is to prevent the accumulation of irreversible disability. This is difficult to assess given the short time course of clinical trials. MRI markers and relapses are often used as surrogate of disability in MS studies, but their validity remains controversial. We sought to validate, at the individual patient level, MRI lesions and relapses as surrogates for disability progression over the course of MS trials. METHODS Individual patient data from a large, placebo-controlled trial of interferon β-1a in relapsing-remitting MS (RRMS) were analyzed. The Prentice criteria were applied to evaluate surrogacy of 1-year MRI active lesions and relapses for disability worsening (Expanded Disability Status Scale [EDSS]) over the 2-year follow-up. RESULTS All Prentice criteria were satisfied. Treatment reduced by 31% the odds of having EDSS worsening over 2 years, reducing the mean number of MRI lesions by 61% and the mean number of relapses by 36% over 1 year. Both 1-year MRI lesion activity and relapses, when considered independently, accounted for more than 60% of the treatment effect on 2-year EDSS worsening. A combination of 1-year MRI lesion activity and relapses explained 100% of the treatment effect on EDSS worsening over 2 years. CONCLUSIONS A combined measure of 1-year changes in MRI lesions and relapses after interferon therapy fully estimated the corresponding effect on 2-year EDSS worsening. This short-term combined measure appears to be a surrogate for disability progression over a longer term when evaluating the effect of interferon in RRMS.
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Affiliation(s)
- M P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
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Tam RC, Riddehough A, Li DK. Detection and measurement of coverage loss in interleaved multi-acquisition brain MRIs due to motion-induced inter-slice misalignment. Med Image Anal 2009; 13:381-91. [DOI: 10.1016/j.media.2008.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 07/30/2008] [Accepted: 12/12/2008] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is typically a monophasic demyelinating disorder. However, a clinical presentation consistent with ADEM can also be the first manifestation of multiple sclerosis (MS), particularly in children. Quantitative analyses of MRI images from children with monophasic ADEM have yet to be compared with those from children with MS, and MRI criteria capable of distinguishing ADEM from MS at onset have yet to be derived. METHODS A retrospective analysis of MRI scans obtained at first attack from 28 children subsequently diagnosed with MS and 20 children with ADEM was performed. T2/fluid-attenuated inversion recovery hyperintense lesions were quantified and categorized according to location, description, and size. T1-weighted images before and after administration of gadolinium were evaluated for the presence of black holes and for gadolinium enhancement. Mean lesion counts and qualitative features were compared between groups and analyzed to create a proposed diagnostic model. RESULTS Total lesion number did not differentiate ADEM from MS, but periventricular lesions were more frequent in children with MS. Combined quantitative and qualitative analyses led to the following criteria to distinguish MS from ADEM: any two of 1) absence of a diffuse bilateral lesion pattern, 2) presence of black holes, and 3) presence of two or more periventricular lesions. Using these criteria, MS patients at first attack could be distinguished from monophasic ADEM patients with an 81% sensitivity and a 95% specificity. CONCLUSIONS MRI diagnostic criteria are proposed that may be useful in differentiating children experiencing the first attack of multiple sclerosis from those with monophasic acute disseminated encephalomyelitis.
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Affiliation(s)
- D J A Callen
- Division of Pediatric Neurology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada.
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Abstract
BACKGROUND MRI diagnostic criteria have not yet been adopted for pediatric multiple sclerosis (MS). MRI plays a pivotal role in supporting the diagnosis of MS in adults. We sought to quantitatively define the MRI features of pediatric MS, to determine features that distinguish MS from nondemyelinating relapsing childhood neurologic disorders, and to propose MRI criteria for lesion dissemination in space in children with MS. METHODS A retrospective analysis of MRI scans from 38 children with clinically definite MS and 45 children with nondemyelinating diseases with relapsing neurologic deficits (migraine, systemic lupus erythematosus) was performed. For each scan, T2/FLAIR hyperintense lesions were quantified and categorized according to location and size. Mean lesion counts in specific locations were compared between groups to derive diagnostic criteria. Validation of the proposed criteria was performed using MRI scans from a second independent MS cohort (n = 21). RESULTS MRI lesion location and size categories differed between children with MS and nondemyelinating controls with a medium to large effect size for most variables. The presence of at least two of the following-five or more lesions, two or more periventricular lesions, or one brainstem lesion-distinguished MS from other nondemyelinating disease controls with 85% sensitivity and 98% specificity. CONCLUSIONS We propose modifications to the currently established McDonald MRI criteria for lesion dissemination in space that will enhance the diagnostic accuracy of these criteria for multiple sclerosis in children.
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Affiliation(s)
- D J A Callen
- Division of Pediatric Neurology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada.
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Li DK, Lin H, Kim SM. Effect of rainbow trout (Oncorhynchus mykiss) plasma protein on the gelation of Alaska pollock (Theragra chalcogramma) Surimi. J Food Sci 2008; 73:C227-34. [PMID: 18460115 DOI: 10.1111/j.1750-3841.2008.00712.x] [Citation(s) in RCA: 11] [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] [Indexed: 11/28/2022]
Abstract
The effect of rainbow trout plasma protein (RPP) on the gelation of Alaska pollock surimi was determined to evaluate the possibility of its commercialization as a new protein additive. For modori gel, the breaking force, deformation, whiteness, and water holding capacity increased as the addition amount of RPP (0 to 0.75 mg/g) increased, and decreased at higher concentration of RPP (0.75 to 1.50 mg/g) (P < 0.05). Protein solubility of modori gel in the mixture of SDS, urea, and beta-mercaptoethanol decreased as the addition amount of RPP increased up to 0.75 mg/g, and increased at higher concentration of RPP (0.75 to 1.50 mg/g) (P < 0.05). The contents of trichloroacetic acid-soluble peptide decreased as the addition amount of RPP (0 to 1.50 mg/g) increased (P < 0.05). Based on the result of sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE), most myosin heavy chain of surimi was not degraded when RPP was added. Thus, RPP was supposed to act as a protease inhibitor in the gelation of Alaska pollock surimi. An RPP of 0.75 mg/g was the optimal concentration to prevent the gel weakening of Alaska pollock surimi. Compounds with molecular weights less than 10 kDa in RPP had no significant effect on the gelation of Alaska pollock surimi based on the result of the dialyzed RPP.
