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Smith KA, Hiyoshi A, Vingeliene S, von Kobyletzki L, Montgomery S. Atopic dermatitis and cognitive function: a sibling comparison study among males in Sweden. Br J Dermatol 2024; 190:592-593. [PMID: 38170455 DOI: 10.1093/bjd/ljae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/23/2023] [Accepted: 01/13/2024] [Indexed: 01/05/2024]
Abstract
A previous study indicated that atopic dermatitis (AD) was associated with better cognitive function in males during late adolescence. This association was examined among 2 021 369 males who had a medical examination and cognitive function testing during a military conscription assessment in late adolescence in Sweden. Sibling-comparison analysis to tackle confounding indicated that AD is associated with poorer cognitive function, suggesting AD in childhood is detrimental for the development of cognitive function.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Snieguole Vingeliene
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Laura von Kobyletzki
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, UK
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2
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Smith KA, Piehl F, Olsson T, Alfredsson L, Hillert J, Kockum I, Stridh P, Montgomery S. Spasticity treatment patterns among people with multiple sclerosis: a Swedish cohort study. J Neurol Neurosurg Psychiatry 2022; 94:337-348. [PMID: 36539267 PMCID: PMC10176386 DOI: 10.1136/jnnp-2022-329886] [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] [Received: 06/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spasticity is common among people with multiple sclerosis (MS), but there are few studies of spasticity treatment patterns. We aim to describe associations with spasticity treatment measured primarily by oral baclofen use. METHODS This cohort study using Swedish registers included 1826 and 3519 people with incident and prevalent MS (pwIMS, pwPMS) respectively, followed from 2005 to 2014. Cox regression assessed factors associated with new baclofen prescriptions and its discontinuation. RESULTS A total of 10% of pwIMS and 19% of pwPMS received baclofen, a drug prescribed specifically for spasticity in Sweden, of which many patients had relapsing-remitting course. Prescriptions occurred soon after MS diagnosis: pwIMS received baclofen typically within 6 months of diagnosis, and pwPMS within 3 years. Younger patients compared with older patients were three times more likely to receive baclofen with similar disability level measured using Expanded Disability Severity Scores (EDSS). Patients aged 18-44 years with EDSS 3.0-5.0 have an HR for baclofen use of 5.62 (95% CI 2.91 to 10.85) and EDSS 6+ have an HR of 15.41 (95% CI 7.07 to 33.58) compared with individuals with EDSS 0-2.5. In comparison, patients aged 45+ years with EDSS 3.0-5.0 have an HR of 2.05 (95% CI 1.10 to 3.82) and EDSS 6+ a hour 4.26 (95% CI 1.96 to 9.17). Baclofen discontinuation was high: 49% (95% CI 0.42 to 0.57) of pwIMS discontinued within 150 days of dispensation, 90% discontinued within 2 years including patients with progressive course or higher EDSS. Associations among pwPMS and sensitivity analyses including additional treatments were similar. CONCLUSIONS Younger patients with MS are more likely to receive baclofen compared with older patients with MS. High rates of baclofen discontinuation highlight the need for more tolerable and efficacious spasticity treatments and monitoring of spasticity among people with MS.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Piehl
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Tomas Olsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Academic Specialist Centre, Centre of Neurology, SLSO, Stockholm, Sweden
| | - Lars Alfredsson
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.,Centre of Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jan Hillert
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre of Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Kockum
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Stridh
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Orebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
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McHugh T, Sommer DD, Thamboo A, Tewfik MA, Smith KA. Correction: Image guidance system use amongst Canadian otolaryngologists: a nationwide survey. J Otolaryngol Head Neck Surg 2022; 51:31. [PMID: 35902983 PMCID: PMC9336095 DOI: 10.1186/s40463-022-00589-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- T McHugh
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
| | - D D Sommer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - A Thamboo
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.,Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - M A Tewfik
- Department of Otolaryngology, Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - K A Smith
- ENT Clinic, The Montreal Children's Hospital, 1001 Boulevard Décarie, A.RC.4221, Montréal, QC, H4A 3J1, Canada
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Brand JS, Smith KA, Piehl F, Olsson T, Montgomery S. Risk of serious infections in multiple sclerosis patients by disease course and disability status: Results from a Swedish register-based study. Brain Behav Immun Health 2022; 22:100470. [PMID: 35607517 PMCID: PMC9123212 DOI: 10.1016/j.bbih.2022.100470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background and objectives Serious infections are an emerging concern with increasing use of potent immunomodulation in multiple sclerosis (MS), but the extent to which MS disease features influence infectious susceptibility is poorly characterized. The objective of this study was to assess the associations of MS disease course and disability status with risk of serious infections. Methods A cohort of 8660 MS patients was individually matched on age, sex and region of residence with 86,600 people without MS from the general population using national registers in Sweden. The study period was from 1996 to 2012, with follow-up until December 31, 2014. The main outcomes were infection as the underlying or contributory cause of death or infection-related hospital admission identified in the Cause of Death and Patient registers. MS disease course (relapsing-remitting or progressive disease) and Expanded Disability Status Scale (EDSS) score (six and over or below six) were extracted from the MS Register Hazard ratios (HRs) for any serious infection were estimated using flexible parametric models. Results During a median follow-up of 9.6 years (interquartile range = 5.5-13.5 years), 1337 MS patients experienced a serious infection. Compared with individually matched people without MS, risk of serious infection was greater for progressive disease (HR = 3.80; 95% CI 3.52: 4.09) than relapsing-remitting disease (HR = 1.77; 95% CI: 1.62:1.93). A similar pattern of risk was seen for dichotomised EDSS score (HR = 4.26; 95% CI 3.87: 4.70 for EDSS 6.0-9.5 and HR = 1.30; 95% CI 1.1853: 1.43 for EDSS 0.0-5.5). Overall, associations with greater disability did not notably differ by immunomodulatory therapy use, but associations with lower disability were more pronounced in patients receiving these therapies. Conclusions Disease course or EDSS score (which may be more readily available than MS course in some patients) should be considered in individual management and monitoring of MS patients, including assessing benefit-risk of therapies that influence general immune function.
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Affiliation(s)
- Judith S. Brand
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Kelsi A. Smith
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, UK
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McHugh T, Sommer DD, ThambooTewfik AM, Smith KA, McHugh T. Image guidance system use amongst Canadian otolaryngologists: a nationwide survey. J Otolaryngol Head Neck Surg 2022; 51:27. [PMID: 35698181 PMCID: PMC9190092 DOI: 10.1186/s40463-022-00581-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background The use of image guidance systems has gained widespread acceptance as an adjunctive tool for endoscopic sinus surgery. However, the accessibility and usage of this technology is variable across hospitals in Canada.
Study objective The aim of this study is to investigate the availability, usage, and related issues surrounding the use of image guidance systems in endoscopic sinus surgery across Canadian otolaryngology practice settings. Methods An online survey was electronically distributed to practicing otolaryngologists across Canada. The survey contained 27 questions pertaining to the availability, usage, barriers and overall experience of image guidance systems. Results The survey was electronically sent to a total of 654 Canadian otolaryngologists of which 158 responded (response rate 24.2%). Image guidance was available to 56.3% of respondents. Of the respondents without access to IGS, 85.5% indicated they would use it if it was available. Financial (capital cost) was identified as the most important barrier in obtaining IGS by 76.3% of respondents. Conclusion Over half of Canadian otolaryngologists have access to IGS with over 85% of those without access interested in using it if it was made available. A multitude of different factors contribute to this disparity. We hope that the results of this study will help support Canadian otolaryngologists to access IGS. Graphical Abstract ![]()
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Affiliation(s)
- T McHugh
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - D D Sommer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - A Ma ThambooTewfik
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.,Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - K A Smith
- Department of Otolaryngology, Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Tobial McHugh
- A.RC.4221 ENT Clinic, The Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada.
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Xu Y, Hiyoshi A, Smith KA, Piehl F, Olsson T, Fall K, Montgomery S. Association of Infectious Mononucleosis in Childhood and Adolescence With Risk for a Subsequent Multiple Sclerosis Diagnosis Among Siblings. JAMA Netw Open 2021; 4:e2124932. [PMID: 34633426 PMCID: PMC8506233 DOI: 10.1001/jamanetworkopen.2021.24932] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Epstein-Barr virus and its acute manifestation, infectious mononucleosis (IM), are associated with an increased risk of multiple sclerosis (MS). Whether this association is confounded by susceptibility to infection is still debated. OBJECTIVE To assess whether hospital-diagnosed IM during childhood, adolescence, or young adulthood is associated with subsequent MS diagnosis independent of shared familial factors. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used the Swedish Total Population Register to identify individuals born in Sweden from January 1, 1958, to December 31, 1994. Participants aged 20 years were followed up from January 1, 1978, to December 31, 2018, with a median follow-up of 15.38 (IQR, 8.68-23.55; range, 0.01-40.96) years. Data were analyzed from October 2020 to July 2021. EXPOSURE Hospital-diagnosed IM before 25 years of age. MAIN OUTCOMES AND MEASURES Diagnoses of MS from 20 years of age were identified. Risk of an MS diagnosis associated with IM in childhood (birth to 10 years of age), adolescence (11-19 years of age), and early adulthood (20-24 years of age [time-dependent variable]) were estimated using conventional and stratified (to address familial environmental or genetic confounding) Cox proportional hazards regression. RESULTS Of the 2 492 980 individuals (1 312 119 men [52.63%] and 1 180 861 women [47.37%]) included, 5867 (0.24%) had an MS diagnosis from 20 years of age (median age, 31.50 [IQR, 26.78-37.54] years). Infectious mononucleosis in childhood (hazard ratio [HR], 1.98; 95% CI, 1.21-3.23) and adolescence (HR, 3.00; 95% CI, 2.48-3.63) was associated with an increased risk of an MS diagnosis that remained significant after controlling for shared familial factors in stratified Cox proportional hazards regression (HRs, 2.87 [95% CI, 1.44-5.74] and 3.19 [95% CI, 2.29-4.46], respectively). Infectious mononucleosis in early adulthood was also associated with risk of a subsequent MS diagnosis (HR, 1.89; 95% CI, 1.18-3.05), but this risk was attenuated and was not significant after controlling for shared familial factors (HR, 1.51; 95% CI, 0.82-2.76). CONCLUSIONS AND RELEVANCE These findings suggest that IM in childhood and particularly adolescence is a risk factor associated with a diagnosis of MS, independent of shared familial factors.
