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Abbot S, Proudman S, Bednarz J, Williams N. Outcomes of proximal humerus fractures in children: a retrospective cohort study. ANZ J Surg 2024; 94:743-748. [PMID: 38366714 DOI: 10.1111/ans.18900] [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: 11/15/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Paediatric proximal humerus fractures (PHFs) have historically been treated non-operatively. However, the management of severely displaced PHFs in older children has been debated over the years, with contemporary studies advocating for surgery. The purpose of this study was to review the outcomes of a cohort of paediatric patients treated for a PHF to guide management of future paediatric PHFs. METHODS The records of the Women's and Children's Hospital in South Australia were reviewed to identify paediatric PHFs occurring between 1 January 2010 and 1 June 2020. Participants completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Shoulder Pain and Disability Index, and the Paediatric Outcomes Data Collection Instrument via phone interview. Participants' shoulder range-of-motion was assessed via telehealth using Zoom. Multivariable logistic regression was used to identify patient and clinical variables that were associated with a poorer outcome. RESULTS Of 307 patients contacted, 125 participated. Forty-six patients met the definition of a poorer clinical outcome, defined as a QuickDASH score of ≥2. Fractures of greater severity were predictive of a poorer outcome, and patients aged ≥12 years old at the time of injury had higher total QuickDASH scores. The findings did not suggest that these subgroups of patients have superior outcomes if treated surgically. CONCLUSION The majority of paediatric PHFs have an acceptable clinical outcome, irrespective of treatment methodology. Multicentre prospective studies are required to establish the indications for surgery for adolescent patients with severely displaced PHFs.
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Affiliation(s)
- Samuel Abbot
- Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia, Australia
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Bartsch DR, McLeod Everitt C, Bednarz J, Ludbrook C, Cammell P. A State-Wide Initiative to Improve Health System Responses to People With Borderline Personality Disorder Symptoms in Crisis: A Retrospective Audit. J Pers Disord 2024; 38:87-108. [PMID: 38324250 DOI: 10.1521/pedi.2024.38.1.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Gold Card SA is a four-session structured psychological intervention offered soon after an acute crisis presentation to people with symptoms characteristic of borderline personality disorder. This study describes individual and system-level outcomes from a large-scale health-care improvement initiative to implement Gold Card SA across South Australia. An uncontrolled pre-post study design was utilized examining service user (n = 332) patient-reported outcome measures and hospital service utilization records (6 months before and after Gold Card SA). Mixed-effects negative binomial regression analysis revealed a significant decrease in rates of service utilization across emergency department presentations (63%), mental health-related inpatient admissions (65%), and bed days (82%). Linear mixed-effect regression indicated large reductions in borderline symptoms and nonspecific psychological distress, and small to moderate improvements in psychosocial functioning. People presenting with or experiencing borderline personality disorder symptoms may benefit from a brief crisis intervention embedded within a stepped care model.
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Affiliation(s)
- Dianna R Bartsch
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
- School of Psychology, The University of Adelaide, Adelaide, South Australia
| | - Cathy McLeod Everitt
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, South Australia
| | - Cathy Ludbrook
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Paul Cammell
- Borderline Personality Disorder Collaborative, Barossa Hills Fleurieu Local Health Network, SA Health, Adelaide, South Australia, Australia
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McMillan M, Mohammed H, Bednarz J, Leong LEX, Lawrence A, Sullivan TR, Maiden MCJ, Marshall HS. Longitudinal study of meningococcal carriage in adolescents and young adults in South Australia 2017-2020. J Infect 2024; 88:149-157. [PMID: 38242365 DOI: 10.1016/j.jinf.2024.01.002] [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: 10/16/2023] [Revised: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND This analysis investigated longitudinal changes in meningococcal carriage in adolescents in South Australia over 4 years. METHODS Data from the "B Part of It" study, which included a state-wide cluster randomized controlled trial in secondary-school students (n = 34,489 in 2017 and 2018) and serial cross-sectional studies in school leavers aged 17-25 years (n = 4028 in 2019-2020). Individuals had oropharyngeal swabs collected annually. This study included two unique cohorts: (1) individuals enrolled in 2019, with three consecutive annual swabs taken in 2017, 2018 and 2019; and (2) individuals enrolled in 2020, with swabs taken in 2017, 2018, and 2020. Disease-associated N. meningitidis genogroups were identified using PCR and whole genome sequencing. Univariate analysis identified risk factors for recurrent carriage (≥2). RESULTS Among school leavers, 50 (1.7%, total n = 2980) had carriage detected at successive visits. In participants with meningococcal carriage at successive visits, 38/50 (76.0%) had the same genogroup detected by porA PCR. Of those, 19 had the same MLST type and demonstrated minimal variation, indicating they most likely had sustained carriage of the same isolate (range 226 to 490 days, mean duration 352 [SD 51] days). In the 2019 school leaver cohort, 6.7% acquired carriage in their first year out of school compared to 3.3% in their final school year. Compared to single carriage detection, recurrent carriage was potentially more likely in older adolescents (16 compared to ≤15 years; OR = 1.97 (95%CI 1.0, 3.86); p = 0.048). CONCLUSION Whilst carriage is typically transient, some adolescents/young adults may have persistent carriage and are likely to be an important group in the transmission of meningococci.
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Affiliation(s)
- Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia; SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Lex E X Leong
- Microbiology and Infectious Diseases, SA Pathology, Adelaide 5000, Australia
| | - Andrew Lawrence
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia; Microbiology and Infectious Diseases, SA Pathology, Adelaide 5000, Australia
| | - Thomas R Sullivan
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia; SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
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4
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Kuah S, Simpson B, Salter A, Matthews G, Louise J, Bednarz J, Chandraharan E, Symonds I, McPhee A, Mol BW, Turnbull D, Wilkinson C. Comparison of effect of CTG + STan with CTG alone on emergency Cesarean section rate: STan Australian Randomized controlled Trial (START). Ultrasound Obstet Gynecol 2023; 62:462-470. [PMID: 37289946 PMCID: PMC10946943 DOI: 10.1002/uog.26279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate whether use of ST analysis of the fetal electrocardiogram (STan) as an adjunct to continuous cardiotocography (CTG) reduces the rate of emergency Cesarean section (EmCS) compared with CTG alone. METHODS This was a randomized controlled trial of patients with a singleton fetus in cephalic presentation at ≥ 36 weeks' gestation, requiring continuous electronic fetal monitoring during labor at a tertiary maternity hospital in Adelaide, Australia, between January 2018 and July 2021. Participants were randomized to undergo CTG + STan or CTG alone. The calculated sample size was 1818 participants. The primary outcome was EmCS. Secondary outcomes included metabolic acidosis, a composite adverse perinatal outcome, and other maternal and neonatal morbidity and safety outcomes. RESULTS The present study enrolled 970 women, of whom 967 were included in the primary analysis. EmCS occurred in 107/482 (22.2%) deliveries in the CTG + STan arm and in 107/485 (22.1%) in the CTG arm (adjusted relative risk, 1.02 (95% CI, 0.81-1.27); P = 0.89). There was no difference in the rate of adverse maternal or neonatal outcomes between arms. CONCLUSIONS The addition of STan as an adjunct to continuous CTG did not reduce the EmCS rate. The smaller-than-anticipated sample size meant that this study was underpowered to detect absolute differences of ≤ 5% and, therefore, this negative finding could be due to a Type-2 error. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. Kuah
- Women's and Children's HospitalNorth AdelaideSAAustralia
| | - B. Simpson
- Women's and Children's HospitalNorth AdelaideSAAustralia
- Women's and Children's Health, Adelaide Medical SchoolUniversity of AdelaideNorth AdelaideSAAustralia
| | - A. Salter
- School of Public Health, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSAAustralia
| | - G. Matthews
- Women's and Children's HospitalNorth AdelaideSAAustralia
| | - J. Louise
- Women's and Children's Hospital, Faculty of Health and Medical SciencesUniversity of AdelaideNorth AdelaideSAAustralia
| | - J. Bednarz
- School of Public Health, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSAAustralia
- South Australian Health and Medical Research InstituteSAHMRI Women and KidsNorth AdelaideSAAustralia
| | - E. Chandraharan
- Global Academy of Medical Education and Training LtdLondonUK
| | - I. Symonds
- Adelaide Medical School, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSAAustralia
| | - A. McPhee
- South Australian Health and Medical Research InstituteSAHMRI Women and KidsNorth AdelaideSAAustralia
| | - B. W. Mol
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVICAustralia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - D. Turnbull
- School of Psychology, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSAAustralia
| | - C. Wilkinson
- Women's and Children's HospitalNorth AdelaideSAAustralia