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Affiliation(s)
- D K Li
- College of Food Science and Engineering, Ocean Univ. of China, Qingdao 266003, China
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Abstract
Recombinant chum salmon cystatin (RC) expressed in Saccharomyces cerevisiae was purified by His-select nickel affinity chromatography. The specific inhibitory activities of RC against papain and cathepsin L were 7.45 and 10.24 U/mg, respectively. RC was stable over pH 5.0 to 7.0 and at temperature below 65 degrees C. RC was used to prevent the gel weakening of Alaska pollock surimi. RC at 100 microg/g showed the highest inhibitory activity against the autolysis of surimi based on the analysis of TCA-soluble peptides. As the concentration of RC increased, both the breaking force and deformation of modori gel greatly increased (P < 0.05). The addition of RC resulted in less expressible drip, which coincided with the increase of whiteness. More myosin heavy chain (MHC) was retained as the addition of RC increased. Therefore, RC could prevent the degradation of proteins in Alaska pollock surimi and was better than egg white (EW). Thus, RC could be applied to Alaska pollock surimi to prevent gel weakening and RC at 100 microg/g was the optimal concentration.
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Affiliation(s)
- D K Li
- College of Food Science and Engineering, Ocean Univ. of China, Qingdao 266003, China
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Paty DW, Li DK. Interferon beta-lb is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. 1993 [classical article]. Neurology 2001; 57:S10-5. [PMID: 11902589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Du XL, Zhu Z, Fu Q, Li DK, Xu WB. [Studies on the pharmacokinetics and relative bioavailability of salbutamol aerosol in healthy volunteers]. Yao Xue Xue Bao 2001; 36:616-20. [PMID: 12579942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
AIM To study the pharmacokinetics and relative bioavailability of salbutamol aerosol in healthy volunteers. METHODS An HPLC method for the determination of salbutamol in human plasma was improved. Ten healthy male subjects were enrolled. A randomized, two-way crossover, open design was adopted. After the subjects inhaled or orally administered salbutamol, fourteen blood samples were taken at predetermined time. The concentrations of salbutamol in plasma were determined by HPLC, and then assessed with PCNONLIN software to obtain the pharmacokinetic parameters and relative bioavailability of aerosol versus water solution. RESULTS The standard curve was linear over the range 0.2-20 ng.mL-1. The intra- and interassay RSDs were 7.01% and 2.10% at 0.4 ng.mL-1, 2.18% and 5.25% at 4.0 ng.mL-1 and 4.61% and 4.85% at 15.0 ng.mL-1. The recoveries were between 90% and 110%. The pharmacokinetics of salbutamol aersol was described well with a two-compartment model, and the parameters for salbutamol inhaled and orally administered were assessed as follows: Tmax were (0.22 +/- 0.07) h and (1.8 +/- 0.6) h, Cmax were (3.4 +/- 1.1) ng.mL-1 and (3.9 +/- 1.4) ng.mL-1, T1/2 beta were (4.5 +/- 1.5) h and (4.6 +/- 1.1) h, respectively. The AUC0-20 min (inhal) was 7.94 times as high as the AUC0-20 min (p.o.). There were significant differences between Tmax, AUC, K12, K21, alpha and T1/2 alpha (P < 0.05). The relative bioavailability of salbutamol aerosol was 57.23% compared with its oral solution. CONCLUSION The assay was sensitive, specific, accurate and precise. The absorption process of salbutamol aerosol in human was significantly different from that of the oral solution. It was demonstrated that AUC0-20 min reflected the lung availability of salbutamol inhaler.
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Affiliation(s)
- X L Du
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Abstract
OBJECTIVE To examine MRI changes resulting from treatment of secondary progressive MS (SPMS) with two doses of interferon-beta-1a (Rebif). BACKGROUND Interferon-beta (IFN-beta) reduces relapses and delays progression in relapsing-remitting MS, but there are conflicting results on its clinical benefit in SPMS. METHODS In a double-blind, randomized, multicenter, placebo-controlled study (SPECTRIMS), 618 patients received IFN-beta-1a 22 microg, 44 microg, or placebo subcutaneously three times weekly for 3 years. T2 activity and burden of disease (BOD) were measured in 617 patients by using semiannual proton density/T2-weighted (PD/T2) MRI scans. A cohort of 283 patients also had 11 monthly PD/T2 and T1-weighted gadolinium-enhanced (T1-Gd) scans at study start. RESULTS Treatment reduced median numbers of active lesions per patient per scan (semiannual T2 activity: 0.17, 0.20 and 0.67 for the high dose, low dose, and placebo, p < 0.0001; monthly combined unique activity [T1+T2]: 0.11, 0.22, and 1.00, p < 0.0001) and accumulation of BOD (percent change from baseline to month 36: -1.3, -0.5, and 10.0 for the high dose, low dose, and placebo, respectively; p = 0.0001). MRI benefit was most evident in the subgroup of patients who reported relapses in the 2 years before the study. Neutralizing antibody development was associated with reduction in treatment effect: antibody-positive patients did not show significant differences from placebo at either dose. CONCLUSIONS Interferon-beta-1a used in SPMS showed significant effects on all MRI measures, particularly in patients with relapses in the 2 years before the study.