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Affiliation(s)
- Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Kelsi A. Smith
- Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
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Xu Y, Smith KA, Hiyoshi A, Piehl F, Olsson T, Montgomery S. Hospital-diagnosed infections before age 20 and risk of a subsequent multiple sclerosis diagnosis. Brain 2021; 144:2390-2400. [PMID: 33693538 DOI: 10.1093/brain/awab100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 12/27/2022] Open
Abstract
The involvement of specific viral and bacterial infections as risk factors for multiple sclerosis has been studied extensively. However, whether this extends to infections in a broader sense is less clear and little is known about whether risk of a multiple sclerosis diagnosis is associated with other types and sites of infections, such as of the CNS. This study aims to assess if hospital-diagnosed infections by type and site before age 20 years are associated with risk of a subsequent multiple sclerosis diagnosis and whether this association is explained entirely by infectious mononucleosis, pneumonia, and CNS infections. Individuals born in Sweden between 1970-1994 were identified using the Swedish Total Population Register (n = 2,422,969). Multiple sclerosis diagnoses from age 20 years and hospital-diagnosed infections before age 20 years were identified using the Swedish National Patient Register. Risk of a multiple sclerosis diagnosis associated with various infections in adolescence (11-19 years) and earlier childhood (birth-10 years) was estimated using Cox regression, with adjustment for sex, parental socioeconomic position, and infection type. None of the infections by age 10 years were associated with risk of a multiple sclerosis diagnosis. Any infection in adolescence increased the risk of a multiple sclerosis diagnosis (hazard ratio 1.33, 95% confidence interval 1.21-1.46) and remained statistically significant after exclusion of infectious mononucleosis, pneumonia, and CNS infection (hazard ratio 1.17, 95% confidence interval 1.06-1.30). CNS infection in adolescence (excluding encephalomyelitis to avoid including acute disseminated encephalitis) increased the risk of a multiple sclerosis diagnosis (hazard ratio 1.85, 95% confidence interval 1.11-3.07). The increased risk of a multiple sclerosis diagnosis associated with viral infection in adolescence was largely explained by infectious mononucleosis. Bacterial infections in adolescence increased risk of a multiple sclerosis diagnosis, but the magnitude of risk reduced after excluding infectious mononucleosis, pneumonia and CNS infection (hazard ratio 1.31, 95% confidence interval 1.13-1.51). Respiratory infection in adolescence also increased risk of a multiple sclerosis diagnosis (hazard ratio 1.51, 95% confidence interval 1.30-1.75), but was not statistically significant after excluding infectious mononucleosis and pneumonia. These findings suggest that a variety of serious infections in adolescence, including novel evidence for CNS infections, are risk factors for a subsequent multiple sclerosis diagnosis, further demonstrating adolescence is a critical period of susceptibility to environmental exposures that raise the risk of a multiple sclerosis diagnosis. Importantly, this increased risk cannot be entirely explained by infectious mononucleosis, pneumonia, or CNS infections.
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Affiliation(s)
- Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelsi A Smith
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, UK
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McKay KA, Smith KA, Smertinaite L, Fang F, Ingre C, Taube F. Military service and related risk factors for amyotrophic lateral sclerosis. Acta Neurol Scand 2021; 143:39-50. [PMID: 32905613 PMCID: PMC7756624 DOI: 10.1111/ane.13345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.
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Affiliation(s)
- Kyla A. McKay
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska Institutet Stockholm Sweden
| | - Kelsi A. Smith
- Clinical Epidemiology Division Department of Medicine Solna, Karolinska Institutet Stockholm Sweden
| | - Lidija Smertinaite
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology Insitute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fabian Taube
- School of Public Health and Community Medicine Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Swedish Armed Forces Center for Defence Medicine Gothenburg Sweden
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Chan Y, Angel D, Aron M, Hartl T, Moubayed SP, Smith KA, Sommer DD, Sowerby L, Spafford P, Mertz D, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada. J Otolaryngol Head Neck Surg 2020; 49:76. [PMID: 33106189 PMCID: PMC7586368 DOI: 10.1186/s40463-020-00466-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.
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Affiliation(s)
- Y Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - D Angel
- Division of Otolaryngology - Head & Neck Surgery, Memorial University of Newfoundland, St. John's, NL, Canada
| | - M Aron
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - T Hartl
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - S P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, University of Montreal, Montreal, QC, Canada
| | - K A Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Otolaryngology - Head & Neck Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, ON, Canada
| | - P Spafford
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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Burkill S, Smith KA, Stridh P, Kockum I, Hillert J, Lindahl H, Alfredsson L, Olsson T, Piehl F, Montgomery S, Bahmanyar S. The DQB1 *03:02 Genotype and Treatment for Pain in People With and Without Multiple Sclerosis. Front Neurol 2020; 11:993. [PMID: 33013655 PMCID: PMC7500133 DOI: 10.3389/fneur.2020.00993] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Murine models have demonstrated that the major histocompatibility complex (MHC) is associated with pain-like behavior in peripheral nerve injury, however, the same association has not been shown when considering injury to the central nervous system (CNS), which more closely mimics the damage to the CNS experienced by MS patients. Previous research has indicated the DQB1*03:02 allele of the class II HLA genes as being associated with development of neuropathic pain in persons undergoing inguinal hernia surgery or with lumbar spinal disk herniation. Whether this HLA allele plays a part in susceptibility to pain, has not, as far as we are aware, been previously investigated. This study utilizes information on DQB1*03:02 alleles as part of the EIMS, GEMS, and IMSE studies in Sweden. It also uses register data for 3,877 MS patients, and 4,548 matched comparators without MS, to assess whether the DQB1*03:02 allele is associated with prescribed pain medication use, and whether associations with this genotype differ depending on MS status. Our results showed no association between the DQB1*03:02 genotype and pain medication in MS patients, with an adjusted odds ratio (OR) of 1.02 (95% CI 0.85-1.24). In contrast, there was a statistically significant association of low magnitude in individuals without MS [adjusted OR 1.18 (95% CI 1.03-1.35)], which provides support for HLA influence on susceptibility to pain in the general population. Additionally, the effect of zygosity was evident for the non-MS cohort, but not among MS patients, suggesting the DQB1*03:02 allele effect is modified by the presence of MS.
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Affiliation(s)
- Sarah Burkill
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kelsi A Smith
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Pernilla Stridh
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Hannes Lindahl
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital Solna, Solna, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Shahram Bahmanyar
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
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11
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Smith KA, Hiyoshi A, Burkill S, Bahmanyar S, Öckinger J, Alfredsson L, Olsson T, Montgomery S. Hospital diagnosed pneumonia before age 20 years and multiple sclerosis risk. BMJ Neurol Open 2020; 2:e000044. [PMID: 33681783 PMCID: PMC7903180 DOI: 10.1136/bmjno-2020-000044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Respiratory inflammation has been proposed as a risk factor for MS. This study aims to determine if hospital-diagnosed pneumonia in adolescence (before age 20 years) is associated with subsequent multiple sclerosis (MS). Methods This case-control study included incident MS cases after age 20 years identified using the Swedish national registers. Cases were matched with 10 general population controls by age, sex and region. Pneumonia diagnoses were identified between 0–5, 6–10, 11–15 and 16–20 years of age. Conditional logistic regression models adjusted for infectious mononucleosis (IM) and education calculated ORs with 95% CIs. Urinary tract infections (UTIs), a common complication of MS, before age 20 years were included as a control diagnosis for reverse causation. Results There were 6109 cases and 49 479 controls included. Pneumonia diagnosed between age 11–15 years was associated with subsequent MS (adj OR 2.00, 95% CI 1.22 to 3.27). Although not statistically significant, sensitivity analyses showed similar magnitude associations of pneumonia between age 11–15 years and MS. No statistically significant associations with MS for pneumonia at other age groups were observed. Adjustment for IM had no notable effect on associations, but was statistically significantly associated with MS. UTIs were not associated with MS. Conclusion Pneumonia at 11–15 years of age was associated with MS, suggesting a possible role for inflammation of the respiratory system in the aetiology of MS during a period of susceptibility in adolescence. Further research on respiratory infections prior to MS onset should be conducted to replicate this finding and determine explanatory causal mechanisms.
