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Hando BR, Bryant J, Pav V, Haydu L, Hogan K, Mata J, Butler C. Musculoskeletal injuries in US Air Force Tactical Air Control Party trainees: an 11-year longitudinal retrospective cohort study and presentation of a musculoskeletal injury classification matrix. BMJ Mil Health 2023:military-2023-002417. [PMID: 37220991 DOI: 10.1136/military-2023-002417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Little is known of the epidemiology of musculoskeletal injuries (MSKIs) in US Air Force Special Warfare (AFSPECWAR) Tactical Air Control Party trainees. The purpose of this longitudinal retrospective cohort study was to (1) report the incidence and type of MSKI sustained by AFSPECWAR trainees during and up to 1 year following training, (2) identify factors associated with MSKI, and (3) develop and present the MSKI classification matrix used to identify and categorise injuries in this study. METHODS Trainees in the Tactical Air Control Party Apprentice Course between fiscal years 2010-2020 were included. Diagnosis codes were classified as MSKI or non-MSKI using a classification matrix. Incidence rates and incidence proportion for injury types and regions were calculated. Measures were compared for differences between those who did and did not sustain an MSKI during training. A Cox proportional hazards model was used to identify factors associated with MSKI. RESULTS Of the 3242 trainees, 1588 (49%) sustained an MSKI during training and the cohort sustained MSKIs at a rate of 16 MSKI per 100 person-months. Overuse/non-specific lower extremity injuries predominated. Differences were seen in some baseline measures between those who did and did not sustain an MSKI. Factors retained in the final Cox regression model were age, 1.5-mile run times and prior MSKI. CONCLUSION Slower run times and higher age were associated with an increased likelihood of MSKI. Prior MSKI was the strongest predictor of MSKI during training. Trainees sustained MSKIs at a higher rate than graduates in their first year in the career field. The MSKI matrix was effective in identifying and categorising MSKI over a prolonged (12-year) surveillance period and could be useful for future injury surveillance efforts in the military or civilian settings. Findings from this study could inform future injury mitigation efforts in military training environments.
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Affiliation(s)
- Ben R Hando
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - J Bryant
- Human Performance Squadron, Special Warfare Training Wing, US Air Force, San Antonio, Texas, USA
| | - V Pav
- Kennell and Associates Inc, Falls Church, Virginia, USA
| | - L Haydu
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - K Hogan
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
| | - J Mata
- Special Warfare Training Wing, Human Performance Squadron, US Air Force, San Antonio, Texas, USA
| | - C Butler
- Special Warfare Training Wing, Human Performance Squadron, US Air Force Education and Training Command, San Antonio, Texas, USA
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Jonsdottir GM, Kvaran RB, Skarphedinsdottir SJ, Karason S, Krueger D, Coursin DB, Binkley N, Hoofnagle AN, Hogan K, Sigurdsson GH, Sigurdsson MI. Changes in vitamin D metabolites at the time of critical illness and six months later ‐ a prospective observational study. Acta Anaesthesiol Scand 2022; 66:1202-1210. [DOI: 10.1111/aas.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/09/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gudrun Maria Jonsdottir
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
- Department of Anesthesiology and Critical Care Yale New Haven Hospital New Haven CT USA
| | - Runar Bragi Kvaran
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
- Department of Anesthesia and Intensive Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Sigurbjorg Johanna Skarphedinsdottir
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
| | - Sigurbergur Karason
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Diane Krueger
- Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Douglas B. Coursin
- Department of Anesthesiology University of Minnesota Medical School Minneapolis MN USA
| | - Neil Binkley
- Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Kirk Hogan
- Department of Anesthesiology University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Gisli Heimir Sigurdsson
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Martin Ingi Sigurdsson
- Department of Anesthesia and Intensive Care Medicine Operational Services, Landspitali ‐ The National University Hospital of Iceland, Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
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Cottle C, Anbazhagan M, Lipat A, Patel M, Porter AP, Hogan K, Rajan D, Matthews JD, Kugathasan S, Chinnadurai R. Complexity of Secretory Chemokines in Human Intestinal Organoid Cultures Ex Vivo. Gastro Hep Adv 2022; 1:457-460. [PMID: 35634262 PMCID: PMC9141070 DOI: 10.1016/j.gastha.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Cottle
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - M Anbazhagan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia
| | - A Lipat
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - M Patel
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - A P Porter
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - K Hogan
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - D Rajan
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
| | - J D Matthews
- Division of Pediatric Gastroenterology, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia
| | - S Kugathasan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, Georgia
| | - R Chinnadurai
- Department of Biomedical Sciences, Mercer University School of Medicine, Savannah, Georgia
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Jonaitis EM, Zetterberg H, Koscik RL, Betthauser TJ, Van Hulle CA, Hogan K, Hegge L, Kollmorgen G, Suridjan I, Gleason CE, Engelman CD, Okonkwo OC, Asthana S, Bendlin BB, Carlsson CM, Johnson SC, Blennow K. Crosswalk study on blood collection-tube types for Alzheimer's disease biomarkers. Alzheimers Dement (Amst) 2022; 14:e12266. [PMID: 35155728 PMCID: PMC8828996 DOI: 10.1002/dad2.12266] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Blood-based Alzheimer's disease (AD) biomarkers show promise, but pre-analytical protocol differences may pose problems. We examined seven AD blood biomarkers (amyloid beta [A β ] 42 ,A β 40 ,phosphorylated tau [ p - ta u 181 , total tau [t-tau], neurofilament light chain [NfL],A β 42 40 , andp - ta u 181 A β 42 ) in three collection tube types (ethylenediaminetetraacetic acid [EDTA] plasma, heparin plasma, serum). METHODS Plasma and serum were obtained from cerebrospinal fluid or amyloid positron emission tomography-positive and -negative participants (N = 38) in the Wisconsin Registry for Alzheimer's Prevention. We modeled AD biomarker values observed in EDTA plasma versus heparin plasma and serum, and assessed correspondence with brain amyloidosis. RESULTS Results suggested bias due to tube type, but crosswalks are possible for some analytes, with excellent model fit for NfL (R 2 = 0.94), adequate for amyloid (R 2 = 0.40-0.69), and weaker for t-tau (R 2 = 0.04-0.42) andp - ta u 181 (R 2 = 0.22-0.29). Brain amyloidosis differentiated several measures, especially EDTA plasmapTa u 181 A β 42 (d = 1.29). DISCUSSION AD biomarker concentrations vary by tube type. However, correlations for some biomarkers support harmonization across types, suggesting cautious optimism for use in banked blood.