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Affiliation(s)
- D K Li
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Abstract
OBJECTIVE The purpose of this study was to assess regional cerebral glucose metabolism in patients with schizophrenia who had never received antipsychotic medication and whose olfactory identification ability had been assessed. Two hypotheses were examined. First, the patients were compared with normal controls to determine whether differences in regional cerebral metabolism were apparent. Second, regional rates of metabolism were correlated with olfactory ability and the relation between them determined. METHODS The patient (n = 26) and control (n = 32) subjects were scanned at rest using positron emission tomography (PET) after administration of 18F-fluorodeoxyglucose (FDG). In addition, the University of Pennsylvania Smell Identification Test was administered to each patient. RESULTS Patients with schizophrenia had reduced rates of glucose metabolism in the right and left thalamus that reached significance if not corrected for multiple comparisons. However, if a Bonferroni correction was applied over the 27 regions of interest, the differences were not significant. Scores on the Smell Identification Test were negatively correlated with 8 regions of interest. When scores were analyzed using multiple regression, the left frontal cortex and the medial parietal cortex were significant predictors. CONCLUSIONS The finding of reduced metabolism in the thalami is consistent with some of the previous literature, whereas the negative correlations between specific regions and olfactory function are not consistent with studies using activation paradigms.
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Affiliation(s)
- C Clark
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1.
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Abstract
Magnetization transfer ratios (MTRs) were measured separately for the two T(2) components in white matter. For both binomial and off-resonance sinc MT pulses, the MTR was larger for the short T(2) component than for the long T(2) component. This differential MT effect disappeared for delays between the MT pulse and the multi-echo pulse sequence longer than 200 msec, indicating exchange between the two components. When using the sinc MT pulse, the MTR for the short T(2) component was similar for different white matter structures, whereas it varied for different white matter structures when using the binomial pulse-a phenomenon attributed to direct saturation. When the sinc pulse frequency was brought closer to resonance, MTRs in white matter and doped water phantoms increased for both components but more so for the shorter T(2) component. This behavior was consistent with a Bloch equation model of direct saturation.
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Affiliation(s)
- I M Vavasour
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
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Moore GR, Leung E, MacKay AL, Vavasour IM, Whittall KP, Cover KS, Li DK, Hashimoto SA, Oger J, Sprinkle TJ, Paty DW. A pathology-MRI study of the short-T2 component in formalin-fixed multiple sclerosis brain. Neurology 2000; 55:1506-10. [PMID: 11094105 DOI: 10.1212/wnl.55.10.1506] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [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: 11/15/2022] Open
Abstract
OBJECTIVE To determine the pathologic basis of areas not exhibiting signal of the short-T2 component of the T2 relaxation distribution in MS, as studied in formalin-fixed brain. BACKGROUND A myelin-specific MRI signal would be of great importance in assessing demyelination in patients with MS. Evidence indicates that the short-T2 (10 to 50 millisecond) component of the T2 relaxation distribution originates from water in myelin sheaths. The authors present two cases of MS in which the anatomic distribution of the short-T2 component was correlated with the pathologic findings in postmortem formalin-fixed brain. METHOD One half of the formalin-fixed brain was suspended in a gelatin-albumin mixture cross-linked with glutaraldehyde, and scanned with a 32-echo MRI sequence. The brain was then cut along the center of the 5-mm slices scanned, photographed, dehydrated, and embedded in paraffin. Paraffin sections, stained with Luxol fast blue and immunocytochemically for 2',3'-cyclic nucleotide 3'-phosphohydrolase for myelin and by the Bielschowsky technique for axons, were compared with the distribution of the amplitude of the short-T2 component of the comparable image slices. RESULTS The anatomic distribution of the short-T2 component signal corresponded to the myelin distribution. Chronic, silent MS plaques with myelin loss correlated with areas of absence of short-T2 signal. The numbers of axons within lesions were reduced, but many surviving axons were also seen in these areas of complete loss of myelin. CONCLUSION In formalin-fixed MS brains the short-T2 component of the T2 relaxation distribution corresponds to the anatomic distribution of myelin. Chronic, silent demyelinated MS plaques show absence of the short-T2 component signal. These results support the hypothesis that the short-T2 component originates from water related to myelin.-1510
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Affiliation(s)
- G R Moore
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
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Li DK, Zhao G, Paty DW. T2 hyperintensities: findings and significance. Neuroimaging Clin N Am 2000; 10:717-38 ,ix. [PMID: 11359721] [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: 04/16/2023]
Abstract
The hyperintense lesions of multiple sclerosis seen on proton density- and T2-weighted MR images have important clinical and research roles in the diagnosis, follow-up, prognosis, and treatment of the disease.
