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Alemi R, Wolfe J, Neumann S, Manning J, Hanna L, Towler W, Wilson C, Bien A, Miller S, Schafer E, Gemignani J, Koirala N, Gracco VL, Deroche M. Motor Processing in Children With Cochlear Implants as Assessed by Functional Near-Infrared Spectroscopy. Percept Mot Skills 2024; 131:74-105. [PMID: 37977135 PMCID: PMC10863375 DOI: 10.1177/00315125231213167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Auditory-motor and visual-motor networks are often coupled in daily activities, such as when listening to music and dancing; but these networks are known to be highly malleable as a function of sensory input. Thus, congenital deafness may modify neural activities within the connections between the motor, auditory, and visual cortices. Here, we investigated whether the cortical responses of children with cochlear implants (CI) to a simple and repetitive motor task would differ from that of children with typical hearing (TH) and we sought to understand whether this response related to their language development. Participants were 75 school-aged children, including 50 with CI (with varying language abilities) and 25 controls with TH. We used functional near-infrared spectroscopy (fNIRS) to record cortical responses over the whole brain, as children squeezed the back triggers of a joystick that vibrated or not with the squeeze. Motor cortex activity was reflected by an increase in oxygenated hemoglobin concentration (HbO) and a decrease in deoxygenated hemoglobin concentration (HbR) in all children, irrespective of their hearing status. Unexpectedly, the visual cortex (supposedly an irrelevant region) was deactivated in this task, particularly for children with CI who had good language skills when compared to those with CI who had language delays. Presence or absence of vibrotactile feedback made no difference in cortical activation. These findings support the potential of fNIRS to examine cognitive functions related to language in children with CI.
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Affiliation(s)
- Razieh Alemi
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Jace Wolfe
- Oberkotter Foundation, Oklahoma City, OK, USA
| | - Sara Neumann
- Hearts for Hearing Foundation, Oklahoma City, OK, USA
| | - Jacy Manning
- Hearts for Hearing Foundation, Oklahoma City, OK, USA
| | - Lindsay Hanna
- Hearts for Hearing Foundation, Oklahoma City, OK, USA
| | - Will Towler
- Hearts for Hearing Foundation, Oklahoma City, OK, USA
| | - Caleb Wilson
- Department of Otolaryngology-Head & Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexander Bien
- Department of Otolaryngology-Head & Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sharon Miller
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, TX, USA
| | - Erin Schafer
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, TX, USA
| | - Jessica Gemignani
- Department of Developmental and Social Psychology, University of Padua, Padova, Italy
| | | | | | - Mickael Deroche
- Department of Psychology, Concordia University, Montreal, QC, Canada
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Alemi R, Wolfe J, Neumann S, Manning J, Towler W, Koirala N, Gracco VL, Deroche M. Audiovisual integration in children with cochlear implants revealed through EEG and fNIRS. Brain Res Bull 2023; 205:110817. [PMID: 37989460 DOI: 10.1016/j.brainresbull.2023.110817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/22/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Sensory deprivation can offset the balance of audio versus visual information in multimodal processing. Such a phenomenon could persist for children born deaf, even after they receive cochlear implants (CIs), and could potentially explain why one modality is given priority over the other. Here, we recorded cortical responses to a single speaker uttering two syllables, presented in audio-only (A), visual-only (V), and audio-visual (AV) modes. Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were successively recorded in seventy-five school-aged children. Twenty-five were children with normal hearing (NH) and fifty wore CIs, among whom 26 had relatively high language abilities (HL) comparable to those of NH children, while 24 others had low language abilities (LL). In EEG data, visual-evoked potentials were captured in occipital regions, in response to V and AV stimuli, and they were accentuated in the HL group compared to the LL group (the NH group being intermediate). Close to the vertex, auditory-evoked potentials were captured in response to A and AV stimuli and reflected a differential treatment of the two syllables but only in the NH group. None of the EEG metrics revealed any interaction between group and modality. In fNIRS data, each modality induced a corresponding activity in visual or auditory regions, but no group difference was observed in A, V, or AV stimulation. The present study did not reveal any sign of abnormal AV integration in children with CI. An efficient multimodal integrative network (at least for rudimentary speech materials) is clearly not a sufficient condition to exhibit good language and literacy.
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Affiliation(s)
- Razieh Alemi
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec H4B 1R6, Canada.
| | - Jace Wolfe
- Oberkotter Foundation, Oklahoma City, OK, USA
| | - Sara Neumann
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Jacy Manning
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Will Towler
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Nabin Koirala
- Haskins Laboratories, 300 George St., New Haven, CT 06511, USA
| | | | - Mickael Deroche
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec H4B 1R6, Canada
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Deroche MLD, Wolfe J, Neumann S, Manning J, Towler W, Alemi R, Bien AG, Koirala N, Hanna L, Henry L, Gracco VL. Auditory evoked response to an oddball paradigm in children wearing cochlear implants. Clin Neurophysiol 2023; 149:133-145. [PMID: 36965466 DOI: 10.1016/j.clinph.2023.02.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE Although children with cochlear implants (CI) achieve remarkable success with their device, considerable variability remains in individual outcomes. Here, we explored whether auditory evoked potentials recorded during an oddball paradigm could provide useful markers of auditory processing in this pediatric population. METHODS High-density electroencephalography (EEG) was recorded in 75 children listening to standard and odd noise stimuli: 25 had normal hearing (NH) and 50 wore a CI, divided between high language (HL) and low language (LL) abilities. Three metrics were extracted: the first negative and second positive components of the standard waveform (N1-P2 complex) close to the vertex, the mismatch negativity (MMN) around Fz and the late positive component (P3) around Pz of the difference waveform. RESULTS While children with CIs generally exhibited a well-formed N1-P2 complex, those with language delays typically lacked reliable MMN and P3 components. But many children with CIs with age-appropriate skills showed MMN and P3 responses similar to those of NH children. Moreover, larger and earlier P3 (but not MMN) was linked to better literacy skills. CONCLUSIONS Auditory evoked responses differentiated children with CIs based on their good or poor skills with language and literacy. SIGNIFICANCE This short paradigm could eventually serve as a clinical tool for tracking the developmental outcomes of implanted children.
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Affiliation(s)
- Mickael L D Deroche
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec H4B 1R6, Canada.
| | - Jace Wolfe
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Sara Neumann
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Jacy Manning
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - William Towler
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Razieh Alemi
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec H4B 1R6, Canada
| | - Alexander G Bien
- University of Oklahoma College of Medicine, Otolaryngology, 800 Stanton L Young Blvd., Oklahoma City, OK 73117, USA
| | - Nabin Koirala
- Haskins Laboratories, 300 George St., New Haven, CT 06511, USA
| | - Lindsay Hanna
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
| | - Lauren Henry
- Hearts for Hearing Foundation, 11500 Portland Av., Oklahoma City, OK 73120, USA
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Alexander H, Manning J. 951 SETTING UP A GERIATRIC LIAISON SERVICE WITHIN UROLOGY IN A DISTRICT GENERAL HOSPITAL. Age Ageing 2022. [PMCID: PMC9384282 DOI: 10.1093/ageing/afac126.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction One might refer to urologists as the ‘hidden providers’ of geriatric care, ultimately sought out by many geriatric patients. POPS, the Peri-Operative care of Older People’s Service started at Guys Hospital in London is often quoted as the gold standard for liaison services. Having set up liaison services in Orthopaedics and General Surgery in my previous job, an exciting opportunity arose after the first COVID—19 wave when I found my new office directly under the Urology Assessment Unit. Method A Geriatric Urology liaison service was set up by a Consultant Geriatrician with SpR support. One hour per week was agreed within the department to pilot the service. By May 2021 the service had been running for 8 months. During this period 30 patients had been seen (36 patient visits). Results The patient’s mean age was 82 years. The advice given included: O Stopping medication (7 cases) O Recommending iron infusions instead of tablets (5 cases) O Adjusting analgesia (4 cases) O Ordering brain imaging (3 cases) Commonly there was the recognition of the need for palliative care in this frail population. There have been complex cases: O A gentleman with a large perinephric bleed. O A young man with seizures and cognitive issues following renal stones. O A patient with post-operative rhabdomyolysis following nephrectomy. Pre-operative assessments have now been started as part of enhanced care: O Two cystectomy patients (one ward/one telephone) O Two TURBT patients (one with low sodium). Conclusion Staff feedback has been excellent especially linking to the Palliative Care Team. We presented our data at the Urology governance meeting in September 2021 and again received excellent feedback. The urology staff have felt increasingly supported. Data collection has helped build a business case for two Consultant posts in surgical liaison.