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Affiliation(s)
- Erin M. Jonaitis
- School of Medicine and Public HealthWisconsin Alzheimer's InstituteUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyUniversity of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratoryInstitute of Neuroscience and PhysiologySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyLondonUK
- UK Dementia Research Institute at UCLLondonUK
- Hong Kong Center for Neurodegenerative DiseasesHong KongChina
| | - Rebecca Langhough Koscik
- School of Medicine and Public HealthWisconsin Alzheimer's InstituteUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Tobey J. Betthauser
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Carol A. Van Hulle
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Kirk Hogan
- Department of AnesthesiologySchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Laura Hegge
- School of Medicine and Public HealthWisconsin Alzheimer's InstituteUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | | | | | - Carey E. Gleason
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Corinne D. Engelman
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Department of Population Health SciencesUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Barbara B. Bendlin
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Cynthia M. Carlsson
- School of Medicine and Public HealthWisconsin Alzheimer's InstituteUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Sterling C. Johnson
- School of Medicine and Public HealthWisconsin Alzheimer's InstituteUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin–MadisonMadisonWisconsinUSA
- Geriatric Research Education and Clinical Center of the Wm. S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Kaj Blennow
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologyUniversity of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratoryInstitute of Neuroscience and PhysiologySahlgrenska University HospitalMölndalSweden
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Alhamar M, Ahsan B, Hogan K, Raoufi M. Appendiceal intussusception presenting as a caecal mass. Malays J Pathol 2020; 42:483-486. [PMID: 33361733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The differential diagnosis of caecal mass is broad and the inclusion of appendiceal pathologies is an important element. CASE REPORT We report a 37-year-old woman with recurrent right iliac fossa pain. Computed tomography scan revealed a caecal mass suggesting complete inversion or intussusception of the appendix, which was confirmed by pathologic microscopic examination. This case report discusses appendiceal intussusception with emphasis on diagnosis and treatment options. DISCUSSION Appendiceal intussusception is a rare entity and the complete type typically presents as a polypoid lesion located at the appendiceal orifice in the caecum. It is imperative to include this entity in the differential diagnosis of caecal mass, especially during colonoscopy, as the removal of this polypoid lesion can result in a devastating caecal perforation or haemorrhage.
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Affiliation(s)
- M Alhamar
- Henry Ford Hospital, Department of Pathology and Lab Medicine, Detroit, MI, United State of America.
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Green MA, Miles L, Sage E, Smith J, Carlson G, Hogan K, Bogucki J, Ferenzi L, Hartman E, Tao Y, Peng Y, Roche AI, Bolenbaugh MA, Wienkes C, Garrison Y, Eilers S. Cardiac biomarkers of disordered eating as a function of diagnostic subtypes. Eat Behav 2020; 39:101425. [PMID: 32916550 PMCID: PMC7704766 DOI: 10.1016/j.eatbeh.2020.101425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to identify cardiac biomarkers of disordered eating as a function of diagnostic subtype as assessed via self-report inventory. METHOD Mean heart rate (HR), systolic and diastolic blood pressure, mean R wave amplitude (mV), mean T wave amplitude (mV), QTc interval (sec), Tpeak-Tend interval prolongation (sec), QTc interval prolongation (sec), QRS prolongation (sec), and spectral indicators of cardiac dysfunction (LF/HF spectral ratio, HF spectral power) were assessed via electrocardiography among women with no eating disorder symptoms (n = 32), subclinical eating disorder symptoms (n = 92), anorexia nervosa (n = 7), bulimia nervosa (n = 89), binge eating disorder (BED: n = 20), and other specified feeding and eating disorders (OSFED: n = 19). RESULTS MANOVA results showed statistically significant group differences. Follow-up tests revealed significantly decreased mean R wave amplitude among participants with self-indicated clinical (bulimia nervosa, binge eating disorder) and subclinical forms of disordered eating compared to asymptomatic controls. DISCUSSION Results suggest decreased mean R wave amplitude is a promising cardiac biomarker of disordered eating.