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Affiliation(s)
- Kelsi A Smith
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, Örebro Universitet-Campus USÖ, Orebro, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Sarah Burkill
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Johan Öckinger
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology and Biostatistics, Örebro Universitet-Campus USÖ, Orebro, Sweden
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12
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Xu Y, Hiyoshi A, Brand JS, Smith KA, Bahmanyar S, Alfredsson L, Olsson T, Montgomery S. Higher body mass index at ages 16 to 20 years is associated with increased risk of a multiple sclerosis diagnosis in subsequent adulthood among men. Mult Scler 2020; 27:147-150. [DOI: 10.1177/1352458520928061] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Evidence for the association between body mass index (BMI) and multiple sclerosis (MS) among men remains mixed. Objective and methods: Swedish military conscription and other registers identified MS after age of 20 years and BMI at ages 16–20 years ( N = 744,548). Results: Each unit (kg/m2) BMI increase was associated with greater MS risk (hazard ratio and 95% confidence interval = 1.034, 1.016–1.053), independent of physical fitness (1.021, 1.001–1.042). Categorised, overweight and obesity were associated with statistically significant raised MS risk compared to normal weight, but not after adjustment for physical fitness. Conclusion: MS risk rises with increasing BMI, across the entire BMI range.
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Affiliation(s)
- Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Judith S Brand
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelsi A Smith
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden/Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shahram Bahmanyar
- Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden/Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden/Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden/Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden/Department of Epidemiology and Public Health, University College London, London, UK
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13
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Smith KA, Burkill S, Hiyoshi A, Olsson T, Bahmanyar S, Wormser D, Geissbühler Y, Moore A, Kharat V, Montgomery S. Comorbid disease burden among MS patients 1968-2012: A Swedish register-based cohort study. Mult Scler 2020; 27:268-280. [PMID: 32162580 PMCID: PMC7820574 DOI: 10.1177/1352458520910497] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: People with multiple sclerosis (pwMS) have increased comorbid disease (CMD) risk. Most previous studies have not considered overall CMD burden. Objective: To describe lifetime CMD burden among pwMS. Methods: PwMS identified using Swedish registers between 1968 and 2012 (n = 25,476) were matched by sex, age, and county of residence with general-population comparators (n = 251,170). Prevalence, prevalence ratios (PRs), survival functions, and hazard ratios by MS status, age, and time period compared seven CMD: autoimmune, cardiovascular, depression, diabetes, respiratory, renal, and seizures. Results: The magnitude of the PRs for each CMD and age group decreased across time, with higher PRs in earlier time periods. Before 1990, younger age groups had higher PRs, and after 1990, older age groups had higher PRs. Male pwMS had higher burden compared with females. Overall, renal, respiratory, and seizures had the highest PRs. Before 2001, 50% of pwMS received a first/additional CMD diagnosis 20 years prior to people without MS, which reduced to 4 years after 2001. PwMS had four times higher rates of first/additional diagnoses in earlier time periods, which reduced to less than two times higher in recent time periods compared to people without MS. Conclusion: Swedish pwMS have increased CMD burden compared with the general population, but this has reduced over time.
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Affiliation(s)
- Kelsi A Smith
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Department of Translational Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Burkill
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden/Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Scott Montgomery
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden/Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden/Department of Epidemiology and Public Health, University College London, London, UK
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14
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Hoxworth JM, Eschbacher JM, Gonzales AC, Singleton KW, Leon GD, Smith KA, Stokes AM, Zhou Y, Mazza GL, Porter AB, Mrugala MM, Zimmerman RS, Bendok BR, Patra DP, Krishna C, Boxerman JL, Baxter LC, Swanson KR, Quarles CC, Schmainda KM, Hu LS. Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies. AJNR Am J Neuroradiol 2020; 41:408-415. [PMID: 32165359 DOI: 10.3174/ajnr.a6486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Perfusion MR imaging measures of relative CBV can distinguish recurrent tumor from posttreatment radiation effects in high-grade gliomas. Currently, relative CBV measurement requires normalization based on user-defined reference tissues. A recently proposed method of relative CBV standardization eliminates the need for user input. This study compares the predictive performance of relative CBV standardization against relative CBV normalization for quantifying recurrent tumor burden in high-grade gliomas relative to posttreatment radiation effects. MATERIALS AND METHODS We recruited 38 previously treated patients with high-grade gliomas (World Health Organization grades III or IV) undergoing surgical re-resection for new contrast-enhancing lesions concerning for recurrent tumor versus posttreatment radiation effects. We recovered 112 image-localized biopsies and quantified the percentage of histologic tumor content versus posttreatment radiation effects for each sample. We measured spatially matched normalized and standardized relative CBV metrics (mean, median) and fractional tumor burden for each biopsy. We compared relative CBV performance to predict tumor content, including the Pearson correlation (r), against histologic tumor content (0%-100%) and the receiver operating characteristic area under the curve for predicting high-versus-low tumor content using binary histologic cutoffs (≥50%; ≥80% tumor). RESULTS Across relative CBV metrics, fractional tumor burden showed the highest correlations with tumor content (0%-100%) for normalized (r = 0.63, P < .001) and standardized (r = 0.66, P < .001) values. With binary cutoffs (ie, ≥50%; ≥80% tumor), predictive accuracies were similar for both standardized and normalized metrics and across relative CBV metrics. Median relative CBV achieved the highest area under the curve (normalized = 0.87, standardized = 0.86) for predicting ≥50% tumor, while fractional tumor burden achieved the highest area under the curve (normalized = 0.77, standardized = 0.80) for predicting ≥80% tumor. CONCLUSIONS Standardization of relative CBV achieves similar performance compared with normalized relative CBV and offers an important step toward workflow optimization and consensus methodology.
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Affiliation(s)
- J M Hoxworth
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | | | | | - K W Singleton
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - G D Leon
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - K A Smith
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - A M Stokes
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - Y Zhou
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | - G L Mazza
- Department of Health Sciences Research (G.L.M.), Division of Biomedical Statistics and Informatics, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | | | | | | | - B R Bendok
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - D P Patra
- Departments of Neurosurgery (D.P.P.)
| | | | - J L Boxerman
- Department of Diagnostic Imaging (J.L.B.), Rhode Island Hospital, Providence, Rhode Island
| | - L C Baxter
- Neuropsychology (L.C.B.), Mayo Clinic Hospital, Phoenix, Arizona
| | - K R Swanson
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | | | - K M Schmainda
- Department of Radiology (K.M.S.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L S Hu
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
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15
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Smith KA, Frazzini Padilla P, Sprague ML. 2131 Trends in Patient Follow-Up after Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Cardenas LM, Bhogal A, Chadwick DR, McGeough K, Misselbrook T, Rees RM, Thorman RE, Watson CJ, Williams JR, Smith KA, Calvet S. Nitrogen use efficiency and nitrous oxide emissions from five UK fertilised grasslands. Sci Total Environ 2019; 661:696-710. [PMID: 30684838 PMCID: PMC6383039 DOI: 10.1016/j.scitotenv.2019.01.082] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 05/15/2023]
Abstract
Intensification of grasslands is necessary to meet the increasing demand of livestock products. The application of nitrogen (N) on grasslands affects the N balance therefore the nitrogen use efficiency (NUE). Emissions of nitrous oxide (N2O) are produced due to N fertilisation and low NUE. These emissions depend on the type and rates of N applied. In this study we have compiled data from 5 UK N fertilised grassland sites (Crichton, Drayton, North Wyke, Hillsborough and Pwllpeiran) covering a range of soil types and climates. The experiments evaluated the effect of increasing rates of inorganic N fertiliser provided as ammonium nitrate (AN) or calcium ammonium nitrate (CAN). The following fertiliser strategies were also explored for a rate of 320 kg N ha-1: using the nitrification inhibitor dicyandiamide (DCD), changing to urea as an N source and splitting fertiliser applications. We measured N2O emissions for a full year in each experiment, as well as soil mineral N, climate data, pasture yield and N offtake. N2O emissions were greater at Crichton and North Wyke whereas Drayton, Hillsborough and Pwllpeiran had the smallest emissions. The resulting average emission factor (EF) of 1.12% total N applied showed a range of values for all the sites between 0.6 and 2.08%. NUE depended on the site and for an application rate of 320 kg N ha-1, N surplus was on average higher than 80 kg N ha-1, which is proposed as a maximum by the EU Nitrogen Expert Panel. N2O emissions tended to be lower when urea was applied instead of AN or CAN, and were particularly reduced when using urea with DCD. Finally, correlations between the factors studied showed that total N input was related to Nofftake and Nexcess; while cumulative emissions and EF were related to yield scaled emissions.