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Affiliation(s)
| | - J Manning
- Ashford and St Peter’s Hospital NHS Foundation Trust
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Pain C, Murray A, Dinsdale G, Marsden A, Manning J, Herrick A. POS1304 CORRELATION OF SKIN SCORES (LoSCAT) WITH PATIENT REPORTED OUTCOMES IN JUVENILE LOCALISED SCLERODERMA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJuvenile localised scleroderma (JLS) or morphea is a rare condition, causing inflammation and fibrosis in skin and underlying tissues. A validated skin score (Localized Scleroderma Cutaneous Assessment Tool, LoSCAT) has been developed [1]. This tool has both activity (mLoSSi) and damage indices (LoSDI). Several patient-reported outcomes (PRO) have been studied in JLS including visual analogue scales (VAS), functional and health-related quality of life measures.ObjectivesTo assess the associations between different PROs and the activity and damage indices of the LoSCAT.MethodsParticipants aged 4 to 17 were recruited from 3 tertiary paediatric rheumatology centres in the UK and attended 4 visits at 3 monthly intervals as part of a program of research on JLS. Patient-reported VAS (6 different scales), the Children’s Dermatology Life Quality Index (CDLQI) and Childhood Health Assessment Questionnaires (CHAQ) were completed at each visit. LoSCAT was completed by the two same clinicians throughout the study (both trained in skin score techniques). Pearson correlation coefficients were calculated between each PRO and each component of the LoSCAT.Results24 participants completed all 4 visits and 1 attended 3 visits. 20 participants were female (80%) and 5 were male (20%). Mean age at diagnosis was 7.6 years with mean disease duration of 4.9 years. Subtype of disease was linear head in 5/25 (20%), linear limb 12/25 (48%), generalised morphoea 1/25 (4%), mixed 5/25 (20%) and superficial plaque in 2/25 (8%). Table 1 shows the correlations with figures in bold highlighting positive correlations which were statistically significant (p<0.05) and medium-sized (r>0.3).Table 1.Correlation between patient reported outcomes and LoSCATPROTotal skin activity (mLoSSi)Total skin damage (LoSDI)r (95% CI)p-valuer (95% CI)p-valueCDLQI0.61 (0.02, 1.20)0.0440.42 (0.01, 0.83)0.044CHAQ0.30 (0.03, 0.57)0.0270.20 (-0.14, 0.54)0.244VAS 1: How much IMPACT has your disease had on your life in the PAST MONTH?0.49 (0.00, 0.98)0.0500.38 (0.06, 0.71)0.021VAS 2: How much has your condition (localized scleroderma) affected you OVERALL in the PAST MONTH?0.59 (0.09, 1.09)0.0220.42 (0.13, 0.72)0.005VAS 3: Have your lesions felt itchy and/or scratchy in PAST MONTH?0.40 (-0.01, 0.81)0.0560.31 (0.03, 0.59)0.028VAS 4: Have you felt numbness, tingling, and/or other “funny” feeling in or around your lesion in PAST MONTH?0.55 (0.04, 1.05)0.0330.33 (-0.04, 0.71)0.084VAS 5: How much WORRY do you have about LONG- -TERM problems from your disease?0.40 (-0.01, 0.81)0.0530.32 (0.00, 0.63)0.047VAS 6: How much WORRY do you have about problems from MEDICATIONS used to treat your condition?0.41 (0.00, 0.82)0.0500.29 (-0.09, 0.66)0.131The VAS of symptoms of numbness/tingling showed a strong positive correlation with mLoSSi but a weak and/or non-significant correlation with LoSDI. VAS itchy/scratchy did not show a strong correlation with mLoSSi but showed a moderate correlation with LoSDI. Patient global VAS correlated with both mLoSSi and LoSDI, as did CDLQI. CHAQ correlated with activity only.ConclusionSymptoms within lesions are often interpreted as indicating disease activity. A previous study in adults and children showed itch positively correlated with mLoSSi suggesting it may be a marker of active disease [2]. However, in our study numbness/tingling correlated with disease activity whereas itch did not. Further work is required to understand whether itch correlates to both activity and damage and whether numbness/tingling is a better indicator of activity than itch. Limitations of our study include a heterogenous group of participants with longstanding high-burden disease.References[1]Arkachaisri et al. Rheumatology 2010. 49(2): 373-81.[2]Klimas et al. Br J Derm 2015; 175:1329-1337AcknowledgementsThis study was funded by Scleroderma & Raynaud’s UK.Disclosure of InterestsNone declared
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Pain C, Murray A, Dinsdale G, Marsden A, Manning J, Herrick A. POS0168 NON-INVASIVE IMAGING IN JUVENILE LOCALISED SCLERODERMA: HIGH-FREQUENCY ULTRASOUND, THERMOGRAPHY, LASER DOPPLER & MULTISPECTRAL IMAGING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOutcome measures which can differentiate activity (inflammation) from damage (fibrosis/atrophy) would facilitate development of new treatment strategies in juvenile localized scleroderma (JLS) to target the inflammatory phase of the disease.ObjectivesTo evaluate whether in JLS, non-invasive imaging modalities (high frequency ultrasounds (HFUS), multispectral imaging (MSI), laser doppler imaging (LDI) & infra-red thermography (IRT)) can detect differences between affected & non-affected skin, as a next step in developing these as outcome measures. Our hypothesis was that blood flow (and therefore temperature & oxygenation) would be increased in lesional skin.MethodsParticipants aged 4-17 were recruited from 3 paediatric rheumatology centres in the UK. For each participant, a single lesion was selected. HFUS (30MHz), MSI (bespoke camera and tuneable liquid crystal filter, coupled to custom analysis software, 500nm/710nm wavelengths), LDI and IRT imaging were performed at four sites relating to each lesion: two of affected skin (centre & inner edge of lesion) and two of non-affected skin (one cm from edge of lesion (‘outer’) & contralateral unaffected side). Imaging was performed at 4 visits at 3 monthly intervals. Mean values were compared between the four sites using data from all visits by mixed-effects linear regression to account for individual-level clustering.Results24 participants completed all 4 visits and 1 attended 3. 20 participants were female (80%) & 5 male (20%). Mean age at diagnosis was 7.6 years & disease duration 4.9 years. Subtype of disease was linear head in 5/25 (20%), linear limb 12/25 (48%), generalised morphea 1/25 (4%), mixed 5/25 (20%) and superficial plaque in 2/25 (8%).Table 1 shows a subset of data. All 4 imaging techniques could detect differences between healthy (outer/contralateral) & affected skin (centre/inner edge). For HFUS, there was strong evidence of a difference between affected & unaffected skin (p<0.001) indicating affected skin is thinner than unaffected. Higher mean values of oxygenation, perfusion & temperature were observed in affected compared to non-affected skin in MSI, LDI and IRT respectively. There was no statistical difference seen between inner edge and centre of the lesion in any of the methods.Table 1.Mean differences between different locations for each imaging techniqueImaging techniqueLocationOverall mean difference (95% CI)p-valueHFUS (mm)Centre - Contralateral-0.34 (-0.46, -0.22)<0.001Inner edge - Contralateral-0.30 (-0.40, -0.20)<0.001Centre - Outer-0.35 (-0.46, -0.24)<0.001Inner edge - Outer-0.31 (-0.40, -0.21)<0.001Centre - Inner edge-0.04 (-0.10, 0.02)0.168MSI (rel units)Centre - Contralateral0.06 (0.03, 0.10)<0.001Inner edge - Contralateral0.06 (0.03, 0.09)<0.001Centre - Outer0.04 (0.01, 0.07)0.012Inner edge - Outer0.03 (0.00, 0.06)0.028Centre - Inner edge0.01 (0.00, 0.02)0.251LDI Relative perfusion unitsCentre - Contralateral44.8 (24.4, 65.2)<0.001Inner edge - Contralateral47.9 (21.0, 74.8)<0.001Centre - Outer19.1 (1.0, 37.1)0.039Inner edge - Outer24.8 (6.7, 42.9)0.007Centre - Inner edge-3.5 (-20.3, 13.2)0.679IRT oCCentre - Contralateral0.58 (0.24, 0.91)0.001Inner edge - Contralateral0.44 (0.13, 0.75)0.005Centre - Outer0.44 (0.22, 0.66)<0.001Inner edge - Outer0.30 (0.09, 0.52)0.006Centre - Inner edge0.14 (-0.05, 0.32)0.153The overall mean difference is the measurement of the first location minus the measurement from the second location (e.g. centre minus contralateral), averaged across the four visits.ConclusionOur results suggest non-invasive imaging can detect differences between healthy & unaffected skin in JLS. Whether each technique is only measuring activity & not damage requires further evaluation. The leading edge of lesions has historically been considered as most active compared to the centre. However, no difference was seen between centre & inner edge measurements suggesting that in future studies, imaging protocols can be simplified.AcknowledgementsThis study was funded by Scleroderma & Raynaud’s UK.Disclosure of InterestsNone declared
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Douralis A, Bass G, Dumbill A, Flynn S, Lee N, Manning J, Subiel A. ESTABLISHMENT OF A FLASH RADIOTHERAPY FACILITY AT NPL AND DOSIMETRY STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Williams TM, Costa DFA, Wilson CS, Chang A, Manning J, Swain D, Trotter MG. Sensor-based detection of parturition in beef cattle grazing in an extensive landscape: a case study using a commercial GNSS collar. Anim Prod Sci 2022. [DOI: 10.1071/an21528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wolfe J, Duke M, Miller S, Schafer E, Jones C, Rakita L, Dunn A, Battles J, Neumann S, Manning J. Low-level Speech Recognition of Children with Hearing Aids. J Am Acad Audiol 2021; 33:196-205. [PMID: 34758503 DOI: 10.1055/a-1692-9670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND For children with hearing loss, the primary goal of hearing aids is to provide improved access to the auditory environment within the limits of hearing aid technology and the child's auditory abilities. However, there are limited data examining aided speech recognition at very low (40 dBA) and low (50 dBA) presentation levels. PURPOSE Due to the paucity of studies exploring aided speech recognition at low presentation levels for children with hearing loss, the present study aimed to 1) compare aided speech recognition at different presentation levels between groups of children with normal hearing and hearing loss, 2) explore the effects of aided pure tone average (PTA) and aided Speech Intelligibility Index (SII) on aided speech recognition at low presentation levels for children with hearing loss ranging in degree from mild to severe, and 3) evaluate the effect of increasing low-level gain on aided speech recognition of children with hearing loss. RESEARCH DESIGN In phase 1 of this study, a two-group, repeated-measures design was used to evaluate differences in speech recognition. In phase 2 of this study, a single-group, repeated-measures design was used to evaluate the potential benefit of additional low-level hearing aid gain for low-level aided speech recognition of children with hearing loss. STUDY SAMPLE The first phase of the study included 27 school-age children with mild to severe sensorineural hearing loss and 12 school-age children with normal hearing. The second phase included eight children with mild to moderate sensorineural hearing loss. INTERVENTION Prior to the study, children with hearing loss were fitted binaurally with digital hearing aids. Children in the second phase were fitted binaurally with digital study hearing aids and completed a trial period with two different gain settings: 1) gain required to match hearing aid output to prescriptive targets (i.e., primary program), and 2) a 6-dB increase in overall gain for low-level inputs relative to the primary program. In both phases of this study, real-ear verification measures were completed to ensure the hearing aid output matched prescriptive targets. DATA COLLECTION AND ANALYSIS Phase 1 included monosyllabic word recognition and syllable-final plural recognition at three presentation levels (40, 50, and 60 dBA). Phase 2 compared speech recognition performance for the same test measures and presentation levels with two differing gain prescriptions. RESULTS AND CONCLUSIONS In phase 1 of the study, aided speech recognition was significantly poorer in children with hearing loss at all presentation levels. Higher aided SII in the better ear (55 dB SPL input) was associated with higher CNC word recognition at a 40 dBA presentation level. In phase 2, increasing the hearing aid gain for low-level inputs provided a significant improvement in syllable-final plural recognition at very low-level inputs and resulted in a non-significant trend toward better monosyllabic word recognition at very low presentation levels. Additional research is needed to document the speech recognition difficulties children with hearing aids may experience with low-level speech in the real world as well as the potential benefit or detriment of providing additional low-level hearing aid gain.