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Affiliation(s)
- M. A. Green
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - L. Miles
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - E. Sage
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - J. Smith
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - G. Carlson
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - K. Hogan
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - J. Bogucki
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - L. Ferenzi
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - E. Hartman
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - Y. Tao
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - Y. Peng
- Cornell College Eating Disorder Institute, Cornell College, 600 First Street SW, Mt. Vernon, IA 52314
| | - A. I. Roche
- University of Iowa, Department of Psychological and Brain Sciences, W311 Seashore Hall, Iowa City, IA 52242
| | - M. A. Bolenbaugh
- University of Iowa, Department of Psychological & Quantitative Foundations, 240 South Madison Street, Iowa City, Iowa 52240
| | - C. Wienkes
- University of Iowa, Department of Psychological & Quantitative Foundations, 240 South Madison Street, Iowa City, Iowa 52240
| | - Y. Garrison
- University of Iowa, Department of Psychological & Quantitative Foundations, 240 South Madison Street, Iowa City, Iowa 52240
| | - S. Eilers
- Mercy Medical Center, 1340 Blairs Ferry Rd NE, Hiawatha, IA 52233
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Arora K, Umar B, Hogan K, Winston-McPherson GN, Copeland JR, Varney R, Shah V, Totten A. Tackling The Challenge Of Opioid Use And Abuse And Treatment Of Chronic Pain Management. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Deaths from opioid overdose increased 12% from 2016 to 2017. This major economic burden cost roughly $78.5 billion in the US. This steep increase in drug overdose deaths can be attributed to increased synthetic opioid abuse. To better understand and reduce opioid abuse amongst patients at Henry Ford Health System, Detroit MI, we sought to collaborate with physicians to manage prescribing, interpret test results, improve patient care, and deliver more value.
Primary Aim: To create a directed pain panel for ordering and interpreting pain management drugs to help providers to better manage patients and to assess compliance from test ordering history to serve patients safely and effectively.
Secondary Aim: To streamline the process of prescribing pain medications and to create a patient centered approach to treat chronic non-cancer patients who actually need opioids, to minimize the risk of abuse, diversion and addiction among patients.
Methods
Plan Do Check Act (PDCA) cycles of process improvement were used to achieve our two aims. In the first cycle, a drug screen-ordering guide was developed to facilitate screening (qualitative) and confirmation (quantitative) ordering practices. As part of this, providers prescribing for chronic pain patients were advised to use drugs of abuse panel rather than our emergency drug screen. In the second cycle, a directed pain panel (DPP) was introduced with reflex to confirmation testing. The DPP led to discovery of unexpected fentanyl positives, which were further investigated.
Results
A survey was conducted to investigate provider-ordering practices, which showed that use of the new drugs of abuse panel rose from 57% to 77%. The DPP was accepted by ~60% of physicians and was frequently reordered in follow-up. Analysis of unexpected fentanyl positivity revealed 30% true positivity, thus identifying unknown patient use. A future PDCA cycle is focused on developing, implementing, and measuring the customer value of a laboratory generated interpretive opioid results report at 5 similar organizations with a goal to assist with test selection and simplify provider interpretation of results.
Conclusion
A future PDCA cycle is focused on developing, implementing, and measuring the customer value of a laboratory generated interpretive opioid results report at 5 similar organizations with a goal to assist with test selection and simplify provider interpretation of results.
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Affiliation(s)
- K Arora
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - B Umar
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - K Hogan
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - G N Winston-McPherson
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - J R Copeland
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - R Varney
- Pathology and laboratory medicine, Henry ford health system, Detroit, Michigan, UNITED STATES
| | - V Shah
- Internal medicine, henry ford health system, Detroit, Michigan, UNITED STATES
| | - A Totten
- Administration, henry ford health system, Detroit, Michigan, UNITED STATES
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Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, Oh ES, Crosby G, Berger M, Eckenhoff RG, Ames D, Chan H, Deiner S, Dijk D, Eriksson L, Galasko D, Hogan K, Inouye S, Lyketsos C, cantonio E, Maruff P, Maze M, Orser B, Ottens T, Price C, Sachdev P, Schenning K, Seiber F, Silverstein J, Steinmetz J, Terrando N, Trzapacz P, Whittington R, Xie Z. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Acta Anaesthesiol Scand 2018; 62:1473-1480. [PMID: 30325016 DOI: 10.1111/aas.13250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
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Affiliation(s)
- Lis Evered
- St Vincent's Hospital Melbourne, Fitzroy Victoria Australia
- University of Melbourne Fitzroy Victoria Australia
| | - Brendan Silbert
- St Vincent's Hospital Melbourne, Fitzroy Victoria Australia
- University of Melbourne Fitzroy Victoria Australia
| | | | - David A. Scott