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Affiliation(s)
- L M Cardenas
- Rothamsted Research, Okehampton, Devon, EX20 2SB, UK.
| | - A Bhogal
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - D R Chadwick
- School of Natural Sciences, Bangor University, Bangor LL57 2UW, UK
| | - K McGeough
- Agri-Food and Biosciences Institute, 18a, Newforge Lane, BT9 5PX Belfast, UK
| | - T Misselbrook
- Rothamsted Research, Okehampton, Devon, EX20 2SB, UK
| | - R M Rees
- Scotland's Rural College (SRUC), King's Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - R E Thorman
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - C J Watson
- Agri-Food and Biosciences Institute, 18a, Newforge Lane, BT9 5PX Belfast, UK
| | - J R Williams
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - K A Smith
- School of Geosciences, University of Edinburgh, Crew Building, Alexander Crum Brown Road, Edinburgh EH9 3FF, and Weston Road, Totnes TQ9 5AH, Devon, UK
| | - S Calvet
- Universitat Politècnica de València, Institute of Animal Science and Technology, Camino de Vera s.n., 46022, Valencia, Spain
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17
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Hu LS, Yoon H, Eschbacher JM, Baxter LC, Dueck AC, Nespodzany A, Smith KA, Nakaji P, Xu Y, Wang L, Karis JP, Hawkins-Daarud AJ, Singleton KW, Jackson PR, Anderies BJ, Bendok BR, Zimmerman RS, Quarles C, Porter-Umphrey AB, Mrugala MM, Sharma A, Hoxworth JM, Sattur MG, Sanai N, Koulemberis PE, Krishna C, Mitchell JR, Wu T, Tran NL, Swanson KR, Li J. Accurate Patient-Specific Machine Learning Models of Glioblastoma Invasion Using Transfer Learning. AJNR Am J Neuroradiol 2019; 40:418-425. [PMID: 30819771 DOI: 10.3174/ajnr.a5981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-based modeling of tumor cell density can substantially improve targeted treatment of glioblastoma. Unfortunately, interpatient variability limits the predictive ability of many modeling approaches. We present a transfer learning method that generates individualized patient models, grounded in the wealth of population data, while also detecting and adjusting for interpatient variabilities based on each patient's own histologic data. MATERIALS AND METHODS We recruited patients with primary glioblastoma undergoing image-guided biopsies and preoperative imaging, including contrast-enhanced MR imaging, dynamic susceptibility contrast MR imaging, and diffusion tensor imaging. We calculated relative cerebral blood volume from DSC-MR imaging and mean diffusivity and fractional anisotropy from DTI. Following image coregistration, we assessed tumor cell density for each biopsy and identified corresponding localized MR imaging measurements. We then explored a range of univariate and multivariate predictive models of tumor cell density based on MR imaging measurements in a generalized one-model-fits-all approach. We then implemented both univariate and multivariate individualized transfer learning predictive models, which harness the available population-level data but allow individual variability in their predictions. Finally, we compared Pearson correlation coefficients and mean absolute error between the individualized transfer learning and generalized one-model-fits-all models. RESULTS Tumor cell density significantly correlated with relative CBV (r = 0.33, P < .001), and T1-weighted postcontrast (r = 0.36, P < .001) on univariate analysis after correcting for multiple comparisons. With single-variable modeling (using relative CBV), transfer learning increased predictive performance (r = 0.53, mean absolute error = 15.19%) compared with one-model-fits-all (r = 0.27, mean absolute error = 17.79%). With multivariate modeling, transfer learning further improved performance (r = 0.88, mean absolute error = 5.66%) compared with one-model-fits-all (r = 0.39, mean absolute error = 16.55%). CONCLUSIONS Transfer learning significantly improves predictive modeling performance for quantifying tumor cell density in glioblastoma.
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Affiliation(s)
- L S Hu
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.)
| | - H Yoon
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | | | | | - A C Dueck
- Department of Biostatistics (A.C.D.), Mayo Clinic in Arizona, Scottsdale, Arizona
| | | | | | - P Nakaji
- Neurosurgery (K.A.S., P.N., N.S.)
| | - Y Xu
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | - L Wang
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | | | - A J Hawkins-Daarud
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - K W Singleton
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - P R Jackson
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - B J Anderies
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - B R Bendok
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.).,Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - R S Zimmerman
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - C Quarles
- Neuroimaging Research (C.Q.), Barrow Neurological Institute, Phoenix, Arizona
| | | | - M M Mrugala
- Department of Neuro-Oncology (A.B.P.-U., M.M.M., A.S.)
| | - A Sharma
- Department of Neuro-Oncology (A.B.P.-U., M.M.M., A.S.)
| | - J M Hoxworth
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.)
| | - M G Sattur
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - N Sanai
- Neurosurgery (K.A.S., P.N., N.S.)
| | - P E Koulemberis
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - C Krishna
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - J R Mitchell
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,H. Lee Moffitt Cancer Center and Research Institute (J.R.M.), Tampa, Florida
| | - T Wu
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | - N L Tran
- Department of Cancer Biology (N.L.T.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - K R Swanson
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.).,Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - J Li
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
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18
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Harvey LFB, Smith KA, Curlin H. Improving Operative Room Costs and Efficiency Through Review of Surgeon Preference Cards. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Pieniazek J, Smith KA, Williams MP, Manangi MK, Vazquez-Anon M, Solbak A, Miller M, Lee JT. Evaluation of increasing levels of a microbial phytase in phosphorus deficient broiler diets via live broiler performance, tibia bone ash, apparent metabolizable energy, and amino acid digestibility. Poult Sci 2016; 96:370-382. [PMID: 27444440 DOI: 10.3382/ps/pew225] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/08/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022] Open
Abstract
The objective was to investigate increasing concentrations of an evolved microbial phytase on male broiler performance, tibia bone ash, AME, and amino acid digestibility when fed diets deficient in available phosphorus (aP). Experiment 1 evaluated the effects of phytase during a 21 d battery cage study and Experiment 2 was a 42 d grow-out. Experiment 1 included six treatments; negative control (NC) with an aP level of 0.23% (starter) and 0.19% (grower), two positive controls (PC) consisting of an additional 0.12% and 0.22% aP (PC 1 and PC 2), and the NC supplemented with three levels of phytase (250, 500, and 2,000 U/kg). The NC diet reduced (P < 0.05) FC, BW, and bone ash. Phytase increased (P < 0.05) BW with 2,000 U/kg phytase yielding similar results to the PC2, and improved FCR and increased bone ash was observed at all phytase levels. Amino acid digestibility coefficients were increased (P < 0.05) with phytase at 250 U/kg. Phytase at all rates increased (P < 0.05) AME to levels similar level as PC diets. Linear regression analysis indicated average P equivalency values for BW and bone ash of 0.137, 0.147, and 0.226 for phytase inclusion of 250, 500, and 2000 U/kg, respectively. Experiment 2 included a PC consisting of 0.45%, 0.41%, and 0.38% aP for the starter, grower, and finisher, respectively; NC with reduced aP of 0.17%; and phytase at 500 and 2,000 U/kg. Phytase increased BW (P < 0.05) compared to the NC as 2,000 U/kg phytase resulted in further BW increases compared to the PC (starter and grower). Phytase improved FCR to levels comparable to the PC, with supplementation at 2,000 U/kg resulting in improvements beyond the PC in the starter phase. Amino acid digestibility coefficients were increased with phytase at 2,000 U/kg to levels comparable to that of the PC. These data confirm that the inclusion of phytase improves broiler performance and bone mineralization in aP reduced diets and levels beyond the traditional 500 U/kg can result in further improvements.
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Affiliation(s)
- J Pieniazek
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | - K A Smith
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | - M P Williams
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | | | | | - A Solbak
- Verenium Corporation, San Diego, CA
| | - M Miller
- Verenium Corporation, San Diego, CA
| | - J T Lee
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
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Abstract
OBJECTIVE The purpose of this pilot economic evaluation was to assess the cost-effectiveness of the endoscopic polypectomy in the clinic (EPIC) procedure compared to formal endoscopic sinus surgery (ESS) for the treatment of select chronic rhinosinusitis (CRS) patients with nasal polyposis. DESIGN Cost-effectiveness analysis using a Markov decision tree model with a 30-year time horizon. The two comparative treatment groups were as follows: (i) EPIC and (ii) ESS. Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed. SETTING Economic perspective of the Canadian government third-party payer. PARTICIPANTS CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss. MAIN OUTCOME MEASURES Incremental cost per quality adjusted life year (QALY). RESULTS Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21,345 and produced 13.17 QALYs while the EPIC strategy cost a total of $5591 and produced 12.93 QALYs. The ESS versus EPIC incremental cost-effectiveness ratio was $65,641/QALY. The probability that EPIC is cost-effective compared to ESS at a maximum willingness-to-pay threshold of $30,000 and $50,000/QALY is 66% and 60%, respectively. CONCLUSIONS Outcomes from this study have demonstrated that the EPIC procedure may be a cost-effective treatment strategy for 'select' patients with nasal polyposis. Data from this study were obtained from a small pilot trial, and we feel the results warrant a future randomised controlled trial to strengthen the outcomes.
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Affiliation(s)
- L Rudmik
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Institute of Public Health (IPH), University of Calgary, Calgary, AB, Canada
| | - K A Smith
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - S Kilty
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
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21
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Mellor DD, Madden LA, Smith KA, Kilpatrick ES, Atkin SL. High-polyphenol chocolate reduces endothelial dysfunction and oxidative stress during acute transient hyperglycaemia in Type 2 diabetes: a pilot randomized controlled trial. Diabet Med 2013; 30:478-83. [PMID: 23039340 DOI: 10.1111/dme.12030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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] [Received: 05/08/2012] [Revised: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the effects of high-polyphenol chocolate upon endothelial function and oxidative stress in Type 2 diabetes mellitus during acute transient hyperglycaemia induced following a 75-g oral glucose challenge. METHODS Ten subjects with Type 2 diabetes underwent a double-blinded randomized controlled crossover study. A 75-g oral glucose load was used to induce hyperglycaemia, which was administered to participants 60 min after they had ingested either low (control) or high-polyphenol chocolate. Participants undertook testing at weekly intervals, following an initial cocoa-free period. Endothelial function was assessed by both functional [reactive hyperaemia peripheral artery tonometry (EndoPAT-2000) and serum markers (including intercellular adhesion molecule 1, P-selectin and P-selectin glycoprotein ligand 1]. Urinary 15-F2t-isoprostane adjusted for creatinine was used as an oxidative stress marker. Measurements were made at baseline and 2 h post-ingestion of the glucose load. RESULTS Prior consumption of high-polyphenol chocolate before a glucose load improved endothelial function (1.7 ± 0.1 vs. 2.3 ± 0.1%, P = 0.01), whereas prior consumption of control chocolate resulted in a significant increase in intercellular adhesion molecule 1 (321.1 ± 7.6 vs. 373.6 ± 10.5 ng/ml, P = 0.04) and 15-F2t-isoprostane (116.8 ± 5.7 vs. 207.1 ± 5.7 mg/mol, P = 0.02). Analysis of percentage changes from baseline comparing control and high-polyphenol chocolate showed a significant improvement for high-polyphenol chocolate in both measures of endothelial function (P < 0.05) and for urinary 15-F2t-isoprostane (P = 0.04). CONCLUSION High-polyphenol chocolate protected against acute hyperglycaemia-induced endothelial dysfunction and oxidative stress in individuals with Type 2 diabetes mellitus.