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Affiliation(s)
- D K Li
- Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5
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Escobar GJ, Li DK, Armstrong MA, Gardner MN, Folck BF, Verdi JE, Xiong B, Bergen R. Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study. Pediatrics 2000; 106:256-63. [PMID: 10920148 DOI: 10.1542/peds.106.2.256] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Few data are available on the outcome of neonatal sepsis evaluations in an era when intrapartum antibiotic therapy is common. METHODS We identified all newborns weighing >/=2000 g at birth who were ever evaluated for suspected bacterial infection at 6 Kaiser Permanente hospitals between October 1995 and November 1996, reviewed their records and laboratory data, and tracked them to 1 week after discharge. We analyzed the relationship between key predictors and the presence of neonatal bacterial infection. RESULTS Among 18 299 newborns >/=2000 g without major congenital anomalies, 2785 (15.2%) were evaluated for sepsis with a complete blood count and/or blood culture. A total of 62 (2.2%) met criteria for proven, probable, or possible bacterial infection: 22 (.8%) had positive cultures and 40 (1.4%) had clinical evidence of bacterial infection. We tracked all but 10 infants (.4%) to 7 days postdischarge. There were 67 rehospitalizations (2.4%; 2 for group B streptococcus bacteremia). Among 1568 infants who did not receive intrapartum antibiotics, initial asymptomatic status was associated with decreased risk of infection (adjusted odds ratio [AOR]:.26; 95% confidence interval [CI]:.11-.63), while chorioamnionitis (AOR: 2. 40; 95% CI: 1.15-5.00), low absolute neutrophil count (AOR: 2.84; 95% CI: 1.50-5.38), and meconium-stained amniotic fluid (AOR: 2.23; 95% CI: 1.18-4.21) were associated with increased risk. Results were similar among 1217 infants who were treated, except that maternal chorioamnionitis was not significantly associated with neonatal infection. CONCLUSIONS The risk of bacterial infection in asymptomatic newborns is low. Evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count. Many missed opportunities for treating mothers and infants exist.
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Affiliation(s)
- G J Escobar
- Kaiser Permanente Medical Care Program, Division of Research, Perinatal Research Unit, Oakland, California 94611, USA.
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Ye M, Zhu Z, Fu Q, Shen K, Li DK. Nonlinear pharmacokinetics of paclitaxel in ovarian cancer patients. Acta Pharmacol Sin 2000; 21:596-9. [PMID: 11360664] [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: 04/16/2023] Open
Abstract
AIM To characterize the disposition of paclitaxel in patients with ovarian carcinoma after a 3-h infusion. METHODS Fifteen patients with advanced ovarian cancer were enrolled and were administered paclitaxel in a 3-h infusion at dosing levels of 135 mg/m2, 175 mg/m2, and 235 mg/m2. Thirteen plasma samples were obtained during the infusion and up to 24 h after the infusion. Paclitaxel concentrations in plasma were determined by HPLC assay. Pharmacokinetic parameters were assessed with noncompartment model and model-dependent method. RESULTS The disposition of paclitaxel in patients with ovarian cancer conformed to a two-compartment model. The main pharmacokinetic parameters of three groups were T1/2 beta (5.18 +/- 3.49), (6.26 +/- 2.21), and (6.99 +/- 1.45) h, AUC (14.71 +/- 0.76), (39.09 +/- 13.10), and (66.52 +/- 12.23) mg.h.L-1, Cl (14.29 +/- 0.74), (7.52 +/- 2.15), and (6.25 +/- 1.93) L.h-1, respectively. CONCLUSION The disposition of paclitaxel was nonlinear after a 3-h infusion. There was individual variability of metabolism among patients.
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Affiliation(s)
- M Ye
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing 100730, China.
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Abstract
To determine whether maternal exposure to pre-eclampsia/eclampsia during pregnancy increases the risk of sudden infant death syndrome (SIDS) in offspring, we conducted a population-based case-control study using the California linked birth and death certificate data. All infants who died of SIDS (ICD-9 code 798.0) during 1989-91 were identified as cases. More than 96% of the identified SIDS cases were diagnosed through autopsy. Ten controls who did not die from SIDS were randomly selected for each case from the birth certificate matched to the case on the year of birth. Among 2,029 cases and 21,037 controls included in the final analysis, mothers of 49 cases (2.4%) and 406 controls (1.9%) had a diagnosis of either pre-eclampsia or eclampsia noted on the birth certificate. After adjustment for maternal age, prenatal smoking, race/ethnicity, parity, maternal education, gestational age at the initial visit for prenatal care, infant year of birth and infant sex, maternal pre-eclampsia/ eclampsia during pregnancy was associated with a 50% increased risk of SIDS in the offspring (odds ratio = 1.5, 95% confidence interval 1.1, 2.0). Potential under-reporting of pre-eclampsia/eclampsia on the birth certificates was likely to be non-differential and is unlikely to explain the finding. Fetal hypoxia resulting from pre-eclampsia/ eclampsia or immunological aetiology affecting the risk of both pre-eclampsia/eclampsia and SIDS may explain the finding.
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Affiliation(s)
- D K Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, CA 94611, USA.
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Zhao GJ, Koopmans RA, Li DK, Bedell L, Paty DW. Effect of interferon beta-1b in MS: assessment of annual accumulation of PD/T2 activity on MRI. UBC MS/MRI Analysis Group and the MS Study Group. Neurology 2000; 54:200-6. [PMID: 10636148 DOI: 10.1212/wnl.54.1.200] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the efficacy of interferon beta-1b (IFNbeta-1b) on lesion activity could be shown with annual analysis of MRI. BACKGROUND Clinical outcomes and MRI burden of disease changes in MS patients in a multicenter double-blind placebo-controlled 5-year trial of IFNbeta-1b have been reported, together with an analysis of 6-weekly MRI activity in a small subgroup during 2 years. MRI activity measurements based on annual scans have not been documented. METHODS Patients were randomized into three treatment arms: placebo, 1.6 mIU, and 8 mIU IFNbeta-1b self-administered subcutaneously every other day. Active lesions were identified as new, enlarging, or recurrent on proton density and T2-weighted MRI scans. Gadolinium was not used. An annual accumulation activity index was developed as an additional analysis of lesion activity. RESULTS During the 5 years, both high- and low-dose IFNbeta-1b groups showed a striking reduction in lesion annual accumulation activity on the activity index versus placebo (p = 0.001). Thirty-five percent of the high-dose patients and 29% of the low-dose patients were MRI inactive by this method of analysis, whereas only 16% of placebo patients were inactive (p = 0.001, placebo versus 8 mIU). CONCLUSIONS This analysis of the annual accumulation of lesion activity shows that the previously reported treatment effect seen on MRI scanning once every 6 weeks in a subcohort of the patients can also be seen on yearly scans. This annual accumulation activity analysis provides an independent MRI confirmation of a treatment and dose effect for IFNbeta-1b.