- St Vincent's Hospital Melbourne, Fitzroy Victoria Australia
- University of Melbourne Fitzroy Victoria Australia
| | - Steven T. DeKosky
- Department of Neurology McKnight Brain Institute University of Florida Gainesville FL USA
| | - Lars S. Rasmussen
- Department of Anaesthesia Center of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Esther S. Oh
- Division of Geriatric Medicine and Gerontology the Johns Hopkins University School of Medicine Baltimore MD USA
| | - Greg Crosby
- Harvard Medical School Brigham & Women's Hospital Boston MA USA
| | - Miles Berger
- Neurologic Outcomes Research Group Anesthesiology Department Duke University Medical Center Durham NC USA
| | - R. G. Eckenhoff
- Department of Anesthesiology and Critical Care University of Pennsylvania School of Medicine Philadelphia PA USA
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Hogan K, Uttamsingh V, Hamilton C, Aslanian A, Brummel C, Braman V, Cassella J, Wong D. 1060 JAK inhibitor CTP-543: Modeled exposure-response profile suggests improved therapeutic window. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1073] [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: 10/17/2022]
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Morlighem M, Williams CN, Rignot E, An L, Arndt JE, Bamber JL, Catania G, Chauché N, Dowdeswell JA, Dorschel B, Fenty I, Hogan K, Howat I, Hubbard A, Jakobsson M, Jordan TM, Kjeldsen KK, Millan R, Mayer L, Mouginot J, Noël BPY, O'Cofaigh C, Palmer S, Rysgaard S, Seroussi H, Siegert MJ, Slabon P, Straneo F, van den Broeke MR, Weinrebe W, Wood M, Zinglersen KB. BedMachine v3: Complete Bed Topography and Ocean Bathymetry Mapping of Greenland From Multibeam Echo Sounding Combined With Mass Conservation. Geophys Res Lett 2017; 44:11051-11061. [PMID: 29263561 PMCID: PMC5726375 DOI: 10.1002/2017gl074954] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 05/11/2023]
Abstract
Greenland's bed topography is a primary control on ice flow, grounding line migration, calving dynamics, and subglacial drainage. Moreover, fjord bathymetry regulates the penetration of warm Atlantic water (AW) that rapidly melts and undercuts Greenland's marine-terminating glaciers. Here we present a new compilation of Greenland bed topography that assimilates seafloor bathymetry and ice thickness data through a mass conservation approach. A new 150 m horizontal resolution bed topography/bathymetric map of Greenland is constructed with seamless transitions at the ice/ocean interface, yielding major improvements over previous data sets, particularly in the marine-terminating sectors of northwest and southeast Greenland. Our map reveals that the total sea level potential of the Greenland ice sheet is 7.42 ± 0.05 m, which is 7 cm greater than previous estimates. Furthermore, it explains recent calving front response of numerous outlet glaciers and reveals new pathways by which AW can access glaciers with marine-based basins, thereby highlighting sectors of Greenland that are most vulnerable to future oceanic forcing.
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Affiliation(s)
- M. Morlighem
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
| | - C. N. Williams
- Bristol Glaciology Centre, School of Geographical SciencesUniversity of BristolBristolUK
- Now at British Geological SurveyNottinghamUK
| | - E. Rignot
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - L. An
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
| | - J. E. Arndt
- Alfred‐Wegener‐Institute, Helmholtz Centre for Polar and Marine ResearchBremerhavenGermany
| | - J. L. Bamber
- Bristol Glaciology Centre, School of Geographical SciencesUniversity of BristolBristolUK
| | - G. Catania
- Institute of GeophysicsUniversity of Texas at AustinAustinTXUSA
| | - N. Chauché
- Department of Geography and Earth ScienceAberystwyth UniversityAberystwythUK
| | - J. A. Dowdeswell
- Scott Polar Research InstituteUniversity of CambridgeCambridgeUK
| | - B. Dorschel
- Alfred‐Wegener‐Institute, Helmholtz Centre for Polar and Marine ResearchBremerhavenGermany
| | - I. Fenty
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - K. Hogan
- British Antarctic SurveyNatural Environment Research CouncilCambridgeUK
| | - I. Howat
- Byrd Polar and Climate Research CenterOhio State UniversityColumbusOHUSA
| | - A. Hubbard
- Department of Geography and Earth ScienceAberystwyth UniversityAberystwythUK
- Centre for Arctic Gas Hydrate, Environment and Climate, Department of GeosciencesUiT The Arctic University of NorwayTromsøNorway
| | - M. Jakobsson
- Department of Geology and GeochemistryStockholm UniversityStockholmSweden
| | - T. M. Jordan
- Bristol Glaciology Centre, School of Geographical SciencesUniversity of BristolBristolUK
| | - K. K. Kjeldsen
- Centre for GeoGenetics, Natural History Museum of DenmarkUniversity of CopenhagenCopenhagenDenmark
- Department of Earth SciencesUniversity of OttawaOttawaOntarioCanada
- Department of Geodesy, DTU Space, National Space InstituteTechnical University of DenmarkKongens LyngbyDenmark
| | - R. Millan
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
| | - L. Mayer
- Center for Coastal and Ocean MappingUniversity of New HampshireDurhamNHUSA
| | - J. Mouginot
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
| | - B. P. Y. Noël
- Institute for Marine and Atmospheric Research UtrechtUtrecht UniversityUtrechtNetherlands
| | - C. O'Cofaigh
- Department of GeographyDurham UniversityDurhamUK
| | - S. Palmer
- College of Life and Environmental SciencesUniversity of ExeterExeterUK
| | - S. Rysgaard
- Centre for Earth Observation Science, Department of Environment and GeographyUniversity of ManitobaWinnipegManitobaCanada
- Greenland Institute of Natural ResourcesNuukGreenland
- Arctic Research CentreAarhus UniversityAarhusDenmark