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Affiliation(s)
- D D Mellor
- Department of Clinical Science, University of Chester, Chester, UK.
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22
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Wakil A, Smith KA, Atkin SL, Kilpatrick ES. Short-term glucose variability in healthy volunteers is not associated with raised oxidative stress markers. Diabetes Obes Metab 2012; 14:1047-9. [PMID: 22587382 DOI: 10.1111/j.1463-1326.2012.01625.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/18/2012] [Accepted: 05/09/2012] [Indexed: 12/01/2022]
Abstract
It is unknown whether glycaemic variability adds to the risk of microvascular complications of diabetes over and above the mean glucose value for a patient. We examined the effect of purposefully induced short-term glycaemic variability on oxidative stress markers. Eleven healthy subjects underwent three sequential glycaemic states; sustained hyperglycaemia, sustained euglycaemia and variable glycaemia, using glycaemic clamps for 3 h. Twenty-four hours urinary 8-isoprostane-PGF2α was measured before and after each glycaemic state to assess oxidative stress. The median and interquartile range of the urinary 8-iso-PGF2α in ng/24 h were (1373, 513), (996, 298) and (1227, 472) for the euglycaemic, hyperglycaemic and variable states, respectively. There was no significant difference in urinary isoprostanes between the three different states; mean ranks 20.9, 11.9 and 18.2 for the euglycaemic state, hyperglycaemic state and glycaemic variability state, respectively, p = 0.083. In conclusion, we did not see a significant increase in the urinary isoprostanes when glycaemic variability was induced under controlled conditions in healthy individuals.
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23
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Hooper JMW, Stuijver DJF, Orme SM, van Zaane B, Hess K, Gerdes VE, Phoenix F, Rice P, Smith KA, Alzahrani SH, Standeven KF, Ajjan RA. Thyroid dysfunction and fibrin network structure: a mechanism for increased thrombotic risk in hyperthyroid individuals. J Clin Endocrinol Metab 2012; 97:1463-73. [PMID: 22378816 DOI: 10.1210/jc.2011-2894] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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: 11/19/2022]
Abstract
CONTEXT Hyperthyroidism is associated with increased thrombosis risk, and fibrin clot structure determines susceptibility to vascular thrombotic events. OBJECTIVE Our objective was to investigate clot formation and lysis in hyperthyroidism using observational and interventional studies. DESIGN Ex vivo fibrin clot structure/fibrinolysis and plasma levels of thrombotic/inflammatory markers were investigated in hyperthyroid individuals (n = 24) and matched controls (n = 19), using turbidimetric assays, ELISA, and confocal and electron microscopy. The effects of normalizing thyroid function were analyzed (n = 19) and the role of short-term exogenous hyperthyroidism in healthy volunteers studied (n = 16). RESULTS Hyperthyroid subjects displayed higher clot maximum absorbance compared with controls (0.41 ± 0.03 and 0.27 ± 0.01 arbitrary units, respectively; P < 0.01), and longer clot lysis time (518 ± 23 and 461 ± 18 sec, respectively; P < 0.05), which correlated with free T(4) levels. Plasma levels of fibrinogen and plasminogen activator inhibitor-1 were significantly higher in patients compared with controls. Normalizing thyroid function in 19 subjects was associated with lower maximum absorbance and shorter lysis time, accompanied by reduction in fibrinogen, plasminogen activator inhibitor-1, and D-dimer levels. Complement C3, but not C-reactive protein, levels were higher in hyperthyroid subjects compared with controls (0.92 ± 0.05 and 0.64 ± 0.03 g/liter, respectively; P < 0.01), correlated with clot structure parameters, and decreased after intervention. Confocal and electron microscopy confirmed more compact clots and impaired fibrinolysis during hyperthyroidism. Exogenous hyperthyroidism in healthy volunteers had no effect on any of the clot structure parameters. CONCLUSIONS Endogenous hyperthyroidism is associated with more compact clots and resistance to fibrinolysis ex vivo, related to the degree of hyperthyroidism and C3 plasma levels, and these changes are modulated by achieving euthyroidism. Altered clot structure/lysis may be one mechanism for increased thrombotic risk in hyperthyroidism.
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Affiliation(s)
- J M W Hooper
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds LS2 9JT, United Kingdom
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24
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Hess K, Alzahrani SH, Mathai M, Schroeder V, Carter AM, Howell G, Koko T, Strachan MWJ, Price JF, Smith KA, Grant PJ, Ajjan RA. A novel mechanism for hypofibrinolysis in diabetes: the role of complement C3. Diabetologia 2012; 55:1103-13. [PMID: 21918806 DOI: 10.1007/s00125-011-2301-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/12/2011] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Impaired fibrin clot lysis is a key abnormality in diabetes and complement C3 is one protein identified in blood clots. This work investigates the mechanistic pathways linking C3 and hypofibrinolysis in diabetes using ex vivo/in vitro studies. METHODS Fibrinolysis and C3 plasma levels were determined in type 1 diabetic patients and healthy controls, and the effects of glycaemia investigated. C3 incorporation into fibrin clots and modulation of fibrinolysis were analysed by ELISA, immunoblotting, turbidimetric assays and electron and confocal microscopy. RESULTS Clot lysis time was longer in diabetic children than in controls (599 ± 18 and 516 ± 12 s respectively; p < 0.01), C3 levels were higher in diabetic children (0.55 ± 0.02 and 0.43 ± 0.02 g/l respectively; p < 0.01) and both were affected by improving glycaemia. An interaction between C3 and fibrin was confirmed by the presence of lower protein levels in sera compared with corresponding plasma and C3 detection in plasma clots by immunoblot. In a purified system, C3 was associated with thinner fibrin fibres and more prolongation of lysis time of clots made from fibrinogen from diabetic participants compared with controls (244 ± 64 and 92 ± 23 s respectively; p < 0.05). Confocal microscopy showed higher C3 incorporation into diabetic clots compared with controls, and fully formed clot lysis was prolonged by 764 ± 76 and 428 ± 105 s respectively (p < 0.05). Differences in lysis, comparing diabetes and controls, were not related to altered plasmin generation or C3-fibrinogen binding assessed by plasmon resonance. CONCLUSIONS/INTERPRETATION C3 incorporation into clots from diabetic fibrinogen is enhanced and adversely affects fibrinolysis. This may be one novel mechanism for compromised clot lysis in diabetes, potentially offering a new therapeutic target.
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Affiliation(s)
- K Hess
- University of Leeds, Leeds, UK
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25
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Hu LS, Eschbacher JM, Dueck AC, Heiserman JE, Liu S, Karis JP, Smith KA, Shapiro WR, Pinnaduwage DS, Coons SW, Nakaji P, Debbins J, Feuerstein BG, Baxter LC. Correlations between perfusion MR imaging cerebral blood volume, microvessel quantification, and clinical outcome using stereotactic analysis in recurrent high-grade glioma. AJNR Am J Neuroradiol 2012; 33:69-76. [PMID: 22095961 PMCID: PMC7966183 DOI: 10.3174/ajnr.a2743] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/09/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG. MATERIALS AND METHODS We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-μm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression. RESULTS We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17). CONCLUSIONS rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.
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Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, Arizona, USA.
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26
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DeSilva JHSR, Udinwe V, Sideris PJ, Smart MC, Krause FC, Hwang C, Smith KA, Greenbaum SG. Solid State Multinuclear Magnetic Resonance Investigation of Electrolyte Decomposition Products on Lithium Ion Electrodes. ACTA ACUST UNITED AC 2012; 41:207-214. [PMID: 31007829 DOI: 10.1149/1.4717978] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid electrolyte interphase (SEI) formation in lithium ion cells prepared with advanced electrolytes is investigated by solid state multinuclear (7Li, 19F, 31P) magnetic resonance (NMR) measurements of electrode materials harvested from cycled cells subjected to an accelerated aging protocol. The electrolyte composition is varied to include the addition of fluorinated carbonates and triphenyl phosphate (TPP, a flame retardant). In addition to species associated with LiPF6 decomposition, cathode NMR spectra are characterized by the presence of compounds originating from the TPP additive. Substantial amounts of LiF are observed in the anodes as well as compounds originating from the fluorinated carbonates.