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Affiliation(s)
- Jace Wolfe
- Hearts for Hearing, Oklahoma City, United States
| | | | - Sharon Miller
- Audiology and Speech-Language Pathology, University of North Texas, Denton, United States
| | | | | | | | | | | | - Sara Neumann
- Hearts for Hearing, Oklahoma City, United States
| | - Jacy Manning
- Hearts for Hearing, Oklahoma City, United States
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Vivekanantham A, Dinsdale G, Heal C, Manning J, Herrick AL. Associations with digital pitting in patients with systemic sclerosis: results of a retrospective analysis. Scand J Rheumatol 2021; 51:159-160. [PMID: 34727825 DOI: 10.1080/03009742.2021.1980980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Vivekanantham
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - G Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C Heal
- Centre for Biostatistics, The University of Manchester, Manchester, UK
| | - J Manning
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Schafer EC, Miller S, Manning J, Zhang Q, Lavi A, Bodish E, Fuentes A, De Blaey E. Meta-Analysis of Speech Recognition Outcomes in Younger and Older Adults With Cochlear Implants. Am J Audiol 2021; 30:481-496. [PMID: 34106734 DOI: 10.1044/2021_aja-20-00141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Meta-analyses were conducted to compare pre- to postoperative speech recognition improvements and postoperative scores after cochlear implantation in younger (< 60 years) and older (> 60 years) adults. Method Studies were identified with electronic databases and through manual search of the literature. In the primary analyses, effect sizes between pre- and postoperative scores for each age group were calculated using a formula appropriate for repeated-measures designs. Using the effect sizes, two separate meta-analyses using a random-effects restricted maximum likelihood model were conducted for experiments using word and sentence recognition stimuli in quiet. Secondary meta-analyses were conducted to examine average postimplant, percent correct word recognition, sentence recognition, and speech recognition in noise in studies that included both older and younger age groups. Traditional Hedges's g effect sizes were calculated between the two groups. Results For the primary analyses, experiments using word and sentence recognition stimuli yielded significant, large effect sizes for the younger and older adult cochlear implant recipients with no significant differences between the older and younger age groups. However, the secondary meta-analyses of postoperative scores suggested significant differences between age groups for stimuli in quiet and noise. Conclusions Although older and younger adults with implants achieve the same magnitude of pre- to postimplant speech recognition benefit in quiet, the overall postoperative speech recognition outcomes in quiet and noise are superior in younger over older adults. Strategies to mitigate these group differences are critical for ensuring optimal outcomes in elderly individuals who are candidates for cochlear implants.
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Affiliation(s)
- Erin C. Schafer
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Sharon Miller
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Jacy Manning
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Qi Zhang
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Alexandra Lavi
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Emily Bodish
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Andrea Fuentes
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
| | - Eric De Blaey
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton
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Herrick AL, Heal C, Wilkinson J, Dinsdale G, Manning J, Gunnarsson K, Jakobsson PJ, Murray A. Temperature response to cold challenge and mobile phone thermography as outcome measures for systemic sclerosis-related Raynaud's phenomenon. Scand J Rheumatol 2021; 50:479-484. [PMID: 34132168 DOI: 10.1080/03009742.2021.1907926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: Objective outcome measures of systemic sclerosis (SSc)-related Raynaud's phenomenon (RP) are badly needed. Our objectives were to validate the thermographic response to a standard hand cold challenge as an outcome measure by assessing sensitivity to change, and to explore mobile phone thermography as a feasible, ambulatory tool.Method: Twelve patients with an SSc-spectrum disorder admitted for intravenous iloprost infusions underwent a standard cold challenge before and after one infusion. Thermographic measurements included area under the rewarming curve (AUC) and maximum rewarming temperature (MAX). Before and during another infusion, each patient underwent monitoring of finger skin temperature by two methods: continuous thermocouple recording (standard method) and mobile phone thermography.Results: All cold challenge summary measures, including AUC and MAX, increased after iloprost (most not significantly). However, when the response curves were modelled after averaging across fingers (linear mixed models, three versions), significant change was detected. For example, with Model 1 (no interaction between period and time), temperature was on average 1.67ºC [95% confidence interval (CI) 1.49-1.85, p < 0.001] higher post-iloprost. Mobile phone and thermocouple temperature measurements showed a strong estimated latent correlation (0.88, 95% CI 0.81-0.92). The estimated increases/hour were 0.25ºC (95% CI 0.05-0.45) for the thermocouple and 0.36ºC (95% CI 0.13-0.60) for mobile phone thermography.Conclusion: Our pilot study suggests that the thermographic response to a cold challenge is sensitive to change and mobile phone thermography could bring feasibility to thermographic parameters as outcome measures in later-phase, large-scale, community-based clinical trials of RP.
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Affiliation(s)
- A L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - J Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - G Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J Manning
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - K Gunnarsson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P-J Jakobsson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A Murray
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Schafer EC, Mathews L, Gopal K, Canale E, Creech A, Manning J, Kaiser K. Behavioral Auditory Processing in Children and Young Adults with Autism Spectrum Disorder. J Am Acad Audiol 2020; 31:680-689. [PMID: 33316826 DOI: 10.1055/s-0040-1717138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Auditory-processing deficits are common in children and adults who are diagnosed with autism spectrum disorder (ASD). These deficits are evident across multiple domains as exhibited by the results from subjective questionnaires from parents, teachers, and individuals with ASD and from behavioral auditory-processing testing. PURPOSE Few studies compare subjective and behavioral performance of adults and children diagnosed with ASD using commercially available tests of auditory processing. The primary goal of the present study is to compare the performance of adults and children with ASD to age-matched, neurotypical peers. The secondary goal is to examine the effect of age on auditory-processing performance in individuals with ASD relative to age-matched peers. RESEARCH DESIGN A four-group, quasi-experimental design with repeated measures was used in this study. STUDY SAMPLE Forty-two adults and children were separated into four groups of participants: (1) 10 children with ASD ages 14 years or younger; (2) 10 age-matched, neurotypical children; (3) 11 adolescents and young adults with ASD ages 16 years and older; and (4) 11 age-matched, neurotypical adolescents or young adults. DATA COLLECTION AND ANALYSIS Data from each participant were collected in one test session. Data were analyzed with analysis of variance (ANOVA), repeated measures ANOVA, or nonparametric analyses. Effect sizes were calculated to compare performance between those with ASD and those who were neurotypical within each age group. RESULTS Across all the questionnaires and the majority of the behavioral test measures, participants with ASD had significantly poorer ratings or auditory-processing performance than age-matched, neurotypical peers. Adults had more favorable performance than children on several of the test measures. Medium to large effect sizes corroborated the significant results. CONCLUSION Overall, the questionnaires and behavioral tests used in this study were sensitive to detecting auditory-processing differences between individuals diagnosed with ASD and those who are considered neurotypical. On most test measures, children performed more poorly than adults. The findings in this study support that both children and adults with ASD exhibit auditory-processing difficulties. Appropriate school and work accommodations will be necessary to ensure appropriate access to speech in challenging environments.
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Affiliation(s)
- Erin C Schafer
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Lauren Mathews
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Kamakshi Gopal
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Emilee Canale
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Avery Creech
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Jacy Manning
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Kara Kaiser
- Department of Audiology & Speech-Language Pathology, University of North Texas, Denton, Texas
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Miller SE, Anderson C, Manning J, Schafer E. Insurance Payer Status Predicts Postoperative Speech Outcomes in Adult Cochlear Implant Recipients. J Am Acad Audiol 2020; 31:666-673. [PMID: 33225433 DOI: 10.1055/s-0040-1717137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cochlear implant qualifying criteria for adult patients with public insurance policies are stricter than the labeled manufacturer criteria. It remains unclear whether insurance payer status affects expedient access to implants for adult patients who could derive benefit from the devices. PURPOSE This study examined whether insurance payer status affected access to cochlear implant services and longitudinal speech-perception outcomes in adult cochlear implant recipients. RESEARCH DESIGN Retrospective cross-sectional study. STUDY SAMPLE Sixty-eight data points were queried from the Health Insurance Portability and Accountability Act-Secure, Encrypted, Research Management and Evaluation Solution database which consists of 12,388 de-identified data points from adult and pediatric cochlear implant recipients. DATA ANALYSIS Linear mixed-effects models were used to determine whether insurance payer status affected expedient access to cochlear implants and whether payer status predicted longitudinal postoperative speech-perception scores in quiet and noise. RESULTS Results from linear mixed-effects regression models indicated that insurance payer status was a significant predictor of behavioral speech-perception scores in quiet and in background noise, with patients with public insurance experiencing poorer outcomes. In addition, extended wait time to receive a cochlear implant was predicted to significantly decrease speech-perception outcomes for patients with public insurance. CONCLUSION This study documented patients covered by public health insurance wait longer to receive cochlear implants and experience poorer postoperative speech-perception outcomes. These results have important clinical implications regarding the cochlear implant candidacy criteria and intervention protocols.
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Affiliation(s)
- Sharon E Miller
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Chelsea Anderson
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Jacy Manning
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
| | - Erin Schafer
- Department of Audiology and Speech-Language Pathology, University of North Texas, Denton, Texas
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Hughes M, Rogers S, Carreira J, Moore T, Manning J, Dinsdale G, McCollum C, Herrick AL. Imaging digital arteries in systemic sclerosis by tomographic 3-dimensional ultrasound. Rheumatol Int 2020; 41:1089-1096. [PMID: 32797279 DOI: 10.1007/s00296-020-04675-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Objective methods are needed to quantify digital artery disease in systemic sclerosis (SSc) for clinical trials of vascular therapies. Our primary aim was to examine feasibility of a novel tomographic three-dimensional-(3-D) ultrasound (tUS) with high-frequency ultrasound (HFUS) or ultra-high-frequency ultrasound (UHFUS) to assess the digital arteries in patients with SSc compared to healthy controls. A secondary objective was to compare the total wall volume (TWV) as a measure of intimal/medial thickness. Eighteen patients with a confirmed diagnosis of SSc were studied by tUS HFUS (17.5 MHz, n = 10) or tUS UHFUS (48 and 70 MHz, n = 8) with equal numbers of healthy controls of similar age and gender. The majority of patients had limited cutaneous SSc and were representative of a spectrum of digital vasculopathy, with over half (n = 6 HFUS and n = 5 UHFUS) having previous digital ulceration. Over half were receiving oral vasodilatory therapy. TWV was measured in both digital arteries of the middle finger bilaterally. At least, two digital arteries could be identified at 17.5 MHz in all patients and healthy controls. Whereas, at least two digital arteries could be identified in relatively fewer patients compared to healthy controls using 48 MHz (n = 6 and 10) and especially 70 MHz (n = 4 and 10) UHFUS. The median difference in TWV between patients and healthy controls was -6.49 mm3 using 17.5 MHz, 1.9 mm3 at 48 MHz, and -0.4 mm3 at 70 MHz. tUS using UHFUS is a feasible method to measure TWV of digital arteries in SSc. Transducer frequency plays an important factor in successful digital artery measurement, with 48 MHz being the optimal frequency.