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Stark MJ, Collins CT, Andersen CC, Crawford TM, Sullivan TR, Bednarz J, Morton R, Marks DC, Dieng M, Owen LS, Opie G, Travadi J, Tan K, Morris S. Study protocol of the WashT Trial: transfusion with washed versus unwashed red blood cells to reduce morbidity and mortality in infants born less than 28 weeks' gestation - a multicentre, blinded, parallel group, randomised controlled trial. BMJ Open 2023; 13:e070272. [PMID: 37487676 PMCID: PMC10373745 DOI: 10.1136/bmjopen-2022-070272] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Many extremely preterm newborns develop anaemia requiring a transfusion, with most receiving three to five transfusions during their admission. While transfusions save lives, the potential for transfusion-related adverse outcomes is an area of growing concern. Transfusion is an independent predictor of death and is associated with increased morbidity, length of hospital stay, risk of infection and immune modulation. The underlying mechanisms include adverse pro-inflammatory and immunosuppressive responses. Evidence supports an association between transfusion of washed red cells and fewer post-transfusion complications potentially through removal of chemokines, lipids, microaggregates and other biological response modifiers. However, the clinical and cost-effectiveness of washed cells have not been determined. METHODS AND ANALYSIS This is a multicentre, randomised, double-blinded trial of washed versus unwashed red cells. Infants <28 weeks' gestation requiring a transfusion will be enrolled. Transfusion approaches will be standardised within each study centre and will occur as soon as possible with a recommended fixed transfusion volume of 15 mL/kg whenever the haemoglobin is equal to or falls below a predefined restrictive threshold, or when clinically indicated. The primary outcome is a composite of mortality and/or major morbidity to first discharge home, defined as one or more of the following: physiologically defined bronchopulmonary dysplasia; unilateral or bilateral retinopathy of prematurity grade >2, and; necrotising enterocolitis stage ≥2. To detect a 10% absolute reduction in the composite outcome from 69% with unwashed red blood cell (RBCs) to 59% with washed RBCs with 90% power, requires a sample size of 1124 infants (562 per group). Analyses will be performed on an intention-to-treat basis with a prespecified statistical analysis plan. A cost-effectiveness analysis will also be undertaken. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Women's and Children's Health Network Human Research Ethics Committee (HREC/12/WCHN/55). The study findings will be disseminated through peer-reviewed articles and conferences. TRIAL REGISTRATION NUMBER ACTRN12613000237785 Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Michael J Stark
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Chad C Andersen
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Tara M Crawford
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachael Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Teams, New South Wales, Australia
| | - Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise S Owen
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Critical Care and Neurosciences Division, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Kenneth Tan
- Monah Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Scott Morris
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Neonatal Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Stonehouse W, Benassi-Evans B, Bednarz J, Vincent AD, Hall S, Hill CL. Krill oil improved osteoarthritic knee pain in adults with mild to moderate knee osteoarthritis: a 6-month multicenter, randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2022; 116:672-685. [PMID: 35880828 PMCID: PMC9437987 DOI: 10.1093/ajcn/nqac125] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 11/25/2021] [Accepted: 05/02/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a major cause of chronic pain and disability worldwide. Treatment generally focuses on symptom relief through nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics, which may incur side effects. Krill oil, rich in anti-inflammatory long-chain (LC) omega-3 ( ω-3) PUFAs and astaxanthin, may be a safe and effective alternative treatment. OBJECTIVES This study sought to investigate the effects of a commercially available krill oil supplement on knee pain in adults with mild to moderate knee OA. Secondary outcomes were knee stiffness; physical function; NSAID use; Omega-3 Index; and lipid, inflammatory, and safety markers. METHODS Healthy adults (n = 235, 40-65 y old, BMI >18.5 to <35 kg/m2), clinically diagnosed with mild to moderate knee OA, regular knee pain, and consuming <0.5 g/d LC ω-3 PUFAs, participated in a 6-mo double-blind, randomized, placebo-controlled, multicenter trial. Participants consumed either 4 g krill oil/d (0.60 g EPA/d, 0.28 g DHA/d, 0.45 g astaxanthin/d) or placebo (mixed vegetable oil). Knee outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) numeric scale (normalized to scores of 0-100). Outcomes were assessed at baseline, 3 mo, and 6 mo. RESULTS Omega-3 Index increased with the krill oil supplement compared with placebo (from 6.0% to 8.9% compared with from 5.5% to 5.4%, P < 0.001). Knee pain score improved in both groups with greater improvements for krill oil than for placebo (difference in adjusted mean change between groups at 6 mo: -5.18; 95% CI: -10.0, -0.32; P = 0.04). Knee stiffness and physical function also had greater improvements with krill oil than with placebo (difference in adjusted mean change between groups at 6 mo: -6.45; 95% CI: -12.1, -0.9 and -4.67; 95% CI: -9.26, -0.05, respectively; P < 0.05). NSAID use, serum lipids, and inflammatory and safety markers did not differ between groups. CONCLUSIONS Krill oil was safe to consume and resulted in modest improvements in knee pain, stiffness, and physical function in adults with mild to moderate knee OA.This trial was registered at clinicaltrials.gov as NCT03483090.
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Affiliation(s)
| | - Bianca Benassi-Evans
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, South Australia, Australia
| | - Jana Bednarz
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew D Vincent
- Freemasons Centre for Male Health & Wellbeing, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Hall
- Emeritus Research Pty Ltd, Camberwell, Victoria, Australia,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, Adelaide, South Australia, Australia
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Kaazan P, Li T, Seow W, Bednarz J, Pipicella JL, Krishnaprasad K, Ng W, Williams AJ, Connor SJ, Andrews JM. Assessing effectiveness and patient perceptions of a novel electronic medical record for the management of inflammatory bowel disease. JGH Open 2021; 5:1063-1070. [PMID: 34584976 PMCID: PMC8454479 DOI: 10.1002/jgh3.12631] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 11/08/2022]
Abstract
Background and Aim There is an increasing prevalence of chronic disease worldwide, resulting in multiple management challenges. Inflammatory bowel disease (IBD) is an exemplar chronic disease requiring coordinated longitudinal care. We propose that Crohn's Colitis Care (CCCare), a novel IBD-specific, structured electronic medical record is effective at improving data capture and is acceptable to patients. Methods A comparison was made between IBD-data completeness in usual records and CCCare. CCCare's acceptability to patients was assessed in two independent IBD patient cohorts and included:• Overall ratings of acceptability.• Factors associated with pre-exposure acceptability ratings.• Whether exposure and security concerns influenced acceptability ratings.• Direct patient feedback through CCCare's patient portal. Results In all cases reviewed, there was data gain using structured CCCare fields compared with IBD documentation in usual medical records. The overall acceptability in the combined cohort (n = 310) was very high. More than three-quarters of patients rated acceptability as >7 of 10. Self-reported information technology (IT) literacy positively associated with acceptability. Exposure had a small positive affect on acceptability, whereas security concerns had little impact on acceptability. Patient portal feedback revealed that most patients are very likely to recommend CCCare to others (8.56 ± 2.2 [out of 10]). Conclusion CCCare is effective in supporting more complete IBD-specific data capture compared with usual medical records. It is highly acceptable to patients, especially those with reasonable IT literacy. Patient concerns about privacy and security of electronic medical records (EMRs) did not significantly affect acceptability.
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Affiliation(s)
- Patricia Kaazan
- Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia Australia.,The University of Adelaide Faculty of Health and Medical Sciences Adelaide South Australia Australia
| | - Tracy Li
- Department of Gastroenterology and Hepatology Liverpool Hospital Liverpool New South Wales Australia.,South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia
| | - Warren Seow
- The University of Adelaide Faculty of Health and Medical Sciences Adelaide South Australia Australia
| | - Jana Bednarz
- The University of Adelaide Faculty of Health and Medical Sciences Adelaide South Australia Australia
| | - Joseph L Pipicella
- Department of Gastroenterology and Hepatology Liverpool Hospital Liverpool New South Wales Australia.,The Ingham Institute for Applied Medical Research Department of Gastroenterology and Hepatology Liverpool New South Wales Australia
| | - Krupa Krishnaprasad
- QIMR Berghofer Medical Research institute Department of Gastroenterology and Hepatology Brisbane Queensland Australia
| | - Watson Ng
- Department of Gastroenterology and Hepatology Liverpool Hospital Liverpool New South Wales Australia.,South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology and Hepatology Liverpool Hospital Liverpool New South Wales Australia.,South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia
| | - Susan J Connor
- Department of Gastroenterology and Hepatology Liverpool Hospital Liverpool New South Wales Australia.,South Western Sydney Clinical School University of New South Wales Sydney New South Wales Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia Australia.,The University of Adelaide Faculty of Health and Medical Sciences Adelaide South Australia Australia
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McMillan M, Koehler AP, Lawrence A, Sullivan TR, Bednarz J, MacLennan JM, Maiden MCJ, Ladhani SN, Ramsay ME, Trotter C, Borrow R, Finn A, Kahler CM, Whelan J, Vadivelu K, Richmond PC, Marshall HS. 'B Part of It' School Leaver study: a repeat cross-sectional study to assess the impact of increasing coverage with meningococcal B (4CMenB) vaccine on carriage of Neisseria meningitidis. J Infect Dis 2021; 225:637-649. [PMID: 34487174 DOI: 10.1093/infdis/jiab444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/14/2021] [Accepted: 09/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recombinant protein-based vaccines targeting serogroup B meningococci protect against invasive disease, but impacts on carriage are uncertain. This study assessed carriage prevalence of disease-associated meningococci from 2018-2020, as the proportion of vaccinated adolescents increased following introduction of a school-based 4CMenB immunisation program. METHODS Eligible participants who completed high school (age 17-25) in South Australia in the previous year had an oropharyngeal swab taken and completed a risk factor questionnaire. Disease-associated meningococci (genogroups A, B, C, W, X, Y) were detected by meningococcal and genogroup-specific polymerase chain reaction. RESULTS The final analysis included 4104 participants in 2018, 2690 in 2019, and 1338 in 2020. The proportion vaccinated with 4CMenB increased from 43% in 2018, to 78% in 2019, and 76% in 2020. Carriage prevalence of disease-associated meningococci in 2018 was 225/4104 (5.5%). There was little difference between the carriage prevalence in 2019 (134/2690, 5.0%, adjusted odds ratio [aOR] 0.82, 95% CI 0.64-1.05) and 2020 (68/1338, 5.1% aOR 0.82, 95% CI 0.57-1.17) compared to 2018. CONCLUSIONS Increased 4CMenB uptake in adolescents was not associated with a decline in carriage of disease-associated meningococci. 4CMenB immunisation programs should focus on direct (individual) protection for groups at greatest risk of disease.