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Affiliation(s)
- G J Zhao
- Division of Neurology, University of British Columbia, Vancouver Hospital and Health Science Center, Canada
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Abstract
To determine whether changing paternity affects the risk of preeclampsia or eclampsia in the subsequent pregnancy and whether the effect depends on a woman's history of preeclampsia/eclampsia with her previous partner, a cohort study was conducted based on 140,147 women with two consecutive births during 1989-1991 identified through linking of annual California birth certificate data. Among women without preeclampsia/eclampsia in the first birth, changing partners resulted in a 30% increase in the risk of preeclampsia/eclampsia in the subsequent pregnancy compared with those who did not change partners (95% confidence interval: 1.1, 1.6). On the other hand, among women with preeclampsia/eclampsia in the first birth, changing partners resulted in a 30% reduction in the risk of preeclampsia/eclampsia in the subsequent pregnancy (95% confidence interval: 0.4, 1.2). The difference of the effect of changing paternity on the risk of preeclampsia/eclampsia between women with and those without a history of this condition was significant (p < 0.05 for the interaction term). The above estimates were adjusted for potential confounders. These findings suggest that the effect of changing paternity depends on the history of preeclampsia/eclampsia with the previous partner and support the hypothesis that parental human leukocyte antigen sharing may play a role in the etiology of preeclampsia/eclampsia.
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Affiliation(s)
- D K Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA 94611, USA
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Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH. The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis. Neurology 1999; 53:448-56. [PMID: 10449103 DOI: 10.1212/wnl.53.3.448] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
MRI is very sensitive in showing MS lesions throughout the CNS. Using MRI for diagnostic purposes, however useful, is a complex issue because of limited specificity of findings and a variety of options as to when, how, and which patients to examine. Comparability of data and a common view regarding the impact of MRI are needed. Following a review of the typical appearance and pattern of MS lesions including differential diagnostic considerations, we suggest economic MRI examination protocols for the brain and spine. Recommendations for referral to MRI consider the need to avoid misdiagnosis and the probability of detecting findings of diagnostic relevance. We also suggest MRI classes of evidence for MS to determine the diagnostic weight of findings and their incorporation into the clinical evaluation. These proposals should help to optimize and standardize the use of MRI in the diagnosis of MS.
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Affiliation(s)
- F Fazekas
- Department of Neurology and MRI Center, Karl-Franzens University, Graz, Austria.
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Li DK, Paty DW. Magnetic resonance imaging results of the PRISMS trial: a randomized, double-blind, placebo-controlled study of interferon-beta1a in relapsing-remitting multiple sclerosis. Prevention of Relapses and Disability by Interferon-beta1a Subcutaneously in Multiple Sclerosis. Ann Neurol 1999; 46:197-206. [PMID: 10443885 DOI: 10.1002/1531-8249(199908)46:2<197::aid-ana9>3.0.co;2-p] [Citation(s) in RCA: 231] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The PRISMS (Prevention of Relapses and Disability by Interferon-beta1a Subcutaneously in Multiple Sclerosis) trial was a double-blind, randomized, multicenter, phase III, placebo-controlled study of interferon-beta1a in 560 patients from 22 centers in 9 countries with clinically definite or laboratory-supported relapsing-remitting multiple sclerosis. The patients were randomized to receive recombinant interferon-beta1a (Rebif), 22 microg (6 mIU), 44 microg (12 mIU), or placebo, given subcutaneously, three times weekly for 2 years. All patients underwent biannual proton density/T2-weighted magnetic resonance imaging scans to determine the overall magnetic resonance imaging disease activity and burden of disease, and a cohort of 205 patients had 11 initial monthly proton density/T2-weighted and gadolinium-enhanced/T1-weighted magnetic resonance imaging scans. Over the 2 years, the placebo group showed a progressive median increase in burden of disease of 10.9%, whereas the 22-microg group and 44-microg group showed median decreases of 1.2% and 3.8%, respectively. The number of T2 active lesions and percentage of scans showing T2 activity on the biannual scans were also significantly reduced in both treatment groups compared with placebo, with a clear dose-effect favoring the 44-microg dose over the 22-microg dose. In the subgroup undergoing initial monthly scanning, this reduction in activity became statistically significant 2 months after the start of treatment. These results provide strong, objective evidence to support the positive clinical results of reduction in relapses and delay in disease progression. In addition, they also demonstrate a significant dosage effect, favoring the 44-microg dose.
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Affiliation(s)
- D K Li
- Department of Radiology, UBC Hospital, Vancouver, BC, Canada
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38
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Abstract
T2 relaxation decay curves from in vivo human brain tissue are rarely mono-exponential. Partial volume averaging further reduces the chance of mono-exponential decay. Moreover, the parameters derived from few-echo mono-exponential fits change with the measurement echo times and have the largest possible variance. In this note, multi-exponential fits to 32-echo relaxation decay curves from in vivo human brain are used to design simulations (where the truth is known) to demonstrate the pitfalls of few-echo mono-exponential interpretations.