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Affiliation(s)
- M Hughes
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.
| | - S Rogers
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
| | - J Carreira
- Independent Vascular Services Ltd, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - T Moore
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - J Manning
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - G Dinsdale
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - C McCollum
- Academic Surgery Unit, Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - A L Herrick
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
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Vivekanantham A, Dinsdale G, Heal C, Manning J, Herrick A. AB0622 ASSOCIATIONS WITH DIGITAL PITTING IN SYSTEMIC SCLEROSIS: A RETROSPECTIVE ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Digital pitting, the loss of tissue at the fingertip, is a cardinal feature of systemic sclerosis (SSc), contributing 3 of the 9 required points to fulfil the 2013 ACR/EULAR classification criteria. However, research into digital pitting has been scarce, despite it being painful and impacting on hand function.Objectives:To identify factors associated with digital pitting in patients with SSc.Methods:This was a retrospective analysis of data from patients with SSc attending a tertiary referral centre. Patients were subdivided into those with and without digital pitting, as recorded at their last documented attendance. The following variables were analysed: age, gender, age at Raynaud’s onset, age at SSc onset, limited/ diffuse cutaneous subtype, history of intravenous (IV) vasodilators, amputations, debridements and autoantibody status (anti-RNA polymerase, anti-Scl70, anti-centromere and anti-RNP).Results:Data were available from 713 patients with SSc. Digital pitting was present in approximately half of these patients (n=362, 51%). Table 1 summarises their characteristics.Table 1.Descriptive statistics of patients with and without digital pittingDigital Pitting(n=362)No Digital Pitting(n=351)Age, mean (SD)67.1 (14.5)66.5 (13.6)Females, n (%)287 (79.3)301 (85.8)Age at Raynaud’s onset/ Age at SSc onset, median (IQR)39.3 (25.2, 49.3)/ 41.4 (26.2, 52.5)47.5 (35.3, 57.3)/ 52.5 (41.9, 60.4)Limited/ Diffuse subtype, n (%)276/85 (76.5/ 23.6)257/93 (73.6/ 26.6)History of IV vasodilators, n (%)167 (46.4)52 (14.9)History of amputations, n (%)52 (14.4)5 (1.4)Debridements, n (%)72 (20.2)18 (5.1)Autoantibody status, n (%):Anti-RNA polymerase/ Anti-Scl70/Anti-centromere/ Anti-RNP13 (6.2)1/ 61 (17.1)3/ 152 (42.6)5/ 15 (4.3)734 (14.0)2/ 41 (12.0)4/ 120 (35.4)6/ 22 (6.5)8Denominator populations1210,2246,3357,4345,5357,6341,7352,8341From the univariable analysis (Table 2), gender (female, p=0.02), age at Raynaud’s onset (p<0.001), age at SSc onset (p<0.001), IV vasodilators (p<0.001), amputations (p<0.001), debridements (p<0.001), anti-RNA polymerase (p=0.01), anti-Scl70 (p=0.05) and anti-centromere (p=0.05) were found to be significantly associated (anti-RNA polymerase negatively (p=0.20)) with digital pitting (p≤0.05). Further analysis adjusting the p value for multiple testing (Bonferroni adjustment, p≤0.0036) found age at Raynaud’s onset, age at SSc onset, history of IV vasodilators, amputations and debridements to be significantly associated with digital pitting.Table 2.Univariable logistic regressionOdds Ratio95% Confidence IntervalP value1Number of patients in each analysisAge1.0000.998 to 1.0030.62713Female1.1161.015 to 1.2310.02713Age at Raynaud’s onset1.0081.007 to 1.010<0.001713Age at SSc onset1.0041.003 to 1.005<0.001713Limited/ Diffuse subtype1.039/ 1.0411.049 to 1.127/ 1.046 to 1.1390.39/ 0.35710/ 711History of IV vasodilators1.4481.336 to 1.553<0.001710History of amputations1.5531.363 to 1.768<0.001713Debridements1.4051.259 to 1.568<0.001707Autoantibody status:Anti-RNA polymerase/ Anti-Scl70/ Anti-centromere/ Anti-RNP1.223/ 1.111/ 1.081/ 1.1141.052 to 1.419/ 1.000 to 1.234/ 1.002 to 1.162/ 1.310 to 1.7860.01/ 0.05/ 0.05/ 0.20456/ 702/ 698/ 6931p≤0.05Conclusion:The results from this exploratory study in a large cohort of SSc patients provide valuable insights into factors associated with digital pitting. Patients with digital pitting often have an earlier onset of Raynauds and of SSc and significantly more debridements/amputations, suggesting that digital pitting is associated with vascular disease severity. Our findings indicate the need for further research investigating pathophysiology of digital pitting, to inform development of preventative treatment strategies.Disclosure of Interests:None declared
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Nolan E, Manning J, Heal C, Moore T, Herrick AL. Impact and associates of digital pitting in patients with systemic sclerosis: a pilot study. Scand J Rheumatol 2020; 49:239-243. [PMID: 31928291 DOI: 10.1080/03009742.2019.1683888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Despite being a cardinal clinical sign of systemic sclerosis (SSc), digital pitting has been little studied. Our objective was to test, in a pilot study, the hypothesis that pitting is painful and associated with digital vascular disease severity.Method: Fifty patients with SSc were recruited: 25 with and 25 without digital pitting. Fingertip pain was assessed on a 0-10 scale. Thermography of both hands assessed surface temperature, allowing calculation of the distal-dorsal difference (temperature gradient) for each finger. Nailfold capillaroscopy was performed in each finger using a dermatoscope, and graded on a 0-3 scale (0 = normal; 3 = grossly abnormal).Results: In the 25 patients with digital pitting, 65 fingers in total were affected (mainly the index and middle fingers). Pain scores were higher in 'pitting' patients [median 4 (interquartile range 3-8) vs 0 (0-2), p < 0.001], and pitting patients reported that pitting impacted on activities of everyday living. Temperature gradients along the fingers did not differ significantly between patients with and without pitting (p = 0.248). Pitting patients were more likely to have 'grossly abnormal' capillaries than those without pitting, and less likely to have 'no/mild' nailfold capillary changes.Conclusions: Digital pitting is painful and impacts on hand function. Capillaroscopy findings provide further support for an association between pitting and severity of digital vascular change. Larger, more comprehensive studies are required to examine the pathophysiology of pitting and to pave the way to therapeutic intervention, ideally including preventive strategies.
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Affiliation(s)
- E Nolan
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J Manning
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - T Moore
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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McGreevy D, Abu-Zidan F, Sadeghi M, Pirouzram A, Toivola A, Skoog P, Idoguchi K, Kon Y, Ishida T, Matsumura Y, Matsumoto J, Reva V, Maszkowski M, Bersztel A, Caragounis E, Falkenberg M, Handolin L, Oosthuizen G, Szarka E, Manchev V, Wannatoop T, Chang S, Kessel B, Hebron D, Shaked G, Bala M, Coccolini F, Ansaloni L, Dogan E, Manning J, Hibert-Carius P, Larzon T, Nilsson K, Hörer T. Feasibility and Clinical Outcome Of REBOA in Patients With Impending Traumatic Cardiac Arrest. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rippaus N, Manning J, Droop A, Al-Jabri M, Care M, Bruns AF, Jenkinson MD, Brodbelt A, Chakrabarty A, Ismail A, Short S, Stead LF. OS9.5 Evidence that adult glioblastoma adapts to standard therapy though chromatin remodeling. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma (GBM) tumours recur following standard treatment in almost all cases. We use ‘omics technologies to simultaneously profile pairs of primary and matched recurrent GBM to specifically identify and characterise the cells that resisted treatment, with the aim of determining how to more effectively kill them.
MATERIAL AND METHODS
We have analysed high coverage RNAseq data from pairs of GBM tumours: primary de novo tumour and matched local recurrence from patients that underwent standard therapy. Our original cohort constituted 23 pairs and our validation cohort was an additional 22 pairs. We also cultured two plates of spheroids directly from a patient’s GBM, treating one with radiation and temozolomide. We monitored growth and captured and sequenced RNA from single cells at two time-points: one week post-treatment when the deviation between untreated and treated spheroid growth curves was most pronounced; and three weeks post-treatment when the growth rate of treated spheroids had recovered. We investigated differential gene expression between primary and recurrent pairs, and single cells pre- and post-treatment, and performed a bespoke per patient gene set enrichment analysis.
RESULTS
Differential gene expression analysis in 23 tumour pairs indicated a treatment-induced shift in cell states linked to normal neurogenesis and prompted us to develop a novel gene set enrichment analysis approach to identify gene regulatory factors that may orchestrate such a shift. This revealed the significant and universal dysregulation of genes, through therapy, that are targeted by a specific chromatin remodeling machinery. This finding was validated in an independent cohort of 22 further GBM pairs. To understand the therapeutic potential of this finding we must determine whether genes are dysregulated through therapy owing to a) their fixed expression in inherently treatment resistance cells in the primary tumour which get selected during therapy to increase the signal of that profile, or b) changes in expression during the process of cells acquiring treatment resistance. To inspect this, we analysed single cell gene expression data from GBM spheroids pre- and post-treatment. We found that there was significant dysregulation of the genes associated with the chromatin remodeling complex but only at the three-week post-treatment time-point.
CONCLUSION
Our results indicate that GBM cells are being transcriptionally reprogrammed in response to treatment; the mechanism of which may represent a therapeutic opportunity.