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Affiliation(s)
- J H S R DeSilva
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
- Graduate Center of CUNY, New York, New York, 10016, USA
| | - V Udinwe
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
| | - P J Sideris
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
| | - M C Smart
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - F C Krause
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - C Hwang
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - K A Smith
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - S G Greenbaum
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
- Graduate Center of CUNY, New York, New York, 10016, USA
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Rashid RS, Smith KA, Nambiar KZ, Frew AJ, Tarzi MD. Pollen-food syndrome is related to Bet v 1/PR-10 protein sensitisation, but not all patients have spring rhinitis. Allergy 2011; 66:1391-2. [PMID: 21569050 DOI: 10.1111/j.1398-9995.2011.02618.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R S Rashid
- Department of Immunology, Brighton and Sussex Medical School, University of Sussex, UK
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28
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Smith KA, Shepherd J, Wakil A, Kilpatrick ES. A comparison of methods for the measurement of 8-isoPGF(2α): a marker of oxidative stress. Ann Clin Biochem 2011; 48:147-54. [PMID: 21292864 DOI: 10.1258/acb.2010.010151] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oxidative stress describes the cellular damage caused by excess reactive oxygen species not adequately inactivated by antioxidants. Oxidative stress has been implicated in playing a role in many disorders. Lipid peroxidation end-products are employed as markers of oxidative stress, of which the isoprostane, 8-iso-PGF(2α), is widely used. 8-iso-PGF(2α) is measured in plasma or urine by gas chromatography-mass spectrometry (GC/MS), liquid chromatography-mass spectrometry (LC/MS), tandem-mass spectrometry or enzyme-linked immunosorbent assay (ELISA). However, discrepancies between the specificity of these methods means correlation is poor. METHODS A tandem-mass spectrometric (LC/MS/MS) method, using immunoaffinity purification, for urinary 8-iso-PGF(2α) was developed and compared with two commercial ELISAs (A--Cayman Chemicals, B--Oxford Biomedical Research) in urine samples (n = 156). RESULTS An LC/MS/MS method coupled to immunoaffinity purification was developed with satisfactory performance and comparison to ELISAs A and B. Spearman rank correlation demonstrated significant correlation between all methods (P = <0.0001); however, r² values ranged from 0.68 to 0.72. Bland-Altman plots revealed a proportional positive bias of ELISA B when compared with ELISA A and LC/MS/MS. Furthermore, the agreement between ELISA A and LC/MS/MS was poor. CONCLUSIONS The poor agreement between methods for measurement of 8-iso-PGF(2α) highlights differences in selectivity. 8-iso-PGF(2α) is an isoprostane, a family of isomeric end-products of arachidonic acid peroxidation, which are produced by peroxidation or enzymatically. This makes avoiding cross-reactivity between 8-iso-PGF(2α) and related isomers challenging. When assessing oxidative stress studies, the selectivity of the methods used should be taken into account, particularly when comparing studies.
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Affiliation(s)
- K A Smith
- Department of Clinical Biochemistry, Hull Royal Infirmary, Anlaby Road, Hull HU32JZ, UK
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Smith KA, Qiu Z, Wong R, Tam VL, Tam BL, Joea DK, Quach A, Liu X, Pold M, Malyankar UM, Bot A. Multivalent immunity targeting tumor-associated antigens by intra-lymph node DNA-prime, peptide-boost vaccination. Cancer Gene Ther 2010; 18:63-76. [PMID: 20725097 DOI: 10.1038/cgt.2010.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Active immunotherapy of cancer has yet to yield effective therapies in the clinic. To evaluate the translatability of DNA-based vaccines we analyzed the profile of T-cell immunity by plasmid vaccination in a murine model, using transcriptome microarray analysis and flow cytometry. DNA vaccination resulted in specific T cells expressing low levels of co-inhibitory molecules (most notably PD-1), strikingly different from the expression profile elicited by peptide immunization. In addition, the T-cell response primed through this dual-antigen-expressing plasmid (MART-1/Melan-A and tyrosinase) translated into a substantial proliferation capacity and functional conversion to antitumor effector cells after tyrosinase and MART-1/Melan-A peptide analog boost. Furthermore, peptide boost rescued the immune response against the subdominant tyrosinase epitope. This immunization approach could be adapted to elicit potent immunity against multiple tumor antigens, resulting in a broader immune response that was more effective in targeting human tumor cells. Finally, this study sheds light on a novel mechanism of immune homeostasis through synchronous regulation of co-inhibitory molecules on T cells, highly relevant to heterologous prime boost approaches involving DNA vaccines as priming agents.
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Affiliation(s)
- K A Smith
- Department of Research and Development, Mannkind Corporation, Valencia, CA 91355, USA
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30
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Meadows MD, Smith KA, Kinsey RA, Rothgeb TM, Skarjune RP, Oldfield E. High-resolution solid-state NMR of quadrupolar nuclei. Proc Natl Acad Sci U S A 2010; 79:1351-5. [PMID: 16593165 PMCID: PMC345967 DOI: 10.1073/pnas.79.4.1351] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report the observation of high-resolution solid-state NMR spectra of (23)Na (I = [unk]), (27)Al (I = [unk]) and (51)V (I = [unk]) in various inorganic systems. We show that, contrary to popular belief, relatively high-resolution ( approximately 10 ppm linewidth) spectra may be obtained from quadrupolar systems, in which electric quadrupole coupling constants (e(2)qQ/h) are in the range approximately 1-5 MHz, by means of observation of the ((1/2), -(1/2)) spin transition. The ((1/2), -(1/2)) transition for all nonintegral spin quadrupolar nuclei (I = [unk], [unk], [unk], or [unk]) is only normally broadened by dipolar, chemical shift (or Knight shift) anisotropy or second-order quadrupolar effects, all of which are to a greater or lesser extent averaged under fast magic-angle sample rotation. In the case of (23)Na and (27)Al, high-resolution spectra of (23)NaNO(3) (e(2)qQ/h approximately 300 kHz) and alpha-(27)Al(2)O(3) (e(2)qQ/h approximately 2-3 MHz) are presented; in the case of (51)V(2)O(5) (e(2)qQ/h approximately 800 kHz), rotational echo decays are observed due to the presence of a approximately 10(3)-ppm chemical shift anisotropy. The observation of high-resolution solid-state spectra of systems having spins I = [unk], [unk], and [unk] in asymmetric environments opens up the possibility of examining about two out of three nuclei by solid-state NMR that were previously thought of as "inaccessible" due to the presence of large (a few megahertz) quadrupole coupling constants. Preliminary results for an I = [unk] system, (93)Nb, having e(2)qQ/h approximately 19.5 MHz, are also reported.
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Affiliation(s)
- M D Meadows
- School of Chemical Sciences, University of Illinois at Urbana-Champaign, 505 South Mathews Avenue, Urbana, Illinois 61801
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Abstract
As an attempt to provide an organized way to study the chaotic structures and their effects in solving combinatorial optimization with chaotic neural networks (CNN's), a unifying framework is proposed to serve as a basis where the existing CNN models can be placed and compared. The key of this proposed framework is the introduction of an extra energy term into the computational energy of the Hopfield model, which takes on different forms for different CNN models, and modifies the original Hopfield energy landscape in various manners. Three CNN models, namely the Chen and Aihara model with self-feedback chaotic simulated annealing (CSA), the Wang and Smith model with timestep CSA, and the chaotic noise model, are chosen as examples to show how they can be classified and compared within the proposed framework.
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Hu LS, Baxter LC, Pinnaduwage DS, Paine TL, Karis JP, Feuerstein BG, Schmainda KM, Dueck AC, Debbins J, Smith KA, Nakaji P, Eschbacher JM, Coons SW, Heiserman JE. Optimized preload leakage-correction methods to improve the diagnostic accuracy of dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in posttreatment gliomas. AJNR Am J Neuroradiol 2010; 31:40-8. [PMID: 19749223 DOI: 10.3174/ajnr.a1787] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Relative cerebral blood volume (rCBV) accuracy can vary substantially depending on the dynamic susceptibility-weighted contrast-enhanced (DSC) acquisition and postprocessing methods, due to blood-brain barrier disruption and resulting T1-weighted leakage and T2- and/or T2*-weighted imaging (T2/T2*WI) residual effects. We set out to determine optimal DSC conditions that address these errors and maximize rCBV accuracy in differentiating posttreatment radiation effect (PTRE) and tumor. MATERIALS AND METHODS We recruited patients with previously treated high-grade gliomas undergoing image-guided re-resection of recurrent contrast-enhancing MR imaging lesions. Thirty-six surgical tissue samples were collected from 11 subjects. Preoperative 3T DSC used 6 sequential evenly timed acquisitions, each by using a 0.05-mmol/kg gadodiamide bolus. Preload dosing (PLD) and baseline subtraction (BLS) techniques corrected T1-weighted leakage and T2/T2*WI residual effects, respectively. PLD amount and incubation time increased with each sequential acquisition. Corresponding tissue specimen stereotactic locations were coregistered to DSC to measure localized rCBV under varying PLD amounts, incubation times, and the presence of BLS. rCBV thresholds were determined to maximize test accuracy (average of sensitivity and specificity) in distinguishing tumor (n = 21) and PTRE (n = 15) samples under the varying conditions. Receiver operator characteristic (ROC) areas under the curve (AUCs) were statistically compared. RESULTS The protocol that combined PLD (0.1-mmol/kg amount, 6-minute incubation time) and BLS correction methods maximized test AUC (0.99) and accuracy (95.2%) compared with uncorrected rCBV AUC (0.85) and accuracy (81.0%) measured without PLD and BLS (P = .01). CONCLUSIONS Combining PLD and BLS correction methods for T1-weighted and T2/T2*WI errors, respectively, enables highly accurate differentiation of PTRE and tumor growth.
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Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, Arizona 85259, USA.