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Affiliation(s)
- Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ann P Koehler
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | | | - Thomas R Sullivan
- SAHMRI Women & Kids, South Australian Health & Medical Research Institute, Adelaide, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Mary E Ramsay
- Immunisation Department, Public Health England, London, England
| | - Caroline Trotter
- Immunisation Department, Public Health England, London, England.,Department of Pathology & Veterinary Medicine, University of Cambridge, Cambridge, England
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester, England
| | - Adam Finn
- Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine & of Population Health Sciences, University of Bristol, Bristol, England
| | - Charlene M Kahler
- Marshall Centre for Infectious Disease Research and Training, School of Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Peter C Richmond
- School of Medicine, University of Western Australia, Perth Children's Hospital and Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kid's Institute, Perth, Western Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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9
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Jensen ED, Selway CA, Allen G, Bednarz J, Weyrich LS, Gue S, Peña AS, Couper J. Early markers of periodontal disease and altered oral microbiota are associated with glycemic control in children with type 1 diabetes. Pediatr Diabetes 2021; 22:474-481. [PMID: 33398933 DOI: 10.1111/pedi.13170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine the relationship between periodontal disease and glycemic control in children with type 1 diabetes and to characterize the diversity and composition of their oral microbiota. METHODS Cross-sectional study including children with type 1 diabetes recruited from clinics at the Women's and Children's Hospital (Australia). Participants had a comprehensive dental assessment, periodontal examination, and buccal and gingival samples collected for 16S rRNA sequencing. RESULTS Seventy-seven participants (age 13.3 ± 2.6 years, 38 males, BMI z-score 0.81 ± 0.75) had a diabetes duration of 5.6 ± 3.9 years and median HbA1c of 8.5% (range 5.8-13.3), 69.4 mmol/mol (range 39.9-121.9). Thirty-eight (49%) had early markers of periodontal disease. HbA1c was positively correlated with plaque index (Rho = 0.34, P = 0.002), gingival index (Rho = 0.30, P = 0.009), bleeding on probing (Rho = 0.44, P = 0.0001) and periodontal pocket depth >3 mm (Rho = 0.21, P = 0.06). A 1% increase in HbA1c was independently associated with an average increase in bleeding on probing of 25% (P = 0.002) and with an increase in the rate of sites with pocket depth >3 mm of 54% (P = 0.003). Higher HbA1c was independently related to increased phylogenetic alpha diversity (P = 0.008) and increased compositional variation (beta diversity P = 0.02) in gingival, but not buccal, microbiota. Brushing frequency, plaque index, and gingival index had a significant effect on microbiota composition, independent of HbA1c. CONCLUSIONS Children with type 1 diabetes showed a continuous relationship between less favorable glycemic control and increased early markers of periodontal disease. Glycemic control was also related to the complexity and richness of the plaque microbiota, with diversity increasing as HbA1c levels increase.
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Affiliation(s)
- Emilija D Jensen
- Discipline of Paediatric Dentistry, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Caitlin A Selway
- Department of Molecular and Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Gabrielle Allen
- Discipline of Paediatric Dentistry, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jana Bednarz
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Laura S Weyrich
- Department of Molecular and Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia.,Department of Anthropology and Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sam Gue
- Private Practice, Dulwich, Dulwich, South Australia, Australia
| | - Alexia S Peña
- Discipline of Paediatrics and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jennifer Couper
- Discipline of Paediatrics and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Diabetes and Endocrinology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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10
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Harris D, Martin D, Bednarz J, Ellis DY. Acute traumatic coagulopathy and the relationship to prehospital care and on-scene red blood cell transfusion. Emerg Med Australas 2021; 33:834-840. [PMID: 33556992 DOI: 10.1111/1742-6723.13734] [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: 07/10/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the incidence of acute traumatic coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital, analyse prehospital contributors, including red blood cell transfusion and assess the clinical significance of ATC. METHODS A retrospective database review was undertaken using conventional coagulation assays and viscoelastic testing (ROTEM) for diagnosis of ATC. RESULTS Baseline ATC incidence is 10% in trauma patients, increasing to over 80% among those where the prehospital team has attended and given a transfusion of red cells. ATC was significantly associated with higher severity of trauma (odds ratio [OR] 1.11, P < 0.0001), prehospital (OR 11.8, P < 0.0001) and in-hospital blood transfusions (OR 17.9, P < 0.0001), and massive transfusions (P < 0.001). CONCLUSIONS Prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma.
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Affiliation(s)
- Daniel Harris
- Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Emergency Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia
| | - Daniel Martin
- MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia.,School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jana Bednarz
- Adelaide Health Technology Assessment, The University of Adelaide, Adelaide, South Australia, Australia
| | - Daniel Y Ellis
- Trauma Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,MedSTAR Emergency Medical Retrieval, SA Ambulance Service, Adelaide, South Australia, Australia.,School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
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11
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Jensen E, Allen G, Bednarz J, Couper J, Peña A. Periodontal risk markers in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2021; 37:e3368. [PMID: 32558110 DOI: 10.1002/dmrr.3368] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Periodontal disease is a frequent complication of diabetes in adults, and both conditions are associated with systemic inflammatory states. This systematic review and meta-analysis was conducted to establish the relative severity of periodontal disease risk markers in children and adolescents with type 1 diabetes (T1D). METHODS A systematic search strategy using PubMed and EMBASE databases was performed to identify relevant studies assessing periodontal risk markers in children and adolescents and T1D through to February 2019. Eligible studies were assessed for quality and heterogeneity, and a random effects model was used to estimate differences in selected periodontal risk markers in children with T1D relative to healthy controls. RESULTS The search identified 551 studies from which 23 were found to meet the inclusion criteria. Random effects meta-analyses demonstrated that relative to healthy controls, children and adolescents with T1D had higher mean values for plaque index, gingival index, bleeding on probing, pocket depth and clinical attachment loss (all P < .001). CONCLUSIONS Risk markers for periodontal disease were found to be more pronounced among children and adolescents with T1D compared to healthy controls. Early referral of these at risk individuals for dental examination is recommended to allow for early intervention.
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Affiliation(s)
- Emilija Jensen
- Discipline of Paediatric Dentistry, University of Adelaide, Adelaide, South Australia, Australia
- Department of Paediatric Dentistry, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Gabrielle Allen
- Discipline of Paediatric Dentistry, University of Adelaide, Adelaide, South Australia, Australia
- Department of Paediatric Dentistry, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jana Bednarz
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Alexia Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
- Department of Diabetes and Endocrinology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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12
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Gold MS, Lincoln G, Bednarz J, Braunack-Mayer A, Stocks N. Consumer acceptability and validity of m-Health for the detection of adverse events following immunization - The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial. Vaccine 2020; 39:237-246. [PMID: 33309486 DOI: 10.1016/j.vaccine.2020.12.011] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Monitoring for adverse events following immunisation (AEFI) is critical for vaccine pharmacovigilance. Given the global and expanding availability of mobile phones their utility for consumer-based vaccine safety surveillance is of interest but little is known about consumer acceptability. This study nested within the Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial sought to evaluate the acceptability of SMS for AEFI surveillance. METHODS The primary STARSS study was a multi-centre RCT evaluating the efficacy of repeated SMS prompts for AEFI surveillance with participants being adult vaccinees or parents of children receiving any vaccine. This nested study enrolled primary RCT participants who completed a detailed computer assisted telephone interview to determine their attitudes towards SMS-based surveillance and ascertain their knowledge and attitudes toward vaccine safety, efficacy, data privacy and use of electronic health records. Attitudes to surveillance and related behaviour were used as measures of acceptability. RESULTS 20% (1200/6555) of the participants were enrolled and 1139 completed the full-length questionnaire. 96% indicated that SMS-based surveillance after immunisation to check the safety of the vaccine "should be done" but 62% of all respondents said it should be done but consent should be sought first. Neither vaccine safety attitudes nor attitudes toward privacy were associated with opposition to SMS-based surveillance. In terms of SMS related behaviour demographic rather than attitudinal factors were associated with non-compliance. CONCLUSION Overall, the attitude towards SMS-based surveillance was very favourable. Experiencing the SMS surveillance has the effect of reducing opposition to an SMS surveillance system, and at the same time increasing the likelihood of a preference for prior consent. Detection of a vaccine safety signal could be impeded in particular demographic groups who are non-compliant and we should undertake further research to understand why these groups are non-compliant and how this can be improved.
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Affiliation(s)
- M S Gold
- Discipline of Paediatrics, Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - G Lincoln
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J Bednarz
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Australia
| | - A Braunack-Mayer
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, New South Wales, Australia
| | - N Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Australia
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13
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Gregory D, Turnbull D, Bednarz J, Gregory T. The role of social support in differentiating trajectories of adolescent depressed mood. J Adolesc 2020; 85:1-11. [DOI: 10.1016/j.adolescence.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/19/2022]
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14
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Gallagher C, Wong C, Hendriks J, Bednarz J, Elliott A, Linz D, Middeldorp M, Mahajan R, Lau D, Sanders P. Implications of presenting to hospital with AF: the REVIEW AF study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is a growing burden of hospitalizations due to atrial fibrillation (AF). The implications of hospitalisation to the individual with AF has not been well characterized.
Purpose
To characterise the consequences of presenting to hospital with AF.
Methods
Individuals presenting to the emergency department (ED) of three hospitals in South Australia from March 2013 to February 2014 with a primary diagnosis of AF were enrolled. Based on coding and individual electronic medical record review all re-presentations over follow up were characterised as: 1) AF related; 2) cardiovascular related (excluding AF); or 3) all other causes. Mortality over follow up was also determined.
Results
The study cohort comprised of 437 individuals with an AF related index presentation. Mean age was 69±15 years and 49.9% were male. Individuals were followed for a mean of 3.7±0.4 years. There were 2304 unplanned presentations over follow up. The percentage of the study cohort who presented to the ED or were admitted to hospital over follow up is detailed in Figure 1. Compared to individuals who did not have a hospital admission for AF over follow up, those who were readmitted for AF were more likely to be hypertensive (63.2% vs 49.3%, p<0.001); and have a higher CHA2DS2-VASc score (3.2±1.8 vs 2.7±1.9, p=0.002) and HAS-BLED score (2.0±1.0 vs 1.5±1.1, p<0.001). A total of 71 individuals (16.2%) died during the follow-up period (annual mortality rate of 3.78%).