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Affiliation(s)
- N Rippaus
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - J Manning
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - A Droop
- Leeds Institute of Data Analytics, Leeds, United Kingdom
| | - M Al-Jabri
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - M Care
- Leeds Institute of Data Analytics, Leeds, United Kingdom
| | - A F Bruns
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - M D Jenkinson
- Walton Centre NHS Trust, Liverpool, United Kingdom
- Institute of Translational Medicine, Liverpool, United Kingdom
| | - A Brodbelt
- Walton Centre NHS Trust, Liverpool, United Kingdom
| | - A Chakrabarty
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A Ismail
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S Short
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - L F Stead
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
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Waduud MA, Wood B, Keleabetswe P, Manning J, Linton E, Drozd M, Hammond CJ, Bailey MA, Scott DJA. Influence of psoas muscle area on mortality following elective abdominal aortic aneurysm repair. Br J Surg 2019; 106:367-374. [PMID: 30706453 PMCID: PMC7938852 DOI: 10.1002/bjs.11074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Received: 07/26/2018] [Revised: 09/24/2018] [Accepted: 11/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The effect of sarcopenia based on the total psoas muscle area (TPMA) on CT is inconclusive in patients undergoing abdominal aortic aneurysm (AAA) intervention. The aim of this prospective cohort study was to evaluate morphometric sarcopenia as a method of risk stratification in patients undergoing elective AAA intervention. METHODS TPMA was measured on preintervention CT images of patients undergoing elective endovascular aneurysm repair (EVAR) or open aneurysm repair. Mortality was assessed in relation to preintervention TPMA using Cox regression analysis, with calculation of hazard ratios at 30 days, 1 year and 4 years. Postintervention morbidity was evaluated in terms of postintervention care, duration of hospital stay and 30-day readmission. Changes in TPMA on surveillance EVAR imaging were also evaluated. RESULTS In total, 382 patient images acquired between March 2008 and December 2016 were analysed. There were no significant intraobserver and interobserver differences in measurements of TPMA. Preintervention TPMA failed to predict morbidity and mortality at all time points. The mean(s.d.) interval between preintervention and surveillance imaging was 361·3(111·2) days. A significant reduction in TPMA was observed in men on surveillance imaging after EVAR (mean reduction 0·63(1·43) cm2 per m2 ; P < 0·001). However, this was not associated with mortality (adjusted hazard ratio 1·00, 95 per cent c.i. 0·99 to 1·01; P = 0·935). CONCLUSION TPMA is not a suitable risk stratification tool for patients undergoing effective intervention for AAA.
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Affiliation(s)
- M A Waduud
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Wood
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Keleabetswe
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Manning
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - E Linton
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Drozd
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - C J Hammond
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M A Bailey
- Leeds Institute for Cardiovascular and Metabolic Medicine, LIGHT Laboratories, University of Leeds, Leeds, UK
| | - D J A Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Peytrignet S, Manning J, Wragg E, Moore T, Samaranayaka M, Dinsdale G, Herrick AL. Changes in disability and their relationship with skin thickening, in diffuse and limited cutaneous systemic sclerosis: a retrospective cohort study. Scand J Rheumatol 2018; 48:230-234. [PMID: 30394164 DOI: 10.1080/03009742.2018.1523455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The burden of disability associated with systemic sclerosis (SSc) is being increasingly recognized. Our aim was to test the hypothesis that changes in functional ability over time differ between patients with limited (lcSSc) and diffuse cutaneous (dcSSc) subtypes, and that in dcSSc (but not lcSSc) these changes correlate with skin thickening. METHOD This was a retrospective analysis of data collected prospectively between 2005 and 2016 at a single centre. Data recorded at annual review visits included modified Rodnan skin score (mRSS) and Health Assessment Questionnaire Disability Index (HAQ-DI). Yearly rates of mRSS and HAQ-DI change were assessed by individual linear regressions, and those gradients were compared between disease groups (lcSSc/dcSSc) for each of early/late disease (less/greater than 5 years' duration). RESULTS The study included 402 patients (110 dcSSc, 292 lcSSc), with mean length of follow-up of 5.5 years (sd 3.5). Mean baseline HAQ-DI was 1.4 in dcSSc and 1.2 in lcSSc. In dcSSc, increased mRSS was associated with worsening disability (ρ = 0.36, p = 0.004) during early but not late disease (ρ = 0.12, p = 0.331). In lcSSc, changes in mRSS were not associated with changes in disability for early (ρ = -0.15, p = 0.173) or late disease (ρ = 0.10, p = 0.137). CONCLUSION These findings confirm high disability in patients with SSc. A relationship between HAQ-DI and mRSS (worsening mRSS associated with increasing disability) was found only in patients with early dcSSc, suggesting that in other patient subgroups other factors play the major role.
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Affiliation(s)
- S Peytrignet
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - J Manning
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,b Rheumatology Department , Salford Royal NHS Foundation Trust , Salford , UK
| | - E Wragg
- b Rheumatology Department , Salford Royal NHS Foundation Trust , Salford , UK
| | - T Moore
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,b Rheumatology Department , Salford Royal NHS Foundation Trust , Salford , UK
| | - M Samaranayaka
- b Rheumatology Department , Salford Royal NHS Foundation Trust , Salford , UK
| | - G Dinsdale
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - A L Herrick
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,c NIHR Manchester Musculoskeletal Biomedical Research Centre , Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
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Hughes M, Moore T, Manning J, Wilkinson J, Watson S, Samraj P, Dinsdale G, Roberts C, Rhodes LE, Herrick AL, Murray A. A feasibility study of a novel low-level light therapy for digital ulcers in systemic sclerosis. J DERMATOL TREAT 2018; 30:251-257. [PMID: 29862855 PMCID: PMC6484448 DOI: 10.1080/09546634.2018.1484875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Locally acting, well-tolerated treatments for systemic sclerosis (SSc) digital ulcers (DUs) are needed. Objectives: Our primary aim was to investigate the safety, feasibility, and tolerability of a novel low-level light therapy (LTTT). A secondary aim was to tentatively assess efficacy. Methods: A custom-built device comprising infrared (850 nm), red (660 nm), and violet (405 nm) LEDs was utilized. DUs were irradiated with 10 J/cm2 twice weekly for 3 weeks, with follow-up at weeks 4 and 8. Any safety concerns were documented. Patient opinion on time to deliver, feasibility, and pain visual analogue score (VAS; 0–100, 100 most severe) was collected. Patient and clinician DU global assessment VAS were documented. DUs were evaluated by laser Doppler perfusion imaging pre- and post-irradiation. Results: In all, 14 DUs in eight patients received a total of 46 light exposures, with no safety concerns. All patients considered LTTT ‘took just the right amount of time’ and was ‘feasible’, with a low associated mean pain VAS of 1.6 (SD: 5.2). Patient and clinician global DC VAS improved during the study (mean change: –7.1 and –5.2, respectively, both p < .001). DU perfusion significantly increased post-irradiation. Conclusions: LTTT for DUs is safe, feasible, and well tolerated. There was an early tentative suggestion of treatment efficacy.
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Affiliation(s)
- M Hughes
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - T Moore
- b Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - J Manning
- b Department of Rheumatology , Salford Royal NHS Foundation Trust , Salford , UK
| | - J Wilkinson
- c Research and Development , Salford Royal NHS Foundation Trust , Salford , UK
| | - S Watson
- d Medical Physics Department and University of Manchester , Manchester Academic Health Science Centre , Salford Royal NHS Foundation Trust , UK
| | - P Samraj
- e Medical Physics Department , Salford Royal NHS Foundation Trust , UK
| | - G Dinsdale
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - C Roberts
- f Centre for Biostatistics , Institute of Population Health, School of Medicine, The University of Manchester , Manchester , UK
| | - L E Rhodes
- g Photobiology Unit, Dermatology Centre, Division of Musculoskeletal and Dermatological Sciences , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
| | - A L Herrick
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,h NIHR Manchester Musculoskeletal Biomedical Research Centre , Central Manchester NHS Foundation Trust , Manchester Academic Health Science Centre , UK
| | - A Murray
- a Centre for Musculoskeletal Research , The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.,i Photon Science Institute , The University of Manchester , UK
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Waduud M, Drozd M, Keleabetswe P, Manning J, Wood B, Linton E, Bailey M, Hammond C, Scott J. Psoas muscle area as a predictor of mortality and morbidity following endovascular aneurysm repair. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hughes M, Moore T, Manning J, Wilkinson J, Dinsdale G, Roberts C, Murray A, Herrick AL. Reduced perfusion in systemic sclerosis digital ulcers (both fingertip and extensor) can be increased by topical application of glyceryl trinitrate. Microvasc Res 2016; 111:32-36. [PMID: 28027937 PMCID: PMC5351498 DOI: 10.1016/j.mvr.2016.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 12/02/2022]
Abstract
Objectives In patients with systemic sclerosis (SSc), fingertip digital ulcers (DUs) are believed to be ischaemic, and extensor surface DUs a result of mechanical factors/microtrauma. Our aim was to assess blood flow response to topical glyceryl trinitrate (GTN) compared to placebo in SSc DUs, looking for differences in pathophysiology between fingertip and extensor lesions. Method This was a double-blind, randomised, crossover, placebo-controlled study. Sixteen (6 fingertip, 10 extensor) DUs were each studied twice (one day apart): once with GTN and once with placebo ointment. Perfusion at the DU centre (‘DUCore’) and periphery (‘DUPeriphery’), as measured by laser Doppler imaging was performed before and immediately after ointment application, then every 10 min, up to 90 min post-application. We calculated the area under the response curve (AUC) and the ratio of peak perfusion to baseline, then compared these between GTN and placebo. Results Perfusion was lower in the DUCore compared to the DUPeriphery (ratio of 0.52). The microvessels of the DUCore were responsive to GTN, with an increase in perfusion, with a similar effect in both fingertip and extensor DUs. The AUC and peak/baseline perfusion difference in means (ratio, 95% confidence interval) between GTN and placebo at the DUCore were 1.2 (1.0–1.6) and 1.2 (1.0–1.5) respectively, and at the DUPeriphery were 1.1 (0.8–1.6) and 1.0 (0.9–1.2) respectively. Conclusion DUs (both fingertip and extensor) were responsive to topical GTN, with an increase in perfusion to the ischaemic DU centre. If both fingertip and extensor DUs have a (potentially reversible) ischaemic aetiology, this has important treatment implications. SSc fingertip DUs are believed to be ischaemic, whereas, extensor surface DUs are a result of mechanical factors/microtrauma. DUs (both fingertip and extensor) were responsive to topical GTN, in particular the ischaemic centre. If both fingertip and extensor DUs have a ischaemic aetiology, this has important treatment implications.