| | - H. Seroussi
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - M. J. Siegert
- Grantham Institute and Department of Earth Science and EngineeringImperial College LondonLondonUK
| | - P. Slabon
- Alfred‐Wegener‐Institute, Helmholtz Centre for Polar and Marine ResearchBremerhavenGermany
| | - F. Straneo
- Department of Physical OceanographyWoods Hole Oceanographic InstitutionWoods HoleMAUSA
| | - M. R. van den Broeke
- Institute for Marine and Atmospheric Research UtrechtUtrecht UniversityUtrechtNetherlands
| | - W. Weinrebe
- Alfred‐Wegener‐Institute, Helmholtz Centre for Polar and Marine ResearchBremerhavenGermany
| | - M. Wood
- Department of Earth System ScienceUniversity of CaliforniaIrvineCAUSA
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Binkley N, Coursin D, Krueger D, Iglar P, Heiner J, Illgen R, Squire M, Lappe J, Watson P, Hogan K. Surgery alters parameters of vitamin D status and other laboratory results. Osteoporos Int 2017; 28:1013-1020. [PMID: 27826645 DOI: 10.1007/s00198-016-3819-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Fracture liaison services often perform laboratory testing, but these results may be altered by surgery. In 40 hip arthroplasty patients, many laboratory parameters of bone health relevance were reduced by 8-22% on the first post-operative day. Laboratory results obtained in the immediate post-surgery interval do not reliably ascertain baseline status. INTRODUCTION As secondary causes of osteoporosis are common, fracture liaison services often perform laboratory testing in the immediate post-fracture interval. We hypothesized that laboratory results obtained shortly after surgery may not accurately ascertain baseline status. If true, such alterations might confound subsequent fracture prevention efforts. METHODS Patients undergoing elective total hip arthroplasty were studied as a surrogate for hip fracture patients. Blood and urine were obtained 2 weeks before surgery, before anesthetic induction, on post-operative day one, and 6 weeks after surgery. Serum total and free 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), calcium, creatinine, albumin (Alb), alkaline phosphatase (ALP), plasma hemoglobin (Hgb) and urinary DBP/creatinine ratio (UDBP/Cr) were measured. RESULTS Forty volunteers (28 women; 12 men) with mean age of 65.7 [8.7] years were studied. Laboratory results were stable from 2 weeks before to the day of surgery. On the first day after surgery, total 25(OH)D, DBP, calcium, creatinine, ALP, and Alb declined 8-22% (p < 0.0001); free 25(OH)D and Hgb declined by 8 and 15% (p < 0.01), respectively; and UDBP/Cr increased 32% (p < 0.01). Using a 25(OH)D <30 ng/mL threshold, vitamin D inadequacy prevalence increased from 38% before surgery to 68% the day after (p < 0.001). All laboratory values returned to baseline at 6 weeks after surgery. CONCLUSIONS Laboratory values are reduced immediately following elective total hip arthroplasty. Testing at that time does not accurately ascertain baseline status and may lead to elevated estimates of vitamin D inadequacy, incorrect interventions, and misallocation of healthcare resources.
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Affiliation(s)
- N Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Ave, Madison, WI, 53705, USA.
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - D Coursin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - D Krueger
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Ave, Madison, WI, 53705, USA
| | - P Iglar
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 707 WARF Building, 610 North Walnut Street, Madison, WI, 53726, USA
| | - J Heiner
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - R Illgen
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - M Squire
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - J Lappe
- Creighton University Osteoporosis Research Center, 601 N. 30th Street, Suite 4820, Omaha, NE, 68131, USA
| | - P Watson
- Creighton University Osteoporosis Research Center, 601 N. 30th Street, Suite 4820, Omaha, NE, 68131, USA
| | - K Hogan
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
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Williams HE, Woodworth JC, DeRouchey JM, Dritz SS, Tokach MD, Hogan K, Webster SR. 302 Evaluation of Elarom SES in nursery pig diets with or without the inclusion of high zinc oxide or feed antimicrobials. J Anim Sci 2017. [DOI: 10.2527/asasmw.2017.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Denlinger LC, Schell K, Angelini G, Green D, Guadarrama A, Prabhu U, Coursin DB, Hogan K, Bertics PJ. A novel assay to detect nucleotide receptor P2X7 genetic polymorphisms influencing numerous innate immune functions. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/09680519040100020101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The importance of accessory signaling pathways amplifying endotoxin responses has recently been highlighted by genetic studies describing LPS-hyporesponsive individuals despite carrying the common allele for TLR4. The nucleotide receptor P2X7 modulates the production of numerous LPS-stimulated inflammatory mediators. We have recently described the largest phenotypic screen known for genetic polymorphisms associated with the nucleotide receptor P2X7, a global regulator of leukocyte function. This required the development of a novel monocyte pore assay with numerous advantages over previous methods and with the potential to facilitate rapid (< 3 h), multiplex analysis of clinical samples. This paper addresses aspects pertinent to the development of the monocyte pore assay, briefly summarizes our results suggestingthat P2X7 alleles modulate LPSstimulated cytokine production, and discusses a model wherein P2X7 may serve as an amplification loop of innate immunity.