Conclusions
A hospital presentation with a primary diagnosis of AF identifies individuals at high risk of repeat hospitalisations and death. Urgent studies are needed to improve management of this high-risk cohort.
Figure 1. Repeat hospital presentations in AF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Gallagher
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - C.X Wong
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - J.M Hendriks
- Flinders University, School of Nursing, Adelaide, Australia
| | - J Bednarz
- University of Adelaide, School of Population Health, Adelaide, Australia
| | - A.D Elliott
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - D Linz
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - M.E Middeldorp
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - R Mahajan
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - D.H Lau
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - P Sanders
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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15
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Gallagher C, Wong C, Hendriks J, Nyfort-Hansen K, Rowett D, Bednarz J, Elliott A, Linz D, Middeldorp M, Mahajan R, Lau D, Sanders P. Opportunities to reduce the risk of stroke in AF: the REVIEW AF study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Stroke is one of the most devastating complications of atrial fibrillation (AF) and is associated with poor patient outcomes. Recent registry data has demonstrated improved use of stroke prevention therapy with the advent of direct-acting oral anticoagulants, but little data exists in the Australian health care setting.
Purpose
To examine the use of oral anticoagulant therapy in a cohort of individuals presenting to the emergency department (ED) due to AF.
Methods
A total of 437 consecutive individuals who presented to the ED with a primary diagnosis of AF to three tertiary hospitals in our city in South Australia between March 2013 and March 2014 were included. Data were collected retrospectively from electronic medical record review. CHA2DS2-VASc and HAS-BLED scores were calculated and any documented contraindications to the use of oral anticoagulation (OAC) taken in to consideration.
Results
Mean age was 69±15 years and 49.9% were male. A total of 244 (55.8%) individuals had a prior diagnosis of AF at index presentation. 179 (73.4%) of these individuals recorded a CHA2DS2-VASc score of ≥2. A total of 124 of these individuals were appropriately anticoagulated (69.3%) whilst 37 individuals were not treated with OAC and did not have a documented contraindication (20.7%). Anticoagulation status was unknown in 18 individuals due to a lack of documentation (10.0%). A CHA2DS2-VASc score of 0 was recorded in 25 individuals with a prior diagnosis of AF at index presentation with 3 individuals (12%) inappropriately overtreated with OAC. The remaining 193 individuals (44.2%) presented with a first episode of AF. In 129 (66.8%) of these individuals a CHA2DS2-VASc score of ≥2 was recorded and only 10 individuals had a documented contraindication to the use of OAC. In 119 (61.7%) individuals there were no documented contraindications to the use of OAC. In 74 (62.2%) of these presentations OAC was not commenced, whilst in 45 (37.8%) individuals OAC was prescribed.
Conclusions
Significant opportunity exists to improve the use of stroke prevention therapy in AF. Despite repeated opportunities to commence this therapy within the hospital setting, it remains frequently underutilised in individuals at high risk of stroke.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Gallagher
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - C.X Wong
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - J.M Hendriks
- Flinders University, School of Nursing, Adelaide, Australia
| | - K Nyfort-Hansen
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - D Rowett
- University of South Australia, School of Pharmacy, Adelaide, Australia
| | - J Bednarz
- University of Adelaide, School of Population Health, Adelaide, Australia
| | - A.D Elliott
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - D Linz
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - M.E Middeldorp
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - R Mahajan
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - D.H Lau
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - P Sanders
- University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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16
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Kaazan P, Tan Z, Bednarz J, Hughes J, Grafton R, Andrews JM. Infliximab-related weight gain in inflammatory bowel disease: associations and financial impacts. Intern Med J 2020; 50:1134-1138. [PMID: 32929820 DOI: 10.1111/imj.14987] [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] [Received: 12/29/2019] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022]
Abstract
Association between tumour necrosis alpha inhibitors and weight gain has been reported. We examined weight change in our cohort of inflammatory bowel disease patients treated with infliximab (IFX) for over 12 months, its associations and financial implications. Two-thirds of patients gained weight during the course of therapy. The mean change in weight after 12 months of IFX therapy was 3.3 (±6.5) kg.
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Affiliation(s)
- Patricia Kaazan
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zhi Tan
- Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Julie Hughes
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rachel Grafton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Division of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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17
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McCabe D, Bednarz J, Lockwood C, Barker TH. Specific Nutrient Intake Via Diet and/or Supplementation in Relation to Female Stress: A Cross-Sectional Study. Womens Health Rep (New Rochelle) 2020; 1:241-251. [PMID: 33786486 PMCID: PMC7784802 DOI: 10.1089/whr.2020.0035] [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] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Background: Women are negatively impacted by psychological stress and despite the prolific use of dietary supplements to manage stress there is little evidence to support their use for such. This study examined the relationship between intake of specific nutrients through diet and/or dietary supplementation and level of perceived stress. Method: In this cross-sectional study of adult Australian women (n = 74), perceived stress was measured using the Perceived Stress Scale, dietary intake was assessed using a validated Food Frequency Questionnaire, and supplement usage was recorded using a Supplement Use Questionnaire. Results: Potentially substantive reductions in stress scores were associated with polyunsaturated fatty acid supplementation: α-linolenic acid (mean difference [MD] = −3.34, 95% confidence interval [CI] = −7.97 to 1.29), linoleic acid (MD = −4.08, 95% CI = −8.97 to 0.82), γ-linolenic acid (MD = −2.23, 95% CI = −7.20 to 2.74), and eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) (MD = −4.05, 95% CI = −8.07 to −0.03). There were negative correlations between intake of vitamin B6 and vitamin C and stress (ρ = −0.50 and −0.35, respectively). Compared with nonsupplementers, stress scores were on average 0.92 units lower among those supplementing with magnesium and vitamin B6 concurrently (95% CI = −3.88 to 2.03). An increase in vitamin B6 through food was related to lower stress scores. For most nutrients, intake from food was positively associated with supplementation status. Conclusion: There is some evidence to suggest potentially meaningful associations between intake of particular nutrients and stress, although CIs were wide and there were no statistically significant relationships observed. Further research is warranted to investigate any potential benefits more precisely using randomized controlled trials or large-scale observational studies.
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Affiliation(s)
- Delia McCabe
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Jana Bednarz
- Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Timothy H Barker
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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18
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Brown Z, Metcalf R, Bednarz J, Spargo L, Lee A, Hill C, Wechalekar M, Stavrou C, James M, Cleland L, Proudman S. Modifiable Lifestyle Factors Associated With Response to Treatment in Early Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:371-377. [PMID: 32453505 PMCID: PMC7301874 DOI: 10.1002/acr2.11132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/18/2023] Open
Abstract
Objective We aimed to evaluate the associations between response to algorithm‐directed treat‐to‐target conventional synthetic disease‐modifying antirheumatic drug therapy and potentially modifiable lifestyle factors, including dietary fish oil supplementation, body mass index (BMI), and smoking history in a rheumatoid arthritis (RA) inception cohort. Methods Patients with RA with a duration of less than 12 months were reviewed every 3 to 6 weeks to adjust therapy according to disease response. All patients received advice to take fish oil supplements, and omega‐3 status was measured as plasma levels of eicosapentaenoic acid (EPA). Lifestyle factors and other variables potentially prognostic for 28‐joint Disease Activity Score (DAS28) remission and DAS28 low disease activity (LDA) at the 12‐month visit were included in multivariable logistic regression models. Results Of 300 participants, 57.7% reached DAS28 LDA, and 43.7% were in DAS28 remission at 1 year. Increase in plasma EPA was associated with an increase in the odds of being in LDA (adjusted odds ratio [OR] = 1.27; P < 0.0001) and remission (adjusted OR = 1.21; P < 0.001). There was some evidence that the effect of BMI on LDA might be modified by smoking history. An increase in BMI was associated with a decrease in the odds of being in LDA in current and former smokers but had no impact on LDA in patients who had never smoked. There were no meaningful associations between BMI or smoking history and remission. Conclusion Omega‐3 status, BMI, and smoking history are potential predictors of outcome in early RA. The possibility of an effect modification by smoking on the predictive value of BMI merits further investigation.
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Affiliation(s)
- Zoe Brown
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Metcalf
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jana Bednarz
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Anita Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine Hill
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Mihir Wechalekar
- Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | | | - Michael James
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Les Cleland
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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19
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Finlay B, Bednarz J, Dawson J. A Multidisciplinary Approach to Oncological Resections with Vascular Surgeons Improves Patient Outcomes. Eur J Vasc Endovasc Surg 2020; 60:293-299. [PMID: 32402805 DOI: 10.1016/j.ejvs.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Oncological resections have become more radical in pursuit of disease free margins. Consequently, vascular structures may be injured inadvertently or purposely resected, with or without subsequent reconstruction. Thus, vascular surgeons have an increasing role in oncological surgery. The present authors sought to review their experience and examine the effect of timing of referral to a Vascular Surgeon (VS) on patient and surgical outcomes following tumour resection. METHODS A retrospective review was conducted of a prospectively maintained database at a public hospital network in Adelaide, Australia. All cases of collaboration between a VS and other surgeons for resection of cancer or non-malignant tumour were included. Medical records and operative, pathological, and transfusion data were reviewed, with particular attention to referring team, timing of VS referral (pre- or intra-operative), and the operative role of the VS. RESULTS Seventy-two cases were identified from January 2004 to June 2018. The most common collaborators were General Surgery and Urology. Of the cases, 86% were elective and 71% were referred to the VS pre-operatively. Pre-operative referral was associated with a predominant VS role of dissection and exposure. Pre-operative referral was associated with lower odds of vessel repair and reconstruction compared with intra-operative referral (adjusted OR = 0.20; 95% CI 0.04-0.93; p = .040) and a lower incidence of positive surgical margins (35% vs. 80%, p = .028). The rate of blood product units required was lower among pre-operative referrals relative to intra-operative referrals, but the effect of timing was not significant after adjustment for potential confounders (IRR = 0.80, 95% CI 0.26-2.44; p = .70). CONCLUSION Pre-operative planned involvement of vascular surgery in oncological operations can improve surgical outcomes, with additional expected benefits for surgical training and cross specialty collaboration.