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Affiliation(s)
- M Hughes
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - T Moore
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - J Manning
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - J Wilkinson
- Research and Development, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - G Dinsdale
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - C Roberts
- Centre for Biostatistics, Institute of Population Health, School of Medicine, The University of Manchester, Manchester, United Kingdom
| | - A Murray
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Photon Science Institute, The University of Manchester, United Kingdom
| | - A L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom
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Hughes M, Moore T, Manning J, Dinsdale G, Murray A, Herrick AL. Digital ulcers in systemic sclerosis are associated with microangiopathic abnormalities of perilesional skin as assessed by capillaroscopy. Scand J Rheumatol 2016; 46:81-82. [DOI: 10.1080/03009742.2016.1178802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M Hughes
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - T Moore
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Manning
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK
| | - G Dinsdale
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Murray
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- Photon Science Institute, The University of Manchester, Manchester, UK
| | - AL Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Manning J, Buckley MM, O'Halloran KD, O'Malley D. In vivo neutralization of IL-6 receptors ameliorates gastrointestinal dysfunction in dystrophin-deficient mdx mice. Neurogastroenterol Motil 2016; 28:1016-26. [PMID: 26920808 DOI: 10.1111/nmo.12803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/25/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a fatal disease characterized by progressive deterioration and degeneration of striated muscle. A mutation resulting in the loss of dystrophin, a structural protein which protects cells from contraction-induced damage, underlies DMD pathophysiology. Damage to muscle fibers results in chronic inflammation and elevated levels of proinflammatory cytokines such as interleukin-6 (IL-6). However, loss of cellular dystrophin also affects neurons and smooth muscle in the gastrointestinal (GI) tract with complaints such as hypomotility, pseudo-obstruction, and constipation reported in DMD patients. METHODS Using dystrophin-deficient mdx mice, studies were carried out to examine colonic morphology and function compared with wild-type mice. Treatment with neutralizing IL-6 receptor antibodies (xIL-6R) and/or the corticotropin-releasing factor (CRF) 2 receptor agonist, urocortin 2 (uro2) was tested to determine if they ameliorated GI dysfunction in mdx mice. KEY RESULTS Mdx mice exhibited thickening of colonic smooth muscle layers and delayed stress-induced defecation. In organ bath studies, neurally mediated IL-6-evoked contractions were larger in mdx colons. In vivo treatment of mdx mice with xIL-6R normalized defecation rates and colon lengths. Uro2 treatment did not affect motility or morphology. The potentiated colonic contractile response to IL-6 was attenuated by treatment with xIL-6R. CONCLUSIONS & INFERENCES These findings confirm the importance of dystrophin in normal GI function and implicate IL-6 as an important regulator of GI motility in the mdx mouse. Inhibition of IL-6 signaling may offer a potential new therapeutic strategy for treating DMD-associated GI symptoms.
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Affiliation(s)
- J Manning
- Department of Physiology, University College Cork, Cork, Ireland
| | - M M Buckley
- Department of Physiology, University College Cork, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - K D O'Halloran
- Department of Physiology, University College Cork, Cork, Ireland
| | - D O'Malley
- Department of Physiology, University College Cork, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
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Dinsdale G, Moore T, O'Leary N, Manning J, Murray A, Berks M, Tresadern P, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Pyrkotsch P, Smith V, Sulli A, Wildt M, Taylor C, Roberts C, Herrick A. FRI0530 Intra-and Inter-Observer Reliability of Nailfold Videocapillaroscopy – A Possible Outcome Measure for Systemic Sclerosis-Related Microangiopathy?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gauhar R, Wilkinson J, Harris J, Manning J, Herrick AL. Calcinosis preferentially affects the thumb compared to other fingers in patients with systemic sclerosis. Scand J Rheumatol 2016; 45:317-20. [PMID: 26812367 DOI: 10.3109/03009742.2015.1127412] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Although Raynaud's phenomenon often spares the thumb, clinical experience suggests conversely that, in patients with systemic sclerosis (SSc), the thumb is frequently affected by calcinosis (as is demonstrated on plain radiographs). Our aim was to investigate the hypothesis that, in patients with SSc, thumbs are more commonly affected by calcinosis than other digits. METHOD Sixty-eight hand radiographs with at least one area of calcinosis were identified. Each digit on both hands of each patient was assigned a severity score on a scale from 0 to 3 (0 = no calcinosis, 3 = most severe). The scoring was completed twice, including and excluding the metacarpals. RESULTS Right hands were found to be associated with slightly higher scores than left hands [estimate 0.14, 95% confidence interval (CI) 0.03-0.26]. Scores were lower for other fingers compared to thumbs. There was strong evidence (p < 0.0001) of a trend of decreasing severity moving from the thumb to the little finger. There was no evidence that the pattern of severity across the fingers was different on left and right hands (p = 0.77). The results were similar whether or not metacarpals were included. CONCLUSIONS The thumb is affected by calcinosis more than other digits, followed by the index finger. This observation provides insight into the pathogenesis of SSc-related calcinosis, which may relate more to repetitive trauma than to ischaemia.
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Affiliation(s)
- R Gauhar
- a Centre for Musculoskeletal Research , Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - J Wilkinson
- b Centre for Biostatistics, Institute of Population Health , University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - J Harris
- c Department of Radiology , Salford Royal NHS Foundation Trust , Salford , UK
| | - J Manning
- d Rheumatology Directorate , Salford Royal NHS Foundation Trust , Salford , UK
| | - A L Herrick
- a Centre for Musculoskeletal Research , Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.,e NIHR Manchester Musculoskeletal Biomedical Research Unit , Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK
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Mahmood M, Wilkinson J, Manning J, Herrick AL. History of surgical debridement, anticentromere antibody, and disease duration are associated with calcinosis in patients with systemic sclerosis. Scand J Rheumatol 2015; 45:114-7. [DOI: 10.3109/03009742.2015.1086432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Manning J. Low minimally invasive sling rates in UK elderly women. BJOG 2015; 123:1392. [PMID: 26179677 DOI: 10.1111/1471-0528.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J Manning
- John Hunter Hospital, Newcastle, NSW, Australia
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Manning J, Brown G, Vogelsong K, Kildebeck M, Zwerski S, Blithe D. Challenges and opportunities in funding the development and introduction of multipurpose prevention technologies. BJOG 2014; 121 Suppl 5:12-4. [PMID: 25335834 DOI: 10.1111/1471-0528.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 12/01/2022]
Affiliation(s)
- J Manning
- Research Division, Office of Population and Reproductive Health, U.S. Agency for International Development, Washington, DC, USA
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Young Holt B, Romano J, Manning J, Hemmerling A, Shields W, Vyda L, Lusti-Narasimhan M. Ensuring successful development and introduction of multipurpose prevention technologies through an innovative partnership approach. BJOG 2014; 121 Suppl 5:3-8. [DOI: 10.1111/1471-0528.12911] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- B Young Holt
- CAMI Health/Public Health Institute; Folsom CA USA
| | | | - J Manning
- Office of Population & Reproductive Health; USAID; Washington DC USA
| | - A Hemmerling
- University of California San Francisco; San Francisco CA USA
| | - W Shields
- Association of Reproductive Health Professionals; Washington DC USA
| | - L Vyda
- Spark Action Consulting; Oakland CA USA
| | - M Lusti-Narasimhan
- Department of Reproductive Health and Research; World Health Organization; Geneva Switzerland