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Affiliation(s)
- K P Whittall
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Abstract
To determine whether placental abnormality (placental abruption or placental previa) during pregnancy predisposes an infant to a high risk of sudden infant death syndrome (SIDS), the authors conducted a population-based case-control study using 1989-1991 California linked birth and death certificate data. They identified 2,107 SIDS cases, 96% of whom were diagnosed through autopsy. Ten controls were randomly selected for each case from the same linked birth-death certificate data, matched to the case on year of birth. About 1.4% of mothers of cases and 0.7% of mothers of controls had either placental abruption or placenta previa during the index pregnancy. After adjustment for potential confounders, placental abnormality during pregnancy was associated with a twofold increase in the risk of SIDS in offspring (odds ratio = 2.1, 95% confidence interval 1.3-3.1). The individual effects of placental abruption and placenta previa on the risk of SIDS did not differ significantly. An impaired fetal development due to placental abnormality may predispose an infant to a high risk of SIDS.
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Affiliation(s)
- D K Li
- Division of Research, Kaiser Foundation Research Institute, California Region, Oakland 94611, USA
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Wong K, Forster BB, Li DK, Aldrich JE. A simple method of assessing the temporomandibular joint with helical computer tomography: technical note. Can Assoc Radiol J 1999; 50:117-20. [PMID: 10226637] [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] [Indexed: 02/12/2023] Open
Affiliation(s)
- K Wong
- Department of Radiology, University of British Columbia Hospital
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Li DK. Changing paternity and the risk of preterm delivery in the subsequent pregnancy. Epidemiology 1999; 10:148-52. [PMID: 10069250] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
I studied whether changing a partner, and thus changing the likelihood of human leukocyte antigen (HLA) sharing between mating partners, affects the risk of preterm delivery in the subsequent pregnancy. I identified a total of 128,239 women who had two consecutive births during 1989-1991 through data linkage of the California birth certificates. Paternal date of birth and names on the records of the two consecutive births were compared to determine whether the same father was reported on both records. Three cohorts of women were formed on the basis of the gestational age of their first delivery: <34, 34-36, and >36 weeks. If parental HLA sharing is associated with preterm delivery, the likelihood of HLA sharing was expected to be in a decreasing order from most likely among a <34-week cohort to least likely among a >36-week cohort. Among women in the <34-week cohort, changing partners resulted in a 33% reduction in the risk of early preterm delivery in the subsequent pregnancy compared with those who did not change partners [95% confidence interval (CI), 0.52-0.88]. In contrast, among women in the >36-week cohort, changing partners led to a 16% increase in the risk of early preterm delivery in the subsequent pregnancy (95% CI = 1.04-1.30). Among women in the 34-36-week cohort, changing partners did not affect the risk of preterm delivery (95% CI = 0.78-1.25). These estimates were adjusted for maternal race/ethnicity, age, educational level, prenatal smoking, prenatal care, parity, and interval from birth to conception of the subsequent pregnancy. The findings from this study suggest that the effect of changing paternity depends on the pregnancy outcome with the previous partner and support the hypothesis that parental HLA sharing may be related to preterm delivery.
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Affiliation(s)
- D K Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA 94611, USA
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42
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Cover KS, Petkau J, Li DK, Paty DW. Lesion load reproducibility and statistical sensitivity of clinical trials in multiple sclerosis. Neurology 1999; 52:433-5. [PMID: 9932990 DOI: 10.1212/wnl.52.2.433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Li DK. Maternal history of subfertility and the risk of congenital urinary tract anomalies in offspring. Epidemiology 1999; 10:80-2. [PMID: 9888285] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
I studied the relation between a maternal history of subfertility and the risk of congenital urinary tract anomalies (CUTAs) in a case-control study. I defined subfertility as having unprotected intercourse for more than 12 months without getting pregnant at any time before the conception of the index pregnancy. A maternal history of subfertility was associated with a slightly increased risk of CUTAs (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) 0.8-2.4). Risk was higher for mothers whose subfertility occurred at 20 years of age or younger (OR = 2.2, 95% CI 1.0-4.9). The effect of a maternal history of subfertility on the risk of CUTAs was exacerbated by maternal smoking during the index pregnancy and by an early onset of smoking history.
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Affiliation(s)
- D K Li
- Division of Research, Kaiser Foundation Research Institute, Oakland, CA 94611-5711, USA
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44
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Vavasour IM, Whittall KP, MacKay AL, Li DK, Vorobeychik G, Paty DW. A comparison between magnetization transfer ratios and myelin water percentages in normals and multiple sclerosis patients. Magn Reson Med 1998; 40:763-8. [PMID: 9797161 DOI: 10.1002/mrm.1910400518] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Magnetization transfer and T2 relaxation data were obtained for five white and six gray matter brain structures from 10 normal volunteers and 9 multiple sclerosis patients. Thirty MS lesions were also analyzed. Magnetization transfer ratios and myelin water percentages were compared. Both techniques showed a significant difference between the average of white and gray matter of the normal volunteers as well as the average of normal-appearing white matter and gray matter of the multiple sclerosis patients. The average magnetization transfer ratio and myelin water percentage for lesions were significantly lower than those of normal-appearing white matter. Myelin water percentages and magnetization transfer ratios were uncorrelated in white and gray matter but showed a small (R = 0.5, P = 0.005) but significant correlation in multiple sclerosis lesions. In summary, the myelin water percentage and the magnetization transfer ratio provide quantifiable but largely independent measures of multiple sclerosis lesion pathology.