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Affiliation(s)
- Ben Finlay
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Jana Bednarz
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia
| | - Joe Dawson
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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Hurtado PR, Hurtado-Pérez E, Luo C, Bednarz J, Hissaria P, A Peh C. Unexpectedly, low hydroxychloroquine concentration enhances DNA-induced immune stimulation in vitro: potential implication in non-compliant patients with SLE. Lupus 2019; 29:216-218. [PMID: 31870217 DOI: 10.1177/0961203319897810] [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: 11/15/2022]
Affiliation(s)
- P R Hurtado
- Department of Renal Medicine, Royal Adelaide Hospital, Australia.,Faculty of Health and Medical Sciences, the University of Adelaide, Australia
| | - E Hurtado-Pérez
- Faculty of Health and Medical Sciences, the University of Adelaide, Australia
| | - C Luo
- Department of Pharmacology, The University of South Australia, Australia
| | - J Bednarz
- Faculty of Health and Medical Sciences, the University of Adelaide, Australia
| | - P Hissaria
- Department of Clinical Immunology, Royal Adelaide Hospital, Australia
| | - C A Peh
- Department of Renal Medicine, Royal Adelaide Hospital, Australia.,Faculty of Health and Medical Sciences, the University of Adelaide, Australia
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Gallagher C, Wong C, Hendriks J, Bednarz J, Elliott A, Linz D, Middeldorp M, Mahajan R, Lau D, Sanders P. Predictors of Health Care Resource Utilisation in AF: The REVIEW AF Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.212] [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: 10/26/2022]
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Khokhar K, Lau D, Stiles M, Mahajan R, Bednarz J, Misihima R, Gallagher C, Thiyagarajah A, Verdicchio C, Munawar D, Kadhim K, Sanders P. Assessment of Residual Aortic Stiffness in AF: Exploring the Role of Central Haemodynamics Response to Exercise. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The lipids of photosystem II particles, of chloroplasts and leaves are compared in the variegated tobacco mutant NC 95. The mutant differs from other N. tabacum mutants by the phenomenon that it has variegated leaves with green and with yellow-green leaf patches. Chloroplasts from the green leaf areas exhibit photosystem II and photosystem I reactions and have a normal lamellar system with grana and intergrana regions. Chloroplasts from the yellow-green leaf areas, however, yield only photosystem I reactions and have only single stranded isolated thylakoids. Hence, this mutant offers the unique possibility to compare without the use of detergents within the same plant the lipid composition of photosystem II particles with that in intact chloroplasts, exhibiting either photosystem II and I reactions or those exhibiting exclusively photosystem I reactions.
The lipids of photosystem II particles are composed of 37 % glycolipids, 4 % phospholipids, 5 % carotenoids and 54 % chlorophyll. Lipids of chloroplasts with grana stacking are composed of 75% glycolipids, 7 % phospholipids, 2 % carotenoids and 16% chlorophyll. Chloroplasts with single isolated thylakoids have a lipid composition consisting of 8 3 % glycolipids, 14% phospholipids and only 0.5% carotenoids and 2 % chlorophyll. The chloroplast lipid mixture is characterized in comparison to the respective leaf lipid mixture by a 16-17% higher glycolipid portion and by a 13-70% lower phospholipid content.
The main difference in the lipid composition of photosystem I and II consists in the observation that chloroplasts active in only photosystem I contain more than double the amount of glycolipids and the 4-fold amount of phospholipids in comparison to photosystem II active preparations. The amount of monogalactolipid is even 3 times higher in chloroplasts active only in photosystem I when compared to those in photosystem II particles. In photosystem II particles phosphatidylethanolamine is completely lacking and phosphatidylglycerol and phosphatidylinositol occur only in traces.
The fatty acids of the sulfolipid are by 45 % more saturated in the photosystem II particles and the digalactolipids of the photosystem II particles are by 28 % more saturated than in chloroplasts exhibiting photosystem I and II activity.
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Affiliation(s)
- J. Bednarz
- Universität Bielefeld, Fakultät für Biologie, Lehrstuhl Zellphysiologie, D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - A. Radunz
- Universität Bielefeld, Fakultät für Biologie, Lehrstuhl Zellphysiologie, D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - G. H. Schmid
- Universität Bielefeld, Fakultät für Biologie, Lehrstuhl Zellphysiologie, D-4800 Bielefeld 1, Bundesrepublik Deutschland
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Bednarz J, Höper S, Bockstette M, Bader KP, Schmid GH. Interrelationship of Oxygen and Nitrogen Metabolism in the Filamentous Cyanobacterium Oscillatoria chalybea. Z NATURFORSCH C 2014. [DOI: 10.1515/znc-1989-11-1212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Filamentous Cyanobacteria. Hydrogen Peroxide, Photosystem II. Nitrogen Metabolism By means of mass spectrometric analysis we have been able to demonstrate H 20 2-production and its decomposition by photosystem II in thylakoids of the filamentous cyanobacterium Oscil latoria chalybea. This H2O2-production and its quasi simultaneous decomposition by the S-state system can be readily demonstrated in flash light illumination (K. P. Bader and G. H. Schmid, Biochim. Biophys. Acta 936, 179-186 (1988)) or as shown in the present paper in continuous light at low light intensities. These light conditions correspond essentially to the culturing condition of the organism on nitrate as the sole nitrogen source. Under these conditions, however, electron transport between the two photosystems seems to be mostly disconnected and respiratory activity practically non existent. Under these conditions, on the other hand, nitrate reductase is induced and nitrate reduced. The present paper addresses the question how this organism might solve the metabolic problems of nitrate reduction with such an electron transport system. Tested under high light intensities under which the organism would not grow at all, electron transport between the two photosystems is optimally linked and the system funnels part of its photosynthetically produced electrons into a conventional cyanide-sensitive respiratory electron transport chain and even into an alternative Sham-sensitive (cyanide-insensitive) respiratory chain. This is made possible by the overweight of photosystem II capacity in comparison to photosystem I activity as reported in this paper. Under the conditions described, the cyanobacterium grows also on arginine as the sole nitrogen source. Most interestingly under these conditions nitrate reductase induction is not shut off as is the case with other aminoacids like ornithine or alanine in the medium. Nitrite reductase is not induced in these bacteria, if grown on arginine as the sole nitrogen source. This observation is discussed in context with the fact that arginine is a major storage product (cyanophycin) in this organism and that the observed photosystem II mediated H2O2-production might be correlated with arginine metabolism.
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Affiliation(s)
- J. Bednarz
- Universität Bielefeld. Fakultät für Biologie, Lehrstuhl Zellphysiologie. D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - S. Höper
- Universität Bielefeld. Fakultät für Biologie, Lehrstuhl Zellphysiologie. D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - M. Bockstette
- Universität Bielefeld. Fakultät für Biologie, Lehrstuhl Zellphysiologie. D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - K. P. Bader
- Universität Bielefeld. Fakultät für Biologie, Lehrstuhl Zellphysiologie. D-4800 Bielefeld 1, Bundesrepublik Deutschland
| | - G. H. Schmid
- Universität Bielefeld. Fakultät für Biologie, Lehrstuhl Zellphysiologie. D-4800 Bielefeld 1, Bundesrepublik Deutschland
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Bednarz J, Delfabbro P, King D. Practice Makes Poorer: Practice Gambling Modes and Their Effects on Real-Play in Simulated Roulette. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-012-9422-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Schroeter J, Maier P, Bednarz J, Blüthner K, Quenzel M, Pruss A, Reinhard T. [Procedural guidelines. Good tissue practice for cornea banks]. Ophthalmologe 2009; 106:265-74, 276. [PMID: 19263054 DOI: 10.1007/s00347-008-1913-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A cornea bank must have an organizational structure in which responsibility and authority to issue directives are clearly defined. It must also use a documented quality management system on the basis of good practice procedures which is maintained to the current standards. The personnel of a cornea bank must be present in sufficient numbers and be suitably qualified. A cornea bank must be in possession of appropriate facilities which are suitable for the main purpose of conservation of donor corneas. All equipment must be designed and maintained corresponding to the intended purpose. Deviations from the stipulated quality and safety standards must give rise to documented investigations which include decisions on options for correctional and preventive measures. Acquisition of donors and tissue sampling must be strictly controlled and documented. This also applies to entry of donor tissue in the cornea bank. During conservation a microscopic examination of the endothelial cell layer must be carried out at least once. Measures must be taken to keep the risk of contamination as low as possible. Donor corneal tissue can only be released if defined criteria are fulfilled. Any suspicion of severe undesired reactions and events for the recipient of a corneal transplant must be registered with the authorities. The activities of a cornea bank must maintain and adapt the state-of-the-art with respect to scientific progress.