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Abstract
This paper outlines the risk assessment and communication strategy carried out by the Lothian Health Protection Team after notification of a probable case of meningococcal disease (later confirmed as Neisseria meningitidis) in a resident of a city centre backpackers hostel. Six close contacts were identified from the hostel and given rifampicin prophylaxis. Two days after commencing rifampicin one of these contacts was admitted to hospital with a purpuric/petechial rash and thrombocytopenia. The final diagnosis for this contact was thrombocytopenia, either idiopathic or secondary to rifampicin. This example and the potential side effects of administering rifampicin prophylaxis highlight the importance of a thorough risk assessment of contacts of a case to avoid prescribing prophylaxis to anyone other than those at highest risk of becoming a subsequent case.
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Affiliation(s)
- L C Davis
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, United Kingdom.
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Dobbie KE, Heal KV, Aumônier J, Smith KA, Johnston A, Younger PL. Evaluation of iron ochre from mine drainage treatment for removal of phosphorus from wastewater. Chemosphere 2009; 75:795-800. [PMID: 19195678 DOI: 10.1016/j.chemosphere.2008.12.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 05/27/2023]
Abstract
Treatment of polluting discharges from abandoned coal mines in the UK currently produces ca 30,000 t y(-1) of hydrous iron oxides ("ochre"), for which there is no major end-use, but which has previously been shown to have potential for removing P from wastewater and agricultural runoff. The efficiency of ochre for P removal from wastewater was investigated in experiments at two sites in the UK: Leitholm in Scotland and Windlestone in England. The three-year experiment at Leitholm involved diverting secondary-treated wastewater effluent through a trough which contained granular and pelletized ochre at different times. In the nine-month experiment at Windlestone, beds of ochre pellets in horizontal and vertical flow configurations were tested. The ochre treatment systems at Leitholm reduced influent concentrations of total P (TP) and TP mass by ca 80% and 50%, respectively, during optimal flow conditions, and achieved a removal rate of up to 65+/-48 mg TP kg(-1) ochre d(-1). There was no detectable release of potentially toxic metals from the ochre during the experiments. P removal rates by concentration were inversely related to flow and declined during the different phases of the experiments, probably due to clogging. At Windlestone, higher removal rates up to 195 mg TP kg(-1) ochre d(-1) were achieved for short periods of time following cleaning of the experimental system. Ochre has considerable potential to remove P from wastewater in a multi-stage treatment system and has a lifetime estimated to be 10 times longer than other substrates tested for P removal.
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Affiliation(s)
- K E Dobbie
- School of GeoSciences, The University of Edinburgh, Crew Building, West Mains Road, Edinburgh EH9 3JN, UK
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35
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Hu LS, Baxter LC, Smith KA, Feuerstein BG, Karis JP, Eschbacher JM, Coons SW, Nakaji P, Yeh RF, Debbins J, Heiserman JE. Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements. AJNR Am J Neuroradiol 2009; 30:552-8. [PMID: 19056837 DOI: 10.3174/ajnr.a1377] [Citation(s) in RCA: 289] [Impact Index Per Article: 19.3] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence. MATERIALS AND METHODS Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration. RESULTS Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7% and a specificity of 100%. CONCLUSIONS rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.
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Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, AZ 85259, USA.
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Abstract
Stem cell factor (SCF) is an early-acting, hematopoietic growth factor that binds to the receptor encoded by the proto-oncogene c-kit. It is a potent growth factor for primitive bone marrow cells as well as thymocytes. This unit describes three protocols for detecting human and murine SCF. In the first, human or rodent SCF is measured by its ability to stimulate proliferation of the human megakaryoblastic leukemia cell line, UT-7. Because rat and mouse SCF bind well to human c-kit, human and rodent SCF can both be measured using the first basic protocol. In an Alternate Protocol, rodent SCF is assayed by its ability to stimulate proliferation of the clonal murine mast cell line, MC/9. Human SCF is not very active on rodent cells and thus cannot be measured using this protocol. Both of the cell proliferation assays lack specificity because they are capable of detecting other cytokines in addition to SCF. The third protocol is a radioreceptor assay using the human erythroleukemia cell line, OCIM1; it specifically measures murine or human SCF and not other cytokines. Support protocols describe maintenance of UT-7 and MC/9 cells and preparation of plasma membranes from OCIM1 cells.
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Affiliation(s)
- K A Smith
- Amgen, Thousand Oaks, California, USA
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Smith KA. Saints in shining armor: martial asceticism and masculine models of sanctity, ca. 1050-1250. Speculum 2008; 83:572-302. [PMID: 19618560 DOI: 10.1017/s0038713400014597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Okabe T, Mintz GS, Weigold WG, Roswell R, Joshi S, Lee SY, Lee B, Roy P, Steinberg DH, Pinto Slottow TL, Torguson R, Smith KA, Xue Z, Satler LF, Kent KM, Pichard AD, Weissman NJ, Lindsay J, Waksman R. The predictive value of computed tomography calcium scores: a comparison with quantitative volumetric intravascular ultrasound. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Okabe T, Torguson R, Roy P, Steinberg DH, Pinto Slottow TL, Smith KA, Xue Z, Satler LF, Kent KM, Pichard AD, Lindsay J, Waksman R. Safety and efficacy of direct stenting compared with distal protection device in saphenous vein graft lesions. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Heal KV, Dobbie KE, Bozika E, McHaffie H, Simpson AE, Smith KA. Enhancing phosphorus removal in constructed wetlands with ochre from mine drainage treatment. Water Sci Technol 2005; 51:275-82. [PMID: 16042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
No single end-use has yet been identified that is capable of consuming the projected production of ochre (mainly iron (III) oxides) from mine drainage treatment. However, the high sorption capacity of ochre for phosphorus (up to 26 mg kg(-1)) means that it could be used in constructed wetlands to enhance phosphorus removal. Laboratory batch experiments showed that coarse-grained ochre removes 90% of all phosphorus forms from sewage effluent after 15 minutes of shaking. From a larger-scale experiment, it is estimated that constructed wetlands with an ochre substrate should remove phosphorus from sewage effluent for up to 200-300 years. The suitability of ochre for phosphorus removal is being investigated at the field scale in a wastewater constructed wetland (175 m2 area) in Berwickshire, UK. The hydraulic and treatment performance of the wetland were monitored for 15 months prior to installation at the inlet in November 2003 of a tank containing approximately 1200 kg ochre. Results so far show that improved hydraulic design is required for ochre to increase the mean phosphorus removal efficiency of the system (27 +/- 28%), but potentially toxic metals (Al, Cd, Cr, Cu, Fe, Ni, Pb, Zn) have not been released from the ochre into the wetland outflow.
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Affiliation(s)
- K V Heal
- School of Geosciences, University of Edinburgh, Darwin Building, Mayfield Road, Edinburgh EH9 3JU, UK.
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41
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Abstract
We investigate the deformation and breakup in shear flow of an encapsulated drop in which both the core and shell are Newtonian fluids. The equations of motion are solved numerically using a level set method to track interface motion. We consider the case of a drop stretched to a given length in constant shear and then allowed to relax. A range of morphologies is produced, and novel kinematics occur, due to the interaction of the core and outer interfaces. A phase diagram is presented to describe the morphologies produced over a range of capillary numbers and core interfacial tensions.
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Affiliation(s)
- K A Smith
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois 60208, USA
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42
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Abstract
Recombinant antibodies are important tools for biomedical research and are increasingly being used as clinical diagnostic/therapeutic reagents. In this article, a background to humanized antibodies is given, together with details of the generation of antibody fragments--for example, single chain Fv fragments. Phage antibody fragments are fast becoming popular and can be generated by simple established methods of affinity enrichment from libraries derived from immune cells. Phage display methodology can also be used for the affinity enrichment of existing antibody fragments to provide a reagent with a higher affinity. Here, phage antibodies are demystified to provide a greater understanding of the potential of these reagents and to engage clinicians and biomedical scientists alike to think about potential applications in pathology and clinical settings.
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Affiliation(s)
- K A Smith
- Division of Cell and Molecular Medicine, Postgraduate Medical Institute, University of Hull, Cottingham Rd, Hull HU6 7RX, UK.
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43
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Smith KA, Ottino JM, de la Cruz MO. Dynamics of a drop at a fluid interface under shear. Phys Rev E Stat Nonlin Soft Matter Phys 2004; 69:046302. [PMID: 15169094 DOI: 10.1103/physreve.69.046302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Indexed: 05/24/2023]
Abstract
We analyze the dynamics of a two-dimensional drop lying on a fluid interface, sometimes called a liquid lens, subjected to simple shear flow. The three fluids, the drop and the two external fluids, meet at a triple point (or a triple line in three dimensions). A requirement for steady drop shapes is that the triple points are stationary. This leads to a flow topology different than that of a freely suspended drop. Results are substantiated with numerical results using a level set method for interface evolution and treatment of triple points. Possible implications for new drop instabilities are also discussed.
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Affiliation(s)
- K A Smith
- Department of Chemical Engineering, Northwestern University, Evanston, IL 60208, USA
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Wennemann L, Shanks CH, Smith KA. Movement of entomopathogenic nematodes in soils of Fragaria spp. Commun Agric Appl Biol Sci 2004; 69:347-57. [PMID: 15759434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The mobility of three entomopathogenic nematodes (Steinernema carpocapsae UK and All Strain, and S. glaseri (Nematoda: Steinernematidae) was observed in strawberry fields in Vancouver, WA. Nematodes were sprinkled over the soil surface using a mason jar. Soil and soil-moisture content, soil composition, soil pH and conductivity was reported over the evaluation period. 12 cm deep soil samples were taken after surface application at 9 and 25 days, 7, 26 and 45 and 6, 22, 37 and 50 days at the three different test sites within the surface application site and at 5 cm distance. Soil samples taken were divided into three layers (0-4, 5-8 and 9-12 cm) and exposed once to five Galleria larvae in the laboratory to evaluate nematode presence and movement. Results after surface application demonstrated more vertical movement of S. glaseri into deeper soil layers in comparison to both S. carpocapsae strains.