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Affiliation(s)
- Loren C. Denlinger
- Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA, , Department of Biomolecular Chemistry, University of Wisconsin Medical School, Madison Wisconsin, USA
| | - Kathleen Schell
- Comprehensive Cancer Center, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Giuditta Angelini
- Department of Anesthesiology, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Dawn Green
- Department of Anesthesiology, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Arturo Guadarrama
- Department of Biomolecular Chemistry, University of Wisconsin Medical School, Madison Wisconsin, USA
| | - Usha Prabhu
- Department of Biomolecular Chemistry, University of Wisconsin Medical School, Madison Wisconsin, USA
| | - Douglas B. Coursin
- Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA, Department of Anesthesiology, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Kirk Hogan
- Department of Anesthesiology, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | - Paul J. Bertics
- Department of Biomolecular Chemistry, University of Wisconsin Medical School, Madison Wisconsin, USA, Comprehensive Cancer Center, University of Wisconsin Medical School, Madison, Wisconsin, USA
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Baenke F, Chaneton B, Smith M, Van Den Broek N, Hogan K, Tang H, Viros A, Dhomen N, Gottlieb E, Marais R. Metabolic rewiring in melanoma cell lines that acquired resistance to BRAF inhibitors. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61190-5] [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: 10/21/2022]
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Viriós A, Pedersen M, Furney S, Girotti M, Hogan K, Saturno G, Galvani E, Sanchez-Laorden B, Ng C, Reis-Filho J, Lorigan P, Cook M, Marais R. Gene-specific interactions between ultraviolet radiation and melanoma. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61187-5] [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: 10/21/2022]
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Vierow K, Hogan K, Metzroth K, Aldemir T. Application of dynamic probabilistic risk assessment techniques for uncertainty quantification in generation IV reactors. Progress in Nuclear Energy 2014. [DOI: 10.1016/j.pnucene.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Maring E, Raspanti G, Jaschek G, Hogan K, Farmer C, Lovell D, Grutzmacher S, Parikh P, Olcese S. Engineering and public health: An interdisciplinary approach to
addressing water quality in Compone, Peru. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.200] [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: 11/29/2022] Open
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18
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Demeule-Hayes M, Hogan K, Winters M, Getzoff E, Parrish J, Rogers V, Scheimann A. Dietary Intake Quality Improvements after Participation in a Multi-Disciplinary Pediatric Weight Management Program. J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hogan K, Herman A, Nicholson S, Matteucci P. Late extrusion of a temporomandibular joint prosthesis masquerading as a sebaceous cyst. J Plast Reconstr Aesthet Surg 2013; 66:e313-4. [PMID: 23664576 DOI: 10.1016/j.bjps.2013.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
Abstract
Complications of temporomandibular joint prostheses are not uncommon and have been well documented. We report a very late and rare complication following silastic TMJ replacement, believed to be the first implant extrusion through healthy skin. We are reminded that these implants can still cause problems to patients many years after initial surgery.
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Affiliation(s)
- K Hogan
- Department of Plastic Surgery, Castle Hill Hospital, Castle Road, Cottingham, Hull, East Yorkshire HU16 5JQ, UK
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20
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Frers LG, Hepburn J, Hogan K, Parminter C, Mc Gowan L, Vishwanath R, Beaumont S, McDonald R. 269 THE USE OF A NEW EXTENDER FOR STORING FRESH BOVINE SEMEN FOR LONG PERIODS. Reprod Fertil Dev 2010. [DOI: 10.1071/rdv22n1ab269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Processing bovine semen in fresh long life extender for use over 3 to 4 days after collection is a widely used technique in New Zealand (Shannon and Vishwanath 1995 Anim. Reprod. Sci. 39, 1-10). Advantages include greater use of valuable sires, transport without liquid nitrogen, and the possibility of more efficient use of sexed sorted semen. The new extender (Ext. A) also has the advantage of containing no egg yolk. This study compares this new long-life extender (Ext. A) with an existing product (Ext. B) and frozen/thawed semen. Semen from 12 different bulls was diluted to a concentration of 8 × 106 mL-1 and gradually cooled to 16°C. All samples were held at ambient temperature in the dark and motility was evaluated over a storage period of 4 days comparing the extenders. In this part of the trial Ext. A maintained motility better than Ext. B (P = 0.001) during the 4-day storage period (24 h: 90 v. 70%; 96 h: 85 v. 50%). The second part of the trial compared the conception rates (CR) in cows from the use of fresh long-term-extended semen and frozen/thawed semen. On 19 farms, 8546 cows were inseminated with fresh semen stored for 1 to 3 days and 7280 cows were inseminated with frozen semen. The overall CR at 7 to 8 weeks for the 19 farms was 73.7%. On 18 farms within the same farming group, 8498 cows received frozen semen and the CR was 71.1%. Pregnancy results were 2.6% (P = 0.001) higher CR at scanning in herds where fresh semen was used compared with the farms where only frozen/thawed semen was used (73.7 v. 71.1%). In the third part of the trial, semen from 4 different bulls were extended to 1 × 106 mL-1 in Ext. A and held at ambient temperature for 6 days prior to use for IVF. Our lab standard frozen/thawed bull semen was used as a control. Table 1 shows that semen held at ambient temperature in Ext. A for 6 days produced a similar percentage of transferable quality embryos to our IVP control frozen/thawed semen (26.9 v. 25.7%). We conclude that preserved bovine semen in fresh long-life extender for several days offers some advantages in AI and IVP programs compared with frozen semen.