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Affiliation(s)
- J Schroeter
- Augenklinik, Charite-Universitätsmedizin Berlin, Berlin, Deutschland
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Mergler S, Engelmann K, Bednarz J, Pleyer U. Das humane Hornhautendothel: Neue Erkenntnisse zur Physiologie. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922997] [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: 10/19/2022]
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Meyer L, Bednarz J, Müller-Goymann CC, Reichl S. Esteraseaktivität eines organotypischen humanen Kornea-Konstrukts (HCC) als In-vitro-Modell für Permeationsuntersuchungen. Ophthalmologe 2005; 102:971-80. [PMID: 15785910 DOI: 10.1007/s00347-005-1200-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Organotypic cornea equivalents are used as in vitro models for permeation studies. Many ophthalmic drugs are applied as ester prodrugs to achieve a higher bioavailability. The esterase activity of three corneal human cell lines (epithelial, stromal, endothelial cells) as well as of excised porcine cornea, human donor cornea and human cornea construct (HCC) was investigated and compared. Esterase activity was determined using p-nitrophenyl acetate and hydrocortisone acetate (HCA) as esterase substrates. Hydrocortisone acetate permeation across porcine cornea, human donor cornea and HCC was studied in vitro using Franz-diffusion cells. Corneal epithelial cells showed the highest esterase activity and only small differences to keratocytes and endothelial cells were detectable. The permeation barrier properties of the different corneal tissues were very similar in the case of HCA permeation whereas HCA metabolism rates were in the ranking order of porcine cornea > HCC > human donor cornea. Permeation and metabolism studies indicate that the in vitro permeation model HCC is able to adequately convert hydrocortisone acetate to hydrocortisone.
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Affiliation(s)
- L Meyer
- Institut für Pharmazeutische Technologie der Technischen Universität Braunschweig
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Aintablian A, Reichl S, Bednarz J. Auf dem Weg zur künstlichen Hornhaut für Keratoplastik. Ein Zwischenbericht. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-871587] [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: 10/19/2022]
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Abstract
AIMS For the study of transcorneal in vitro permeation of ophthalmic drugs, excised animal cornea or corneal epithelial cell culture are frequently used as a replacement for the human cornea. The main purposes of this study were to reconstruct a complete human organotypic cornea equivalent, consisting of all three different cell types (epithelial, stromal, and endothelial); to test the barrier function of this bio-engineered human cornea using three different model drugs (pilocarpine hydrochloride (PHCl), befunolol hydrochloride (BHCl), and hydrocortisone (HC)); and to determine its usefulness as an in vitro model for prediction of ocular drug absorption into the human eye. METHODS A multilayer tissue construct was created step by step in Transwell cell culture insert using SV-40 immortalised human endothelial and epithelial cells and native stromal cells (fibroblasts). Morphology was characterised by light microscopy using routine H&E staining. Scanning electron microscopy was used to evaluate ultrastructural features. Ocular permeation of drugs across the human cornea construct was tested using modified Franz cells and compared with data obtained from excised porcine cornea and previously described porcine cornea constructs. RESULTS and conclusion: The cornea construct exhibited typical corneal structures such as a monolayer of hexagonally shaped endothelial cells and a multilayered epithelium consisting of seven to nine cell layers with flat superficial cells. The formation of microplicae and microvilli was also confirmed. The human cornea construct showed similar permeation behaviour for all substances compared with excised porcine cornea. However, permeability (permeation coefficients K(p)) of the human cornea equivalent (PHCl 13.4*10(-6) (SD 3.01*10(-6)); BHCl 9.88*10(-6) (SD 1.79*10(-6)); HC 5.41*10(-6) (SD 0.40*10(-6)) cm/s) was about 1.6-1.8 fold higher than excised porcine cornea. Compared with data from the porcine cornea construct the cultivated human equivalent showed a decreased permeability. The reconstructed human cornea could be appropriate to predict drug absorption into the human eye.
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Affiliation(s)
- S Reichl
- Institut für Pharmazeutische Technologie, Technische Universität Braunschweig, Mendelssohnstrasse 3, 38106 Braunschweig, Germany
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Thuret G, Chiquet C, Herrag S, Dumollard JM, Boudard D, Bednarz J, Campos L, Gain P. Mechanisms of staurosporine induced apoptosis in a human corneal endothelial cell line. Br J Ophthalmol 2003; 87:346-52. [PMID: 12598452 PMCID: PMC1771564 DOI: 10.1136/bjo.87.3.346] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [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: 12/13/2022]
Abstract
BACKGROUND Apoptosis very probably plays a key part in endothelial cell loss during corneal storage in organ culture as well as hypothermic storage. However, the mechanisms underlying endothelial apoptosis are poorly understood. The response of a human corneal endothelial cell (HCEC) line to staurosporine, a known inducer of apoptosis, was investigated to gain insights into the intracellular modulators that participate in endothelial cell death. METHODS Immortalised HCECs were studied after 3, 6, 12, and 24 hours of incubation with 0.2 micro M staurosporine. Cell shedding was monitored. Hoechst 33342 fluorescent DNA staining combined with propidium iodide was used for apoptosis/necrosis quantification and morphological examination. The caspase-3 active form was assessed using western blot, proteolytic activity detection, and immunocytochemistry. The cleaved form of poly(ADP-ribose) polymerase (PARP) was assessed using immunocytochemistry and western blot. The ultrastructural features of cells were screened after 12 hours with staurosporine or vehicle. RESULTS The specific apoptotic nature of staurosporine induced HCEC death was confirmed. The ultrastructural features of staurosporine treated cells were typical of apoptosis. HCEC shedding and DNA condensation increased with time. Caspase-3 activity was detected as early as 3 hours after exposure with staurosporine, peaking at 12 hours of incubation. The presence of cleaved PARP after 3 hours confirmed caspase-3 activation. CONCLUSIONS These data suggest strongly that HCEC cell death induced by staurosporine is apoptosis. The main consequence of HCEC apoptosis is shedding. Staurosporine induced apoptosis of endothelial cells involves activation of caspase-3, and could be a useful model to study strategies of cell death inhibition.
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Affiliation(s)
- G Thuret
- Cell death and neoplasia laboratory, EA 3063, University of Saint-Etienne, France
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Bednarz J, Doubilei V, Wollnik PC, Engelmann K. Effect of three different media on serum free culture of donor corneas and isolated human corneal endothelial cells. Br J Ophthalmol 2001; 85:1416-20. [PMID: 11734511 PMCID: PMC1723804 DOI: 10.1136/bjo.85.12.1416] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Removal of bovine serum from organ culture medium is necessary because of the variability in serum composition and the potential risk of infection. Two specific endothelial cell media (F99 and Endothelial-SFM) were compared with the routinely used medium MEM for their use in serum free cultivation of human corneal endothelial cells (HCEC) and donor corneas. METHODS HCEC were incubated in three test media with or without increasing serum content and a growth assay was performed. Seven pairs of donor corneas were cultured in each of three media for 3 weeks, one cornea with serum supplementation and one without. Endothelial cell density was determined once each week. Trypan blue staining of the endothelium and vital staining of keratocytes was performed after 3 weeks. RESULTS All three media promoted proliferation of cultured HCEC when supplemented with serum. Endothelial cell density of donor corneas was comparable after 3 weeks of cultivation in the different media. Only corneas cultured in medium MEM without serum exhibited a higher endothelial cell loss. Trypan blue staining of the endothelium after cultivation revealed the lowest number of damaged cells on corneas cultured in the medium Endothelial-SFM. The highest densities of keratocytes were found in corneas cultured in Endothelial-SFM and the lowest densities occurred after culture in MEM. CONCLUSION After incubation in Endothelial-SFM even under serum free conditions corneas were found to be of higher quality with respect to endothelial cell survival, cell membrane integrity, and keratocyte density. This medium may replace MEM, which is routinely used in European eye banks but requires supplementation with serum.
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Affiliation(s)
- J Bednarz
- Universitäts-Augenklinik Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
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Hempel B, Bednarz J, Engelmann K. Use of a serum-free medium for long-term storage of human corneas. Influence on endothelial cell density and corneal metabolism. Graefes Arch Clin Exp Ophthalmol 2001; 239:801-5. [PMID: 11760044 DOI: 10.1007/s004170100364] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The success of long-term corneal organ culture is limited by the progressive loss of endothelial cells during culture and the use of culture medium supplemented with fetal calf serum as a possible source of contamination with infectious agents. In this study, we investigated the suitability of a serum-free medium (Endothelial-SFM) to improve preservation conditions for human donor corneas. METHODS Six pairs of corneas were stored in Minimum Essential Medium (MEM) supplemented with 2% fetal calf serum (FCS) for 8-14 days. One cornea of each pair was then further cultivated in Endothelial-SFM supplemented with 2% FCS or in MEM with 2% FCS, respectively. In a second series of experiments, the endothelial cell density of seven pairs of freshly isolated donor corneas was determined during cultivation in Endothelial-SFM with 2% FCS or serum-free Endothelial-SFM. RESULTS After precultivation in conventional medium, the endothelial cell density of corneas allocated to cultivation in Endothelial-SFM was 1000-1950 cells/mm2 and that of those subsequently cultured in MEM 1200-2000 cells/mm2. At 9 weeks, cell densities of 900-1500 cells/mm2 were found after cultivation in Endothelial-SFM compared with a total cell loss in MEM. Freshly isolated corneas cultured in Endothelial-SFM with or without FCS supplementation showed a decrease of endothelial cell density of about 20% within the first 2 weeks of storage. During further cultivation cell density remained constant without statistically significant differences between the groups. Glucose consumption of the corneas was higher in Endothelial-SFM than in MEM. Corneas stored in Endothelial-SFM with 2% FCS showed a higher glucose consumption than those preserved in serum-free Endothelial-SFM. CONCLUSION Organ culture of human donor corneas using the serum-free basal medium Endothelial-SFM is superior to conventional culture conditions because the decrease in endothelial cell density can be ameliorated, the culture period can be prolonged and the risk of transmitting infectious agents via serum can be minimised.