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Affiliation(s)
- L Wennemann
- Washington State University, Vancouver Research and Extension Unit, 1919 N.E. 78th Street, Vancouver, WA 98665-9752, USA
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Javedan SP, Manwaring K, Smith KA. Treatment of posterior third ventricular central neurocytoma with endoscopic biopsy, endoscopic third ventriculostomy and stereotactic radiosurgery. Minim Invasive Neurosurg 2003; 46:165-8. [PMID: 12872194 DOI: 10.1055/s-2003-40744] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Central neurocytomas of the posterior third ventricle are rare. These typically benign lesions have recently been shown to respond well to Gamma knife stereotactic radiosurgery (SRS). We present the case of a posterior third ventricle central neurocytoma presenting with aqueduct obstruction. The patient was treated with endoscopic biopsy and endoscopic third ventriculostomy, followed by Gamma knife radiosurgery. At 2 years the tumor has diminished in size and the patient is neurologically intact. This treatment strategy may avoid the risk of open ventricular surgery and the need for shunts in patients with central neurocytomas of appropriate size and location.
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Affiliation(s)
- S P Javedan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Smith KA, Kirkpatrick N, Madden LA, Topping KP, Monson JRT, Greenman J. Isolation and characterisation of vascular endothelial growth factor-165 specific scFv fragments by phage display. Int J Oncol 2003; 22:333-8. [PMID: 12527931 DOI: 10.3892/ijo.22.2.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is a multifunctional cytokine which plays a major role in angiogenesis. Alternative splicing causes the production of several different isoforms (VEGF-A 121, 145, 165, 189, 206). VEGF is essential for tumor angiogenesis and several studies have correlated elevated VEGF levels with tumor stage, metastases and progression. Antibody phage display was employed to isolate two scFv antibody fragments, D8 and F10, with specificity for the VEGF165 isoform. It was shown by ELISA and competitive immunohistochemistry that each clone bound to VEGF165 but not VEGF121. Immunohistochemistry with D8 and F10 on colorectal carcinoma and adenoma sections revealed positive staining similar to that shown by a polyclonal VEGF antibody. The scFv antibody fragments, D8 and F10, will be useful in specifically detecting circulating VEGF165 in cancer patients as most studies to date have quantified the total level of circulating VEGF (121 and 165). These reagents will allow further elucidation of the role of VEGF in tumor angiogenesis.
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Affiliation(s)
- K A Smith
- Department of Surgery, Medical Research Laboratory, Wolfson Building, University of Hull, Hull, HU6 7RX, UK
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Kung L, Smith KA, Smagala AM, Endres KM, Bessett CA, Ranjit NK, Yaissle J. Effects of 9,10 anthraquinone on ruminal fermentation, total-tract digestion, and blood metabolite concentrations in sheep. J Anim Sci 2003; 81:323-8. [PMID: 12597404 DOI: 10.2527/2003.811323x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the effects of adding 9,10 anthraquinone, a known inhibitor of methanogenesis and sulfate reduction, on blood metabolites, digestibility, and distribution of gas in sheep. In all experiments, we fed a complete pelleted diet that contained 17.5% crude protein and 24.5% acid detergent fiber. In an 8-wk study, feeding up to 66 ppm (dry matter basis) of 9,10 anthraquinone had no adverse effects on blood metabolites including indicators of normal enzyme function, mineral concentrations, and hematological measurements. Feeding 9,10 anthraquinone had no effect on average daily gain, although sheep fed a diet containing 66 ppm of 9,10 anthraquinone numerically gained the least weight. The ruminal molar proportions of acetic acid were decreased (P < 0.05) and the molar proportions of propionic acid were increased (P < 0.05) in sheep fed 1.5 and 66 ppm 9,10 anthraquinone when compared to those fed an unsupplemented diet. In a digestion trial, 9,10 anthraquinone (33 and 66 ppm) had no effect on the apparent digestion of nutrients in the total gastrointestinal tract. In a metabolism study, ruminal gasses were collected by rumenocentesis and analyzed for methane and hydrogen concentrations. Feeding 500 ppm of 9,10 anthraquinone to sheep resulted in a decrease (P < 0.07) in the concentration of methane, but an increase (P < 0.05) in hydrogen concentration of ruminal gas throughout the 19 d of feeding. There was no indication of ruminal adaptation throughout this time. These results are the first to show that 9,10 anthraquinone can partially inhibit in vivo rumen methanogenesis, which supports previous in vitro findings. In addition, at the concentrations used in this study, 9,10 anthraquinone was not toxic to ruminants.
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Affiliation(s)
- L Kung
- Department of Animal and Food Sciences, College of Agriculture and Natural Resources, University of Delaware, Newark 19717-1303, USA.
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Smith KA, Ploghaus A, Cowen PJ, McCleery JM, Goodwin GM, Smith S, Tracey I, Matthews PM. Cerebellar responses during anticipation of noxious stimuli in subjects recovered from depression. Functional magnetic resonance imaging study. Br J Psychiatry 2002; 181:411-5. [PMID: 12411267 DOI: 10.1192/bjp.181.5.411] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [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: 11/23/2022]
Abstract
BACKGROUND Subjects recovered from depression have a substantial risk for recurrence of depression, suggesting persistent abnormalities in brain activity. AIMS To test whether women recovered from depression show abnormal brain activity in functional magnetic resonance imaging (fMRI) during a conditioning paradigm with a noxious pain stimulus. METHOD Ten unmedicated women who had recovered from major depression and eight healthy control women each received either noxious hot or non-noxious warm stimuli, the onset of which was signalled by a specific coloured light during 3-tesla echo planar imaging-based fMRI. RESULTS Similar patterns of brain activation were found during painful stimulation for both patients and healthy controls. However, relative to healthy controls, subjects recovered from depression showed a reduced response in the cerebellum during anticipation of the noxious stimulus compared with anticipation of the non-noxious stimulus. CONCLUSIONS Our data suggest that abnormal cerebellar function could be a marker of vulnerability to recurrent depression. This could provide a new target for therapeutic interventions.
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Affiliation(s)
- K A Smith
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
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49
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Murphy FC, Smith KA, Cowen PJ, Robbins TW, Sahakian BJ. The effects of tryptophan depletion on cognitive and affective processing in healthy volunteers. Psychopharmacology (Berl) 2002; 163:42-53. [PMID: 12185399 DOI: 10.1007/s00213-002-1128-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.1] [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] [Received: 11/14/2001] [Accepted: 04/08/2002] [Indexed: 11/26/2022]
Abstract
RATIONALE Cognitive impairment is a common feature of depressive illness. While accumulating evidence suggests that brain serotonin (5-HT) pathways play an important role in the neurobiology of depression, the extent to which altered 5-HT function is responsible for the associated changes in cognition and emotion remains unclear. OBJECTIVE The present study examined the effects of acute dietary depletion of tryptophan (TRP) on cognitive and affective processing in healthy volunteers and explored the putative role of 5-HT in the neuropsychology of depression. METHODS We administered computerised cognitive tests to healthy control participants following ingestion of TRP-free and nutritionally balanced amino acid drinks in a double-blind, placebo-controlled, crossover design. RESULTS The TRP-free amino acid mixture significantly lowered plasma total and free TRP concentrations relative to baseline values and produced selective deficits similar to those observed previously in cases of clinical depression. In particular, TRP depletion increased response times for happy but not sad targets in an affective go/no-go task and slowed responding in a visual discrimination and reversal learning task. These deficits were not due to a global sedative effect, as planning ability was unimpaired. CONCLUSIONS The present data indicate that serotonergic factors may be more involved in the disrupted inhibitory and emotional processing characteristic of depression than in other aspects of executive function, such as planning ability. These findings support the recent proposal that serotonergic manipulation may have greater effects on tasks mediated by frontal circuitry that includes the orbitofrontal cortex than by dorsolateral prefrontal cortex circuitry.
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Affiliation(s)
- F C Murphy
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 2EF, UK
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50
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Abstract
With the advent of highly active anti-retroviral therapy (HAART) in 1997, most investigators felt that HIV infection would be cured with a few years of antiviral therapy. It is now clear that antiviral drugs alone cannot cure the infection, even when applied within a few weeks of initial symptoms. There are now several reports of the discontinuation of HAART after several years of effective suppression of detectable plasma virus. Relapse occurs universally within a few weeks. More promising results have been reported if HAART is initiated early after infection. However, even in this instance, most patients suffer a relapse within a few weeks. If diagnostic treatment interruptions are performed, some individuals appear to control plasma virus concentrations at low levels - <5000 HIV RNA molecules/ml. We have similar results from subjects who were infected chronically before HAART was initiated, so that it is clear that the previous dogma that HIV-specific immune reactivity is absent in individuals who are chronically infected is incorrect. Immune reactivity to HIV does exist, and is detectable in vivo, even when the infection becomes chronic before therapy is initiated. Consequently, we are now faced with a new therapeutic dilemma: how can a cure of this infection be achieved? This review is focused on the rationale and methods to design clinical trials directed towards achieving a cure of HIV infection.
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Affiliation(s)
- K A Smith
- The Division of Immunology, Department of Medicine, Weill Medical College, Cornell University, New York, NY 10021, USA.
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