Table 1.Fresh semen extender (Ext.A) compared with frozen semen in IVP
We appreciate the assistance of Liberty Genetics Ltd.
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Denlinger LC, Shi L, Guadarrama A, Schell K, Green D, Morrin A, Hogan K, Sorkness RL, Busse WW, Gern JE. Attenuated P2X7 pore function as a risk factor for virus-induced loss of asthma control. Am J Respir Crit Care Med 2008; 179:265-70. [PMID: 19201928 DOI: 10.1164/rccm.200802-293oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Upper respiratory tract infection is a guideline accepted risk domain for the loss of asthma control. The ionotrophic nucleotide receptor P2X(7) regulates compartmentalized acute inflammation and the immune response to airway pathogens. OBJECTIVES We hypothesized that variability in P2X(7) function contributes to neutrophilic airway inflammation during a cold and thereby is linked to acute asthma. METHODS Research volunteers with asthma were enrolled at the onset of a naturally occurring cold and monitored through convalescence, assessing symptoms, lung function, and airway inflammation. P2X(7) pore activity in whole blood samples was measured using a genomically validated flow cytometric assay. MEASUREMENTS AND MAIN RESULTS Thirty-five participants with mild to moderate allergic asthma were enrolled and 31 completed all visits. P2X(7) pore function correlated with the change in nasal lavage neutrophil counts during the cold (R(s) = 0.514, P = 0.004) and was inversely related to the change in asthma symptoms (R(s) = -0.486, P = 0.009). The change in peak expiratory flow recordings, precold use of inhaled corticosteroids, and P2X(7) pore function were multivariate predictors of asthma symptoms (P = 0.001, < 0.001 and = 0.003 respectively). Attenuated P2X(7) activity was associated with the risk of losing asthma control (crude odds ratio, 11.0; 95% confidence interval, 1.1-106.4) even after adjustment for inhaled corticosteroids and rhinovirus (odds ratio, 15.0). CONCLUSIONS A whole blood P2X(7) pore assay robustly identifies participants with loss-of-function genotypes. Using this assay as an epidemiologic tool, attenuated P2X(7) pore activity may be a novel biomarker of virus-induced loss of asthma control.
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Affiliation(s)
- Loren C Denlinger
- Section of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, P.O. Box 9988, Madison, WI 53792, USA.
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Padiath QS, Saigoh K, Schiffmann R, Asahara H, Yamada T, Koeppen A, Hogan K, Ptáček LJ, Fu YH. Erratum: Corrigendum: Lamin B1 duplications cause autosomal dominant leukodystrophy. Nat Genet 2007. [DOI: 10.1038/ng0207-276c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hogan K, Markos F. Muscarinic type 1 receptors mediate part of nitric oxide’s vagal facilitatory effect in the isolated innervated rat right atrium. Nitric Oxide 2007; 16:110-7. [PMID: 16843016 DOI: 10.1016/j.niox.2006.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 05/08/2006] [Accepted: 05/31/2006] [Indexed: 11/26/2022]
Abstract
We investigated whether vagal cardiac cholinergic facilitation by nitric oxide (NO) is mediated by cardiac muscarinic receptor subtypes in the vagally innervated rat right atrium in vitro. Experiments were carried out in the presence of atenolol (4 microM). The right vagus was stimulated at 4, 8, 16, 32 Hz; pulse duration 1 ms at 20 V for 20s; vagal postganglionic activation was achieved using nicotine (0.1, 0.3, 0.5, 1mM) and the effect on cardiac interval (ms) assessed. Pirenzepine (1 microM), a M1 antagonist, attenuated vagally induced increase in cardiac interval. L-Arginine (0.34 mM) superfused with pirenzepine failed to reverse this attenuation, however, L-arginine applied alone reversed the reduction vagal cardiac slowing. Similarly, sodium nitroprusside (10 microM) applied alone, and not together with pirenzepine, was able to reverse the attenuation of vagal effects caused by pirenzepine. Synthetic MT7 (1 nM) toxin, a selective M1 antagonist confirmed these results. M3 antagonism using para-fluorohexahydrosiladifenidol (p-F-HHSiD) (300 nM) and M4 antagonism with PD 102807 (200 nM) did not affect the vagally induced increase in cardiac interval. Nicotine induced increase in cardiac interval was not altered by pirenzepine. These results show that antagonism of M1 receptors on cardiac vagal preganglionic fibres reduces vagal efficacy which can be recovered by either a nitric oxide synthase substrate or a NO donor.