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Affiliation(s)
- B Hempel
- Klinik und Poliklinik für Augenheilkunde des Universitätsklinikums Hamburg-Eppendorf, Hamburg, Germany
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Abstract
In vitro cultivation of human corneal endothelial cells (HCEC) is associated with loss of typical cobblestone-like appearance during successive passages. Thus far morphology was the sole criterion for the cell's endothelial nature. Mouse monoclonal antibodies (mabs) to human corneal endothelial cells were raised using standard immunization and hybridoma isolation procedures. The specificity of mabs for human corneal endothelial cells was tested in comparison to other endothelial cell types, to fibroblasts, corneal keratocytes and to human retinal pigmented epithelial cells. In addition immunofluorescence or immunoperoxidase staining was performed with frozen tissue sections of human corneas and with various other human tissues. The mab 9.3.E reacts with cultured human corneal endothelial cells, but not with cultured human fibroblasts and human keratocytes. In frozen sections selective positivity of corneal endothelium in contrast to negativity of the other corneal cell types was confirmed. In investigated extraocular tissues positivity was observed in smooth muscle cells including related cells (i.e. Ito and mesangial cells) and in Schwann's cells and adipocytes, but apparently not in vascular endothelial cells. The mab is human-specific and binds to a protein with a molecular weight of 130 kDa mainly accumulating along cell membranes. A mouse monoclonal antibody against human corneal endothelial cells was established in vitro and was shown to be capable of differentiating corneal endothelial cells from other corneal cell types, especially from corneal keratocytes. It is, however, not cornea-specific, but also reacts with certain extraocular cell types.
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Affiliation(s)
- K Engelmann
- Department of Ophthalmology, University of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany.
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Uphoff J, Bednarz J, Engelmann K. [Follow-up of endothelial cell density after perforating keratoplasty. Effect of donor and recipient-related factors]. Ophthalmologe 2001; 98:550-4. [PMID: 11450479 DOI: 10.1007/s003470170117] [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: 11/26/2022]
Abstract
PURPOSE Endothelial cell loss can be observed after keratoplasty, therefore in a retrospective study we analysed whether there is a correlation between donor age, recipient age, time post-mortem, preoperative cell density, diagnosis of the recipient and postoperative endothelial cell density. METHODS The endothelial cell densities of 120 patients who had undergone penetrating keratoplasty were examined over a period of 2 years. We divided the patients into four groups based on the endothelial cell density over 2 years. We examined the groups with regard to the parameters given above. RESULTS The lowest postoperative cell densities 2 years after keratoplasty showed a high correlation with the highest donor and recipient age. Even the lowest preoperative cell density was found in this group. Patients who underwent keratoplasty because of keratoconus had the highest cell densities after 2 years and also the lowest donor and recipient age. The preoperative cell density was also highest in this group. DISCUSSION The results indicate a correlation between increasing donor and recipient age, decreasing preoperative cell density and loss of endothelial cells 2 years after penetrating keratoplasty. Patients with the diagnosis keratoconus should also receive transplants with higher donor age.
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Affiliation(s)
- J Uphoff
- Universitäts-Augenklinik Hamburg-Eppendorf
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Witt SA, McCulloch M, Sisk E, Gresser C, Moos S, Odabashian J, Jasper S, Bednarz J, Burgess P, Carney D, Moore V, Waggoner A, Adams D. Achieving a diagnostic contrast-enhanced echocardiogram: a series on contrast echocardiography, article 4. J Am Soc Echocardiogr 2001; 14:327-34. [PMID: 11287903 DOI: 10.1067/mje.2001.112242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S A Witt
- Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Spencer KT, Mor-Avi V, Gorcsan J, DeMaria AN, Kimball TR, Monaghan MJ, Perez JE, Weinert L, Bednarz J, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Lang RM. Effects of aging on left atrial reservoir, conduit, and booster pump function: a multi-institution acoustic quantification study. Heart 2001; 85:272-7. [PMID: 11179264 PMCID: PMC1729654 DOI: 10.1136/heart.85.3.272] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the feasibility of measuring left atrial (LA) function with acoustic quantification (AQ) and then assess the effects of age and sex on LA reservoir, conduit, and booster pump function. PATIENTS AND SETTING 165 subjects without cardiovascular disease, 3-79 years old, were enrolled by six tertiary hospital centres. INTERVENTIONS Continuous LA AQ area data were acquired and signal averaged to form composite waveforms which were analysed off-line. MAIN OUTCOME MEASURES Parameters of LA performance according to age and sex. RESULTS Signal averaged LA waveforms were sufficiently stable and detailed to allow automated analysis in all cases. An age related increase in LA area was noted. LA reservoir function did not vary with age or sex. All parameters of LA passive and active emptying revealed a significant age dependency. Overall, the passive emptying phase accounted for 66% of total LA emptying ranging from 76% in the youngest to 44% in the oldest decade. LA contraction accounted for 34% of atrial emptying in all subjects combined with the older subjects being more dependent on atrial booster pump function. When adjusted for atrial size, there were no sex related differences in LA function. CONCLUSIONS LA reservoir, conduit, and booster pump function can be assessed with automated analysis of signal averaged LA area waveforms. As LA performance varies with age, establishment of normal values should enhance the evaluation of pathologic states in which LA function is important.
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Affiliation(s)
- K T Spencer
- University of Chicago, Chicago, Illinois, USA.
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Affiliation(s)
- R K Garg
- Division of Cardiology, University of Chicago Medical Center, Department of Medicine, Section of Cardiology, Chicago, Illinois, USA
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Mor-Avi V, Spencer K, Gorcsan J, Demaria A, Kimball T, Monaghan M, Perez J, Sun JP, Weinert L, Bednarz J, Collins K, Edelman K, Kwan OL, Glascock B, Hancock J, Baumann C, Thomas J, Lang R. Normal values of regional left ventricular endocardial motion: multicenter color kinesis study. Am J Physiol Heart Circ Physiol 2000; 279:H2464-76. [PMID: 11045984 DOI: 10.1152/ajpheart.2000.279.5.h2464] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our goal was to establish normal values for quantitative color kinesis indexes of left ventricular (LV) wall motion over a wide range of ages, which are required for objective diagnosis of regional systolic and diastolic dysfunction. Color-encoded images were obtained in 194 normal subjects (95 males, 99 females, age 2 mo to 79 yr) in four standard views. Quantitative indexes of magnitude and timing of systolic and diastolic function were studied for age- and gender-related differences. Normal limits of all ejection and filling indexes were in a narrow range (< or =25% of the mean), with no major gender-related differences. Despite invariable ejection fractions, both peak filling and ejection rates decreased with age (30 and 20%, correspondingly) with a concomitant increase in mean filling and ejection times, resulting in five- and twofold increases in the late to early filling and ejection ratios, correspondingly. Diastolic asynchrony increased with age (from 4.7 +/- 2.0 to 6.4 +/- 3.2 from the 2nd to 7th decade). The normal values of color kinesis indexes should allow objective detection of regional LV systolic and diastolic dysfunction.
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Affiliation(s)
- V Mor-Avi
- The University of Chicago, Chicago, Illinois 60637, USA.
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40
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McCulloch M, Gresser C, Moos S, Odabashian J, Jasper S, Bednarz J, Burgess P, Carney D, Moore V, Sisk E, Waggoner A, Witt S, Adams D. Ultrasound contrast physics: A series on contrast echocardiography, article 3. J Am Soc Echocardiogr 2000; 13:959-67. [PMID: 11029724 DOI: 10.1067/mje.2000.107004] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M McCulloch
- University of Texas Medical Branch, Galveston, Texas, USA
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41
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Abstract
Between 1997 and 1999 a steady increase in cornea donations was achieved, but the number of transplantations remained stable because many grafts did not pass quality control. Intermediate organ culture of entire bulbi was examined as a possible solution to reduce post-mortem times and increase suitability for transplantation.
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Affiliation(s)
- J Wulf
- Institute of Forensic Medicine, University of Hamburg, Butenfeld 34, 22529, Hamburg, Germany
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42
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Spencer KT, Grayburn PA, Mor-Avi V, Bednarz J, Grimm RA, Furlong K, Farnum RF, Floer SD, Widner PJ, Lang RM. Myocardial contrast echocardiography with power Doppler imaging. Am J Cardiol 2000; 86:479-81. [PMID: 10946053 DOI: 10.1016/s0002-9149(00)00975-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K T Spencer
- University of Chicago Medical Center, Chicago, Illinois, USA
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43
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Mor-Avi V, Bednarz J, Weinert L, Sugeng L, Lang RM. Power Doppler imaging as a basis for automated endocardial border detection during left ventricular contrast enhancement. Echocardiography 2000; 17:529-37. [PMID: 11000587 DOI: 10.1046/j.1540-8175.2000.00529.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Echocardiographic evaluation of left ventricular (LV) systolic function relies on endocardial visualization, which can be improved when necessary using contrast enhancement. However, there is no method to automatically detect the endocardial boundary from contrast-enhanced images. We hypothesized that this could be achieved using harmonic power Doppler imaging. Twenty-two patients were studied in two protocols: (1) 11 patients with poorly visualized endocardium (> 3 contiguous segments not visualized) and (2) 11 consecutive patients referred for dobutamine stress echocardiography who were studied at rest and at peak dobutamine infusion. Patients were imaged in the apical four-chamber view using harmonic power Doppler mode (HP SONOS 5500) during LV contrast enhancement (Optison or Definity DMP115). Digital images were analyzed using custom software designed to automatically extract the endocardial boundary from power Doppler color overlays. LV cavity area was automatically measured frame-by-frame throughout the cardiac cycle, and fractional area change calculated and compared with those obtained by manually tracing the endocardial boundary in end-systolic and end-diastolic gray scale images. Successful border detection and tracking throughout the cardiac cycle was possible in 9 of 11 patients with poor endocardial definition and in 10 of 11 unselected patients undergoing dobutamine stress testing. Fractional area change obtained from power Doppler images correlated well with manually traced area changes (r = 0.82 and r = 0.97, in protocols 1 and 2, respectively). Harmonic power Doppler imaging with contrast may provide a simple method for semi-automated border detection and thus facilitate the objective evaluation of LV function both at rest and under conditions of stress testing. This methodology may prove to be particularly useful in patients with poorly visualized endocardium.