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Wu Z, Holt BY, Manning J, Romano J, Lusti-Narasimhan M, Stone A, Deal C, Wang B. P3.376 Multidisciplinary Approach to Contain HIV-1 and Other STIs in China: Multipurpose Prevention Technologies. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Weinblatt M, Genovese M, Schiff M, Westhovens R, Alten R, Delaet I, Nys M, Manning J, Kremer J. FRI0191 Immunogenicity is low and transient with intravenous abatacept therapy. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tolley E, Manning J. O689 PLANNING FOR SUCCESSFUL INTRODUCTION OF MULTIPURPOSE PREVENTION TECHNOLOGIES IN LOW RESOURCE COUNTRIES. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Romano J, Manning J. O582 THE IDEAL: KEY ATTRIBUTES FOR MULTIPURPOSE PREVENTION TECHNOLOGIES. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lusti-Narasimhan M, Manning J. W424 MAKING THE CASE FOR MULTIPURPOSE PREVENTION TECHNOLOGIES FOR SEXUAL AND REPRODUCTIVE HEALTH. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Backhouse MR, Vinall KA, Redmond A, Helliwell P, Keenan AM, Dale RM, Thomas A, Aronson D, Turner-Cobb J, Sengupta R, France B, Hill I, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S, Ryan S, Lille K, Adams J, Haq I, McArthur M, Goodacre L, Birt L, Wilson O, Kirwan J, Dures E, Quest E, Hewlett S, Rajak R, Thomas T, Lawson T, Petford S, Hale E, Kitas GD, Ryan S, Gooberman-Hill R, Jinks C, Dziedzic K, Boucas SB, Hislop K, Rhodes C, Adams J, Ali F, Jinks C, Ong BN, Backhouse MR, White D, Hensor E, Keenan AM, Helliwell P, Redmond A, Ferguson AM, Douiri A, Scott DL, Lempp H, Halls S, Law RJ, Jones J, Markland D, Maddison P, Thom J, Law RJ, Thom JM, Maddison P, Breslin A, Kraus A, Gordhan C, Dennis S, Connor J, Chowdhary B, Lottay N, Juneja P, Bacon PA, Isaacs D, Jack J, Keller M, Tibble J, Haq I, Hammond A, Gill R, Tyson S, Tennant A, Nordenskiold U, Pease EE, Pease CT, Trehane A, Rahmeh F, Cornell P, Westlake SL, Rose K, Alber CF, Watson L, Stratton R, Lazarus M, McNeilly NE, Waterfield J, Hurley M, Greenwood J, Clayton AM, Lynch M, Clewes A, Dawson J, Abernethy V, Griffiths AE, Chamberlain VA, McLoughlin Y, Campbell S, Hayes J, Moffat C, McKenna F, Shah P, Rajak R, Williams A, Rhys-Dillon C, Goodfellow R, Martin JC, Rajak R, Bari F, Hughes G, Thomas E, Baker S, Collins D, Price E, Williamson L, Dunkley L, Youll MJ, Rodziewicz M, Reynolds JA, Berry J, Pavey C, Hyrich K, Gorodkin R, Wilkinson K, Bruce I, Barton A, Silman A, Ho P, Cornell T, Westlake SL, Richards S, Holmes A, Parker S, Smith H, Briggs N, Arthanari S, Nisar M, Thwaites C, Ryan S, Kamath S, Price S, Robinson SM, Walker D, Coop H, Al-Allaf W, Baker S, Williamson L, Price E, Collins D, Charleton RC, Griffiths B, Edwards EA, Partlett R, Martin K, Tarzi M, Panthakalam S, Freeman T, Ainley L, Turner M, Hughes L, Russell B, Jenkins S, Done J, Young A, Jones T, Gaywood IC, Pande I, Pradere MJ, Bhaduri M, Smith A, Cook H, Abraham S, Ngcozana T, Denton CP, Parker L, Black CM, Ong V, Thompson N, White C, Duddy M, Jobanputra P, Bacon P, Smith J, Richardson A, Giancola G, Soh V, Spencer S, Greenhalgh A, Hanson M, De Lord D, Lloyd M, Wong H, Wren D, Grover B, Hall J, Neville C, Alton P, Kelly S, Bombardieri M, Humby F, Ng N, Di Cicco M, Hands R, Epis O, Filer A, Buckley C, McInnes I, Taylor P, Pitzalis C, Freeston J, Conaghan P, Grainger A, O'Connor PJ, Evans R, Emery P, Hodgson R, Emery P, Fleischmann R, Han C, van der Heijde D, Conaghan P, Xu W, Hsia E, Kavanaugh A, Gladman D, Chattopadhyay C, Beutler A, Han C, Zayat AS, Conaghan P, Freeston J, Hensor E, Ellegard K, Terslev L, Emery P, Wakefield RJ, Ciurtin C, Leandro M, Dey D, Nandagudi A, Giles I, Shipley M, Morris V, Ioannou J, Ehrenstein M, Sen D, Chan M, Quinlan TM, Brophy R, Mewar D, Patel D, Wilby MJ, Pellegrini V, Eyes B, Crooks D, Anderson M, Ball E, McKeeman H, Burns J, Yau WH, Moore O, Foo J, Benson C, Patterson C, Wright G, Taggart A, Drew S, Tanner L, Sanyal K, Bourke BE, Lloyd M, Alston C, Baqai C, Chard M, Sandhu V, Neville C, Jordan K, Munns C, Zouita L, Shattles W, Davies U, Makadsi R, Griffith S, Kiely PD, Ciurtin C, Dimofte I, Dabu M, Dabu B, Dobarro D, Schreiber BE, Warrell C, Handler C, Coghlan G, Denton C, Ishorari J, Bunn C, Beynon H, Denton CP, Stratton R, George Malal JJ, Boton-Maggs B, Leung A, Farewell D, Choy E, Gullick NJ, Young A, Choy EH, Scott DL, Wincup C, Fisher B, Charles P, Taylor P, Gullick NJ, Pollard LC, Kirkham BW, Scott DL, Ma MH, Ramanujan S, Cavet G, Haney D, Kingsley GH, Scott D, Cope A, Singh A, Wilson J, Isaacs A, Wing C, McLaughlin M, Penn H, Genovese MC, Sebba A, Rubbert-Roth A, Scali J, Zilberstein M, Thompson L, Van Vollenhoven R, De Benedetti F, Brunner H, Allen R, Brown D, Chaitow J, Pardeo M, Espada G, Flato B, Horneff G, Devlin C, Kenwright A, Schneider R, Woo P, Martini A, Lovell D, Ruperto N, John H, Hale ED, Treharne GJ, Kitas GD, Carroll D, Mercer L, Low A, Galloway J, Watson K, Lunt M, Symmons D, Hyrich K, Low A, Mercer L, Galloway J, Davies R, Watson K, Lunt M, Dixon W, Hyrich K, Symmons D, Balarajah S, Sandhu A, Ariyo M, Rankin E, Sandoo A, van Zanten JJV, Toms TE, Carroll D, Kitas GD, Sandoo A, Smith JP, Kitas GD, Malik S, Toberty E, Thalayasingam N, Hamilton J, Kelly C, Puntis D, Malik S, Hamilton J, Saravanan V, Rynne M, Heycock C, Kelly C, Rajak R, Goodfellow R, Rhys-Dillon C, Winter R, Wardle P, Martin JC, Toms T, Sandoo A, Smith J, Cadman S, Nightingale P, Kitas G, Alhusain AZ, Verstappen SM, Mirjafari H, Lunt M, Charlton-Menys V, Bunn D, Symmons D, Durrington P, Bruce I, Cooney JK, Thom JM, Moore JP, Lemmey A, Jones JG, Maddison PJ, Ahmad YA, Ahmed TJ, Leone F, Kiely PD, Browne HK, Rhys-Dillon C, Wig S, Chevance A, Moore T, Manning J, Vail A, Herrick AL, Derrett-Smith E, Hoyles R, Moinzadeh P, Chighizola C, Khan K, Ong V, Abraham D, Denton CP, Schreiber BE, Dobarro D, Warrell CE, Handler C, Denton CP, Coghlan G, Sykes R, Muir L, Ennis H, Herrick AL, Shiwen X, Thompson K, Khan K, Liu S, Denton CP, Leask A, Abraham DJ, Strickland G, Pauling J, Betteridge Z, Dunphy J, Owen P, McHugh N, Abignano G, Cuomo G, Buch MH, Rosenberg WM, Valentini G, Emery P, Del Galdo F, Jenkins J, Pauling JD, McHugh N, Khan K, Shiwen X, Abraham D, Denton CP, Ong V, Moinzadeh P, Howell K, Ong V, Nihtyanova S, Denton CP, Moinzadeh P, Fonseca C, Khan K, Abraham D, Ong V, Denton CP, Malaviya AP, Hadjinicolaou AV, Nisar MK, Ruddlesden M, Furlong A, Baker S, Hall FC, Hadjinicolaou AV, Malaviya AP, Nisar MK, Ruddlesden M, Raut-Roy D, Furlong A, Baker S, Hall FC, Peluso R, Dario Di Minno MN, Iervolino S, Costa L, Atteno M, Lofrano M, Soscia E, Castiglione F, Foglia F, Scarpa R, Wallis D, Thomas A, Hill I, France B, Sengupta R, Dougados M, Keystone E, Heckaman M, Mease P, Landewe R, Nguyen D, Heckaman M, Mease P, Winfield RA, Dyke C, Clemence M, Mackay K, Haywood KL, Packham J, Jordan KP, Davies H, Brophy S, Irvine E, Cooksey R, Dennis MS, Siebert S, Kingsley GH, Ibrahim F, Scott DL, Kavanaugh A, McInnes I, Chattopadhyay C, Krueger G, Gladman D, Beutler A, Gathany T, Mudivarthy S, Mack M, Tandon N, Han C, Mease P, McInnes I, Sieper J, Braun J, Emery P, van der Heijde D, Isaacs J, Dahmen G, Wollenhaupt J, Schulze-Koops H, Gsteiger S, Bertolino A, Hueber W, Tak PP, Cohen CJ, Karaderi T, Pointon JJ, Wordsworth BP, Cooksey R, Davies H, Dennis MS, Siebert S, Brophy S, Keidel S, Pointon JJ, Farrar C, Karaderi T, Appleton LH, Wordsworth BP, Adshead R, Tahir H, Greenwood M, Donnelly SP, Wajed J, Kirkham B. BHPR research: qualitative * 1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pusterla N, Kass PH, Mapes S, Johnson C, Barnett DC, Vaala W, Gutierrez C, McDaniel R, Whitehead B, Manning J. Surveillance programme for important equine infectious respiratory pathogens in the USA. Vet Rec 2011; 169:12. [PMID: 21676986 DOI: 10.1136/vr.d2157] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The prevalence and epidemiology of important viral (equine influenza virus [EIV], equine herpesvirus type 1 [EHV-1] and EHV-4) and bacterial (Streptococcus equi subspecies equi) respiratory pathogens shed by horses presented to equine veterinarians with upper respiratory tract signs and/or acute febrile neurological disease were studied. Veterinarians from throughout the USA were enrolled in a surveillance programme and were asked to collect blood and nasal secretions from equine cases with acute infectious upper respiratory tract disease and/or acute onset of neurological disease. A questionnaire was used to collect information pertaining to each case and its clinical signs. Samples were tested by real-time PCR for the presence of EHV-1, EHV-4, EIV and S equi subspecies equi. A total of 761 horses, mules and donkeys were enrolled in the surveillance programme over a 24-month study period. In total, 201 (26.4 per cent) index cases tested PCR-positive for one or more of the four pathogens. The highest detection rate was for EHV-4 (82 cases), followed by EIV (60 cases), S equi subspecies equi (49 cases) and EHV-1 (23 cases). There were 15 horses with double infections and one horse with a triple infection. The detection rate by PCR for the different pathogens varied with season and with the age, breed, sex and use of the animal.