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Affiliation(s)
- I M Vavasour
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
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Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients. Anesthesiology 1998; 89:633-41. [PMID: 9743399 DOI: 10.1097/00000542-199809000-00012] [Citation(s) in RCA: 245] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent evidence suggests that transient neurologic symptoms commonly follow lidocaine spinal anesthesia. However, information concerning factors that affect their occurrence is limited. Accordingly, to evaluate many potential risk factors, the authors undertook a prospective, multicenter, epidemiologic study. METHODS On a voluntary basis, anesthetists at 15 participating centers forwarded a data sheet on patients who had spinal anesthesia to a research nurse blinded to the details of anesthesia and surgery. A subset was randomly selected for follow-up. The pressure [corrected] of transient neurologic symptoms, defined as leg or buttock pain, was the principal outcome variable. Logistic regression was used to control for potential confounders, and adjusted odds ratios and confidence intervals were used to estimate relative risk. RESULTS During a 14-month period, 1,863 patients were studied, of whom 47% received lidocaine, 40% bupivacaine, and 13% tetracaine. Patients given lidocaine were at higher risk for symptoms compared with those receiving bupivacaine (relative risk, 5.1; 95% CI, 2.5 to 10.2) or tetracaine (relative risk, 3.2; 95% CI, 1.04 to 9.84). For patients who received lidocaine, the relative risk of transient neurologic symptoms was 2.6 (95% CI, 1.5 to 4.5) with the lithotomy position compared with other positions, 3.6 (95% CI, 1.9 to 6.8), for outpatients compared with inpatients, and 1.6 (95% CI, 1 to 2.5) for obese (body mass index >30) compared with nonobese patients. CONCLUSIONS These results indicate that transient neurologic symptoms commonly follow lidocaine spinal anesthesia but are relatively uncommon with bupivacaine or tetracaine. The data identify lithotomy position and outpatient status as important risk factors in patients who receive lidocaine. Among other factors postulated to increase risk, obesity had an effect of borderline statistical significance, whereas age, sex, history of back pain, needle type, and lidocaine dose and concentration failed to affect risk.
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Affiliation(s)
- J M Freedman
- Department of Anesthesiology, Kaiser-Permanente Medical Center, Santa Rosa, California, USA
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Zhu Z, Fu Q, Nightingale CH, Zhao YP, Liao Q, Li DK. Penetration kinetics of 5-fluorouracil into pancreatic fluid in post-pancreatoduodenectomy patients. Anticancer Drugs 1998; 9:685-8. [PMID: 9823426 DOI: 10.1097/00001813-199809000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/25/2022]
Abstract
Our aim was to investigate the pharmacokinetic behavior of 5-fluorouracil (5-FU) in pancreatic fluid and to evaluate its penetration characteristics in post-pancreatoduodenectomy patients. After completing the external drainage of the pancreatic duct during pancreatoduodenectomy surgery, eight patients were administered 1.0 g 5-FU i.v. by a 5 min infusion after the eighth day post-surgery on average. Blood and pancreatic fluid were collected, and the 5-FU concentrations were determined by HPLC assay. Their pharmacokinetic parameters were obtained by PCNONLIN and statistical analysis was performed. The Cmax was 20.03 +/- 18.25 mg/l in pancreatic fluid with a Tmax of 15.6 +/- 9.5 min following i.v. administration and 49.69 +/- 20.75 mg/l in plasma. 5-FU in plasma and pancreatic fluid were all in conformity with a non-linear model with a K(m) of 1098.08 +/- 1426.57 and 11.08 +/- 6.38 mg/l, respectively. The concentrations in pancreatic fluid were similar to that observed in plasma with an average penetration index up to 1.01 +/- 0.49. It is suggested therefore that 5-FU is capable of penetrating from blood into the pancreas as evidenced by the observed pancreatic concentrations.
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Affiliation(s)
- Z Zhu
- Department of Pharmacy, Peking Union Medical College (PUMC) Hospital, PUMC, Chinese Academy of Medical Sciences, Beijing, PRC
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Ettinger B, Li DK, Klein R. Unexpected vaginal bleeding and associated gynecologic care in postmenopausal women using hormone replacement therapy: comparison of cyclic versus continuous combined schedules. Fertil Steril 1998; 69:865-9. [PMID: 9591494 DOI: 10.1016/s0015-0282(98)00047-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To measure gynecologic resources required to care for women who have unexpected vaginal bleeding while using hormone replacement therapy (HRT). DESIGN A retrospective cohort study based on review of medical records. SETTING A large health maintenance organization. PATIENT(S) We studied 284 women using continuous combined HRT and 306 women receiving cyclic HRT. MAIN OUTCOME MEASURE(S) We noted episodes of unexpected vaginal bleeding and associated clinic visits and gynecologic procedures recorded during a mean follow-up period of 2 years. RESULT(S) Among women using cyclic HRT for the first time, 38.3% had > or = 1 visit for unexpected bleeding and 12.3% had > or = 1 endometrial biopsy. Among women starting continuous combined HRT, 41.6% had > or = 1 visit for unexpected bleeding and 20.1% had > or = 1 endometrial biopsy. After adjusting for potential confounding variables, we found that recipients of cyclic and continuous combined HRT had similar risks of unexpected bleeding and endometrial biopsy. However, among women continuing HRT for >2 years, those using the continuous combined regimen had somewhat lower rates of unexpected bleeding (22.3 events per 100 patient-years) and endometrial biopsy (10.3 events per 100 patient-years) than those using the cyclic regimen (37.8 episodes of unexpected bleeding per 100 patient-years and 13.9 endometrial biopsies per 100 patient-years). CONCLUSION(S) Unexpected vaginal bleeding and the gynecologic resources required to manage it decreased after 2 years in women using continuous combined HRT but did not decline among those using cyclic HRT.