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Affiliation(s)
- V Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, M.C. 5084, 5841 S. Maryland Ave., Chicago IL 60637,
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44
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Burgess P, Moore V, Bednarz J, Carney D, Floer S, Gresser C, Jasper S, Moos S, Odabashian J, Sisk E, Trough M, Waggoner A, Witt S, Adams D. Performing an echocardiographic examination with a contrast agent: a series on contrast echocardiography, article 2. J Am Soc Echocardiogr 2000; 13:629-34; quiz 635. [PMID: 10849520 DOI: 10.1067/mje.2000.105089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- P Burgess
- Duke University Medical Center, Durham, NC 27710, USA
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45
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Bednarz J, Teifel M, Friedl P, Engelmann K. Immortalization of human corneal endothelial cells using electroporation protocol optimized for human corneal endothelial and human retinal pigment epithelial cells. Acta Ophthalmol Scand 2000; 78:130-6. [PMID: 10794243 DOI: 10.1034/j.1600-0420.2000.078002130.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE In this study we established a protocol for transfection of human corneal endothelial and human retinal pigment epithelial cells. This protocol was used for immortalization of human corneal endothelial cells. METHODS Transfection was performed by means of electroporation. For immortalization a plasmid encoding large and small SV40 T-antigen was used. RESULTS The established electroporation protocol was suitable for both cell types. This protocol was used for transfection of human corneal endothelial cells with a plasmid containing the early region of SV40. The transfected cultures exhibited an increased life-span before they entered crisis. One culture recovered from crisis and was cultivated for 300 population doublings. The cells exhibited an in vivo-like morphology usually lost during cell culture. CONCLUSIONS We describe for the first time a culture of SV40 transfected human corneal endothelial cells which recovered from crisis and can therefore be regarded as immortalized.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, Polyomavirus Transforming/genetics
- Antigens, Polyomavirus Transforming/metabolism
- Blotting, Western
- Cell Division
- Cell Line, Transformed
- Cell Survival
- Cells, Cultured
- Electrophoresis, Polyacrylamide Gel
- Electroporation/methods
- Endothelium, Corneal/cytology
- Endothelium, Corneal/metabolism
- Green Fluorescent Proteins
- Humans
- Luminescent Proteins/metabolism
- Microscopy, Phase-Contrast
- Middle Aged
- Pigment Epithelium of Eye/cytology
- Pigment Epithelium of Eye/metabolism
- Plasmids/genetics
- Transfection/methods
- beta-Galactosidase/metabolism
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Affiliation(s)
- J Bednarz
- Universitäts-Augenklinik, Hamburg, Germany.
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46
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Moos S, Odabashian J, Jasper S, Bednarz J, Burgess P, Carney D, Floer S, Gresser C, Moore V, Sisk E, Trough M, Waggoner A, Witt S, Adams D. Incorporating ultrasound contrast in the laboratory: a series on contrast echocardiography, article 1. J Am Soc Echocardiogr 2000; 13:240-7. [PMID: 10708474 DOI: 10.1067/mje.2000.103599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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47
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Mertens S, Bednarz J, Richard G, Engelmann K. Effect of perfluorodecalin on human retinal pigment epithelium and human corneal endothelium in vitro. Graefes Arch Clin Exp Ophthalmol 2000; 238:181-5. [PMID: 10766289 DOI: 10.1007/s004170050030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Perfluorocarbon liquids are useful intraoperative tools in complicated vitreoretinal surgery. They are usually removed at the end of the procedure, but small amounts may remain in the eye. Recently, contradictory results have been reported on the damage in association with residual perfluorocarbon liquids in the eye. This study examined the effects of perfluorodecalin on human retinal pigment epithelium and corneal endothelium in vitro. METHODS Vitality and proliferative capacity of cell cultures were measured after incubation with perfluorodecalin. Vitality of cell cultures were measured using the Life-Dead assay. Cell proliferation was determined by measuring incorporation of 5-bromo-2'-deoxyuridine into cellular DNA. Furthermore, endothelium of organ-cultured human corneas was examined after incubation with perfluorodecalin by photodocumentation. RESULTS Both cell types showed less extinctions in the Life-Dead assay after incubation with perfluorodecalin. After removing perfluorodecalin from the cultures, cells showed the same capacity of proliferation as the control cells. Compared to control corneas, perfluorodecalin induced a decrease in endothelial cell density. In four corneas, endothelial cell necrosis was observed. CONCLUSION Decreasing extinctions in the Life-Dead assay after incubation with perfluorodecalin can be interpreted as showing a decreasing amount of vital cells. Because cell proliferation showed no significant changes the results suggest that perfluorodecalin may not be directly toxic to cells in vitro. It may exert an indirect or mechanical effect on cell function by impeding the normal metabolic exchange between endothelium and medium. Based on these results perfluorodecalin should be completely removed after operation.
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Affiliation(s)
- S Mertens
- Universitäts-Augenklinik Eppendorf, Hamburg, Germany
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48
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Spencer KT, Bednarz J, Mor-Avi V, Weinert L, Tan J, Godoy I, Lang RM. The role of echocardiographic harmonic imaging and contrast enhancement for improvement of endocardial border delineation. J Am Soc Echocardiogr 2000; 13:131-8. [PMID: 10668016 DOI: 10.1016/s0894-7317(00)90024-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite advances in imaging technology, many myocardial segments remain poorly visualized with echocardiography; however, both contrast enhancement and harmonic imaging have shown promise for improving endocardial definition. Fifty subjects with technically limited echocardiograms were studied with fundamental and harmonic imaging as well as during echocardiographic contrast injection. Overall endocardial visualization scores improved with both techniques compared with fundamental imaging. Harmonic imaging improved endocardial visualization in 43% of all segments and in 57% of segments nonvisualized with fundamental imaging. The benefit of harmonic imaging was seen in all segments. Contrast echocardiography had similar overall improvements in visualization (42% of all segments, 67% of segments nonvisualized with fundamental imaging) but was not helpful in all regions. Harmonic imaging outperformed contrast in 9 of 22 segments, whereas contrast was superior in 4 of 22. In a subgroup of patients with very poor images, contrast enhancement was superior, with a greater increase in overall score and a higher salvage rate than harmonic (68% vs 40%).
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Affiliation(s)
- K T Spencer
- Noninvasive Cardiac Imaging Laboratory, University of Chicago, Chicago, IL 60637, USA.
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49
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Godoy IE, Bednarz J, Sugeng L, Mor-Avi V, Spencer KT, Lang RM. Three-dimensional echocardiography in adult patients: comparison between transthoracic and transesophageal reconstructions. J Am Soc Echocardiogr 1999; 12:1045-52. [PMID: 10588779 DOI: 10.1016/s0894-7317(99)70100-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Three-dimensional (3D) echocardiography is a relatively new technique typically implemented with transesophageal imaging with multiplane transducers. OBJECTIVES The goals of this study were (1) to test the feasibility of 3D reconstruction with a new transthoracic multiplane transducer in adult subjects with excellent quality of 2-dimensional images and (2) to compare these reconstructions with those obtained in the same patients with the transesophageal approach. METHODS Transthoracic multiplane image acquisition was performed in 37 patients who were selected on the basis of the quality of their 2-dimensional images. In addition, transesophageal acquisition was also performed in 19 of 37 patients. Three-dimensional reconstruction of mitral and aortic valves was performed. Three-dimensional images were reviewed, and the visualization of various anatomic features was graded. RESULTS The reconstruction of 25 mitral valves and 16 aortic valves, normal and pathologic, was feasible and resulted in visualization of anatomic detail. Score indexes of all valvular characteristics studied were not significantly different when transthoracic and transesophageal reconstructions were compared. CONCLUSIONS Transthoracic 3D echocardiography with a multiplane transducer in adult patients with good acoustic windows is feasible. This technique will allow easy noninvasive serial assessment of valvular pathophysiologic characteristics.
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Affiliation(s)
- I E Godoy
- Noninvasive Cardiac Imaging Laboratories, Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, IL 60637, USA
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50
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Aboalchamat B, Engelmann K, Böhnke M, Eggli P, Bednarz J. Morphological and functional analysis of immortalized human corneal endothelial cells after transplantation. Exp Eye Res 1999; 69:547-53. [PMID: 10548475 DOI: 10.1006/exer.1999.0736] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Approximately 50% of donor corneas are unsuitable for keratoplasty due to an unacceptably low endothelial cell count. One way of overcoming this problem and minimizing wastage of donor corneas may be to transplant cultured human corneal endothelial cells onto these. In this study, we examined the morphological characteristics and functional attributes of endothelial layers formed after the transplantation of immortalized cells in vitro. Cultured human corneal endothelial cells, immortalized by transfection with a plasmid encoding SV40 T-antigen, were seeded onto human corneas denuded of their own endothelium. Seven days after transplantation the newly established monolayers were examined by light, confocal and scanning electron microscopy. Endothelial pump function was gauged by monitoring changes in corneal thickness during perfusion of the endothelial face. The endothelia formed from transplanted immortalized cells had a cobblestone-like appearance, being composed of polygonal units joined by junctional complexes. The stromal hydration state of corneas bearing such endothelial layers could be controlled during perfusion. This was an active process achieved via the Na(+)/K(+)-ATPase-dependent endothelial pump, as demonstrated by inhibiting the enzyme with ouabain. Transplantation of immortalized human corneal endothelial cells onto recipient corneas led to the establishment of new monolayers which had the morphology of the native ones in organ-cultured corneas. This model provides us with a means of studying the formation and function of corneal endothelial layers in vitro.
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Affiliation(s)
- B Aboalchamat
- Universitäts-Augenklinik, Martinistrasse 52, Hamburg, D-20246, Germany
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