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Affiliation(s)
- N Pusterla
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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Manning J, Katz L, Nauriyal V, Sproule C, McCurdy S. Mesenteric Blood Flow during Hemoglobin-based Oxygen Carrier (HBOC)-201 Fluid Resuscitation in a Swine Model of Severe Hemorrhagic Shock and Uncontrolled Abdominal Hemorrhage. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.706] [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: 11/10/2022]
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Abstract
14148 Background: Chemoradiotherapy has replaced radical surgery as the initial treatment of choice for anal squamous cell carcinoma (ASCC). Optimal chemotherapy regimen for ASCC in HIV positive patients is not yet defined. The addition of mitomycin C to 5-FU and radiotherapy in the past improves local control, colostomy-free, and even disease-free survival in large tumors. The concern is hematologic toxicity if use in HIV positive patients. We report 2 cases safely using low dose mitomycin C, capecitabine and concurrent XRT. One of these patients has ESRD, which the use of cisplatin is not an option. Methods: 2 HIV positive patients, (CD4 range 106–113, at diagnosis of ASCC) were treated with low dose of mitomycin C on day 1 for 2 cycles (5mg flat dose), day 1–7 capecitabine titrated up to 1.5 gm/m2 divided b.i.d, and concurrent XRT (total dose 5040 cGy). Prior to treatment, 1 patient was diagnosed with squamous cell carcinoma in-situ and the other with stage 1 squamous cell carcinoma. 1 patient has end stage renal disease with SCr between 10 and 12 mg/dl at the time of treatment. Results: Both patients completed treatment. No grade 3 or 4 hematologic or gastrointestinal toxicities were noted. No hand-foot syndrome was observed probably due to low dose of capecitabine. Both patients are still alive and remain in remission (16–18 months post treatment). Conclusions: Our 2 cases suggest that the use of low dose mitomycin C in addition to capecitabine and XRT is well tolerated and is efficacious in HIV-positive patients with ASCC. No significant financial relationships to disclose.
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Affiliation(s)
- R. Wadleigh
- US Department of Veterans Affairs, Washington, DC
| | - K. Dinh
- US Department of Veterans Affairs, Washington, DC
| | - J. Manning
- US Department of Veterans Affairs, Washington, DC
| | - A. Kuntz
- US Department of Veterans Affairs, Washington, DC
| | - R. Dorn
- US Department of Veterans Affairs, Washington, DC
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Manning J, Korda A, Benness C, Solomon M. The association of obstructive defecation, lower urinary tract dysfunction and the benign joint hypermobility syndrome: a case-control study. Int Urogynecol J 2003; 14:128-32. [PMID: 12851757 DOI: 10.1007/s00192-002-1025-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2001] [Accepted: 12/14/2002] [Indexed: 11/25/2022]
Abstract
It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.
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Affiliation(s)
- J Manning
- Urogynaecology Unit, Royal Prince Alfred Hospital, Australia
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Uderman H, Vesterqvist O, Manning J, Ferreira I, Delaney C, Liao WC. Omapatrilat: neurohormonal and pharmacodynamic profile when administered with furosemide. J Clin Pharmacol 2001; 41:1291-300. [PMID: 11762556 DOI: 10.1177/00912700122012878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pharmacodynamic effects of combination therapy with omapatrilat and furosemide were evaluated. Two groups of 13 healthy subjects each received furosemide 20 mg dailyfor 15 days coadministered with either placebo on days 6 to 15 or omapatrilat 10 mg on days 6 to 10 and 25 mg on days 11 to 15. In the omapatrilat group, urinary excretion of atrial natriuretic peptide increased, and greater blood pressure reductions were seen compared with placebo. Concomitant omapatrilat treatment did not affect the acute diuresis, natriuresis, and kaliuresis observed with chronic administration of furosemide. Neither effective renal plasma flow nor glomerularfiltration rate changed in either treatment group. No clinically significant safety issues were observed. Daily coadministration of omapatrilat 10 or 25 mg with furosemide 20 mg does not affect the pharmacodynamics offurosemide at steady state.
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Affiliation(s)
- H Uderman
- Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, New Jersey, USA
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Chronowski GM, Ha CS, Wilder RB, Cabanillas F, Manning J, Cox JD. Treatment of unicentric and multicentric Castleman disease and the role of radiotherapy. Cancer 2001. [PMID: 11505414 DOI: 10.1002/1097-0142(20010801)92] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although surgery is considered standard therapy for unicentric Castleman disease, favorable responses to radiotherapy also have been documented. The authors undertook this study to analyze the clinical factors, treatment approaches, and outcomes of patients with unicentric or multicentric Castleman disease, and to report the outcomes of patients with unicentric Castleman disease treated with radiotherapy. METHODS The authors reviewed the medical records of 22 patients who had received a histologic diagnosis of Castleman disease at the University of Texas M. D. Anderson Cancer Center between 1988 and 1999. One patient with a concurrent histopathologic diagnosis of nonsecretory multiple myeloma was excluded from the study. In all patients, the diagnosis of Castleman disease was based on the results of lymph node biopsies. Disease was categorized as being either unicentric or multicentric and further subdivided into hyaline vascular, plasma cell, or mixed variant histologic types. Clinical variables and outcomes were analyzed according to treatment, which consisted of surgery, chemotherapy, or radiotherapy. RESULTS Records from 21 patients were analyzed: 12 had unicentric disease, and 9 had multicentric disease. The mean follow-up time for the entire series was 51 months (median, 40 months). Four patients with unicentric disease were treated with radiotherapy alone: 2 remain alive and symptom free, 2 died of causes unrelated to Castleman disease and had no evidence of disease at last follow-up. Eight patients with unicentric disease were treated with complete or partial surgical resection, and all are alive and asymptomatic. All nine patients with multicentric disease were treated with combination chemotherapy: five are alive with no evidence of disease, and four are alive with progressive disease. CONCLUSIONS Surgery results in excellent rates of cure in patients with unicentric Castleman disease; radiotherapy can also achieve clinical response and cure in selected patients. Multicentric Castleman disease is a more aggressive clinical entity and is most effectively treated with combination chemotherapy, whereas the role of radiotherapy in its treatment remains unclear.
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Affiliation(s)
- G M Chronowski
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Abstract
BACKGROUND Although surgery is considered standard therapy for unicentric Castleman disease, favorable responses to radiotherapy also have been documented. The authors undertook this study to analyze the clinical factors, treatment approaches, and outcomes of patients with unicentric or multicentric Castleman disease, and to report the outcomes of patients with unicentric Castleman disease treated with radiotherapy. METHODS The authors reviewed the medical records of 22 patients who had received a histologic diagnosis of Castleman disease at the University of Texas M. D. Anderson Cancer Center between 1988 and 1999. One patient with a concurrent histopathologic diagnosis of nonsecretory multiple myeloma was excluded from the study. In all patients, the diagnosis of Castleman disease was based on the results of lymph node biopsies. Disease was categorized as being either unicentric or multicentric and further subdivided into hyaline vascular, plasma cell, or mixed variant histologic types. Clinical variables and outcomes were analyzed according to treatment, which consisted of surgery, chemotherapy, or radiotherapy. RESULTS Records from 21 patients were analyzed: 12 had unicentric disease, and 9 had multicentric disease. The mean follow-up time for the entire series was 51 months (median, 40 months). Four patients with unicentric disease were treated with radiotherapy alone: 2 remain alive and symptom free, 2 died of causes unrelated to Castleman disease and had no evidence of disease at last follow-up. Eight patients with unicentric disease were treated with complete or partial surgical resection, and all are alive and asymptomatic. All nine patients with multicentric disease were treated with combination chemotherapy: five are alive with no evidence of disease, and four are alive with progressive disease. CONCLUSIONS Surgery results in excellent rates of cure in patients with unicentric Castleman disease; radiotherapy can also achieve clinical response and cure in selected patients. Multicentric Castleman disease is a more aggressive clinical entity and is most effectively treated with combination chemotherapy, whereas the role of radiotherapy in its treatment remains unclear.
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Affiliation(s)
- G M Chronowski
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Vega F, Medeiros LJ, Jones D, Abruzzo LV, Lai R, Manning J, Dunmire V, Luthra R. A novel four-color PCR assay to assess T-cell receptor gamma gene rearrangements in lymphoproliferative lesions. Am J Clin Pathol 2001; 116:17-24. [PMID: 11447747 DOI: 10.1309/5wfq-n12e-dt05-ux1t] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We describe a novel 4-color polymerase chain reaction (PCR) assay combined with GeneScan analysis to assess for T-cell receptor gamma chain gene (TCRgamma) rearrangements and evaluate its usefulness in 86 lymphoproliferative lesions. In this assay, each variable region (Vgamma) family primer is 5' end-labeled with a different fluorescent dye, allowing determination of the Vgamma family involved in each TCRgamma rearrangement. PCR products were analyzed by capillary electrophoresis. We detected clonal TCRgamma rearrangements in 60 (98%) of 61 T-cell lymphomas, 2 (15%) of 13 B-cell lymphomas, and 3 (25%) of 12 reactive lesions. These results compared favorably with conventional PCR methods using denaturing gradient gel electrophoresis, which revealed clonal TCRgamma rearrangements in 37 (90%) of 41 T-cell lymphomas, 1 (25%) of 4 B-cell lymphomas, and 2 (25%) of 8 reactive lesions. This 4-color PCR assay is at least equivalent to conventional PCR methods and is convenient, allows accurate size determination of TCRgamma rearrangements, and identifies the specific Vgamma family involved, providing more specific information about TCRgamma rearrangement.
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Affiliation(s)
- F Vega
- Division of Pathology and Laboratory Medicine, University of Texas M.D. Anderson Cancer Center, 8515 Fannin, Houston, TX 77030-4095, USA
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O'Grady P, Vesterqvist O, Malhotra B, Manning J, Jemal M, Ge G, Mangold B. Omapatrilat in patients with hepatic cirrhosis. Pharmacodynamics and pharmacokinetics. Eur J Clin Pharmacol 2001; 57:249-57. [PMID: 11497341 DOI: 10.1007/s002280100291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The pharmacodynamics and pharmacokinetics of omapatrilat, a member of a new class of cardiovascular compounds, the vasopeptidase inhibitors, were evaluated in subjects with hepatic cirrhosis (n = 10) and in healthy subjects (n = 10) matched for age, weight, gender and smoking history. METHODS All subjects received omapatrilat 25 mg orally once daily for 14 days. Plasma renin and urinary atrial natriuretic peptide (ANP) levels were measured to assess the effect of omapatrilat on cirrhotic subjects. The effect of omapatrilat on blood pressure as well as changes in ANP and plasma renin levels were not altered by hepatic impairment. Pharmacokinetic parameters were determined from plasma omapatrilat concentrations. RESULTS There were no significant differences between the two subject groups with regard to log-transformed area under the curve or maximum observed plasma concentration. Systemic accumulation was similar in the two groups. CONCLUSION These results suggest, based on findings in otherwise healthy cirrhotic subjects, that no adjustment of standard dosing regimens is indicated for hypertensive patients with mild to moderate cirrhosis.
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Affiliation(s)
- P O'Grady
- Bristol-Myers Squibb PRI, Waterloo, Belgium
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