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Affiliation(s)
- B Ettinger
- Kaiser Permanente Medical Care Program, Oakland, California 94611-5714, USA
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48
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Zhu Z, Fu Q, Nightingale CH, Zhao YP, Liao Q, Wang HN, Xue CQ, Yang ZY, Li DK. Pharmacokinetics of 5-fluorouracil and its penetration into pancreatic juice in dogs. Zhongguo Yao Li Xue Bao 1998; 19:7-9. [PMID: 10375748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIM To study the pharmacokinetic behavior of 5-fluorouracil (5-FU) in pancreatic juice in dogs and its correlation with 5-FU in plasma, and to evaluate its penetration characteristics. METHODS After placing a pancreatico-drainage tube, 8 dogs were injected 5-FU 250 mg i.v. Blood and pancreatic samples were collected and the 5-FU concentrations were determined by HPLC. The pharmacokinetic parameters were obtained with statistical analysis. RESULTS The mean slopes of the terminal phase (K10) in plasma and pancreatic juice were 9.4 h-1 and 10.2 h-1, respectively (P > 0.05). The pharmacokinetic behaviors of 5-FU in plasma and pancreatic juice fitted a nonlinear model. Its penetration index was 3.39 +/- 2.84. The penetration of 5-FU from blood to pancreatic juice was relatively rapid, demonstrating a consistently higher concentration in pancreatic juice than in plasma. CONCLUSIONS The elimination phase of 5-FU in plasma was similar to that in pancreatic juice, indicating that they were in the same kinetic compartment.
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Affiliation(s)
- Z Zhu
- Department of Pharmacy, Peking Union Medical College Hospital, PUMC, Chinese Academy of Medical Sciences, Beijing, China.
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Prior JC, Vigna YM, Wark JD, Eyre DR, Lentle BC, Li DK, Ebeling PR, Atley L. Premenopausal ovariectomy-related bone loss: a randomized, double-blind, one-year trial of conjugated estrogen or medroxyprogesterone acetate. J Bone Miner Res 1997; 12:1851-63. [PMID: 9383690 DOI: 10.1359/jbmr.1997.12.11.1851] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to contrast the effects of conventional estrogen treatment with medroxyprogesterone on cancellous and cortical bone change in the first year following premenopausal ovariectomy. This 1-year double-blind randomized therapy trial was stratified by osteoporosis family history and performed in an academic medical center and community hospitals. Premenopausal women 45 +/- 5 years old, postovariectomy for benign diseases were provided 600 mg/day of calcium and randomized to daily therapy with conjugated equine estrogen (CEE, 0.6 mg) or medroxyprogesterone (MPA, 10 mg). The primary outcome variable was spinal quantitative computed tomography (QCT) bone density change over 1 year with additional outcomes of dual-energy X-ray absorptiometry (DXA) of proximal femur (FN), whole body (WB), and spine segment (WBS) and N-telopeptide, bone-specific alkaline phosphatase, and other bone marker, hormonal, and weight changes. Results in the 33 women completing the study, whose initial bone densities were normal (QCT 133 mg/cm3, femoral neck 0.94 g/cm2, whole body DXA 1.13 g/cm2), showed annual QCT loss during CEE therapy of -11.5 mg/cm3 (p < 0.0007) and MPA bone loss of -19.7 mg/cm3 (p < 0.0001). Losses were marginally greater on MPA than CEE (p = 0.04). Extremely high postovariectomy (5 days) and pretreatment resorption markers (> 3 SD above premenopausal normal levels) were significantly related to bone loss. Across the year, resorption decreased during CEE but increased on MPA treatment. Significant DXA bone losses were prevented by CEE treatment (-1.4% FN, -.4% WB, and -1.5% WBS, all NS). However, DXA bone loss was not prevented by MPA treatment (-5% FN, -2.8% WB, and -6.1% WBS, all p < 0.03). Average weight gain was significant (+ 3.2 +/- 4.0 kg) and greater on CEE than MPA (+ 4.7 vs. + 2.0 kg, p = 0.049). In conclusion, CEE therapy did not prevent significant 8% cancellous spinal bone loss in the first year following premenopausal ovariectomy, despite supplementation with 600 mg/day of calcium, good control of vasomotor symptoms, and nearly 5 kg of gain in weight. Significant DXA bone loss, however, was prevented by CEE, but not by MPA therapy. These unexpected results were statistically related to high bone resorption following ovariectomy, which CEE suppressed but MPA did not. Bone formation markers increased during MPA therapy but were unchanged during CEE therapy.
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Affiliation(s)
- J C Prior
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Zhao GJ, Li DK, Wolinsky JS, Koopmans RA, Mietlowski W, Redekop WK, Riddehough A, Cover K, Paty DW. Clinical and magnetic resonance imaging changes correlate in a clinical trial monitoring cyclosporine therapy for multiple sclerosis. The MS Study Group. J Neuroimaging 1997; 7:1-7. [PMID: 9038425 DOI: 10.1111/jon1997711] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Magnetic resonance imaging (MRI) was used to monitor cyclosporine therapy for chronic progressive multiple sclerosis in a multicenter clinical trial and an analysis was performed to determine whether there was a correlation between clinical changes and MRI changes. MRI was performed on 163 patients at the onset and completion of the 2-year study. Burden of disease (BOD, lesion load) was quantitated by a single observer using a computer program. Active lesions were also identified. The Expanded Disability Status Scale (EDSS) score was determined every 3 months MRI data did not show any effect of cyclosporine treatment on BOD progression (mean 24.5% increase/yr) or lesion activity. However, there was a statistically significant positive correlation between the baseline total BOD value and the baseline EDSS score (r = 0.221, p = 0.005) and a positive correlation between the percent changes in BOD from baseline to exit and EDSS score (r = 0.186, p = 0.018). The study supports the concepts that MRI is a useful technique in monitoring therapeutic trials and that MRI is a direct measure of pathology.
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Affiliation(s)
- G J Zhao
- Division of Neurology, University of British Columbia, Vancouver Hospital and Health Sciences Centre, Canada
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