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Affiliation(s)
- K Hogan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
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Abstract
BACKGROUND Previous research has shown the safety of procedural sedation in the emergency department in university settings involving multiple emergency physicians. OBJECTIVE To examine sedation in the emergency department conducted by a single emergency physician with monitoring by the emergency nurse. METHODS The Procedural Sedation in the Community Emergency Department Registry is a prospective observational database of procedural sedation cases directed by the emergency physicians. Among other parameters, the registry tracts whether emergency physicians or emergency nurses monitored patient sedation. The incidence of complications and outcomes were compared between these two monitoring groups. RESULTS 1028 procedural sedations were performed on 977 patients at 14 sites. In 885 (86.1%) cases the emergency physician directed the sedation, and performed the procedure with monitoring by the emergency nurse. Complications occurred in 42 (4.1%) patients, 35 (4.0%) EN monitored patients and 6 (4.2%) EP monitored patients (p>0.7). Procedures were successful in 863 (97.5%) cases monitored by emergency nurses and in 140 (97.9%) patients monitored by emergency physicians (p>0.7). CONCLUSION Procedural sedation in the emergency department performed by a single emergency physician is safe and effective.
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Affiliation(s)
- K Hogan
- Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, New Jersey, USA
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Padiath QS, Saigoh K, Schiffmann R, Asahara H, Yamada T, Koeppen A, Hogan K, Ptácek LJ, Fu YH. Lamin B1 duplications cause autosomal dominant leukodystrophy. Nat Genet 2006; 38:1114-23. [PMID: 16951681 DOI: 10.1038/ng1872] [Citation(s) in RCA: 291] [Impact Index Per Article: 16.2] [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: 05/12/2006] [Accepted: 07/31/2006] [Indexed: 01/02/2023]
Abstract
Adult-onset autosomal dominant leukodystrophy (ADLD) is a slowly progressive neurological disorder characterized by symmetrical widespread myelin loss in the central nervous system, with a phenotype similar to chronic progressive multiple sclerosis. In this study, we identify a genomic duplication that causes ADLD. Affected individuals carry an extra copy of the gene for the nuclear laminar protein lamin B1, resulting in increased gene dosage in brain tissue from individuals with ADLD. Increased expression of lamin B1 in Drosophila melanogaster resulted in a degenerative phenotype. In addition, an abnormal nuclear morphology was apparent when cultured cells overexpressed this protein. This is the first human disease attributable to mutations in the gene encoding lamin B1. Antibodies to lamin B are found in individuals with autoimmune diseases, and it is also an antigen recognized by a monoclonal antibody raised against plaques from brains of individuals with multiple sclerosis. This raises the possibility that lamin B may be a link to the autoimmune attack that occurs in multiple sclerosis.
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Affiliation(s)
- Quasar S Padiath
- Department of Neurology, University of California, San Francisco, San Francisco, California 94158, USA
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Hogan K, Markos F. Vasoactive intestinal polypeptide receptor antagonism enhances the vagally induced increase in cardiac interval of the rat atrium in vitro. Exp Physiol 2006; 91:641-6. [PMID: 16527861 DOI: 10.1113/expphysiol.2006.033605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effect of vasoactive intestinal polypeptide (VIP) receptor antagonism on preganglionic vagal electrical stimulation and on vagal postganglionic activation using nicotine and 1,1-dimethyl-4-phenylpiperazinium iodide on cardiac interval was evaluated in the isolated innervated rat right atrium. The vagus was stimulated at 4, 8, 16 and 32 Hz, pulse duration 1 ms, 20 V, for 30 s. All experiments were carried out in the presence of atenolol (4 microM). Vagal stimulation caused a frequency-dependent increase in cardiac interval which was amplified significantly at each frequency, except at 32 Hz, following application of the VIP receptor antagonist VIP(6-28) at 2 nM in 15 rats. Application of the ganglionic antagonist hexmethonium (28 microM, n = 7 rats) prior to 2 nM VIP(6-28) abolished this effect. Increasing the concentration of VIP(6-28) 10-fold to 20 nM did not result in a greater increase in cardiac interval than that obtained at 2 nM. Nicotine (0.1, 0.3, 0.5, 1.0 and 2.0 mM) increased cardiac interval by direct activation of postganglionic vagal fibres, but 2 nM VIP(6-28) did not affect the nicotine concentration response (n = 6 rats). 1,1-Dimethyl-4-phenylpiperazinium iodide (25, 50, 100 and 200 microM; n = 6 rats) was also used to induce an increase in cardiac interval; again it was not significantly altered by 2 nM VIP(6-28). Therefore, VIP receptor antagonism enhances the magnitude of vagally induced cardiac slowing, probably via an action at the preganglionic-postganglionic synapse.
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Affiliation(s)
- K Hogan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
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29
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Hogan K, Markos F. An Investigation into the Presence of a Vagal Tachycardia and the Effect of Vasoactive Intestinal Polypeptide on Rat Heart Rate in vitro. Pharmacology 2006; 76:101-4. [PMID: 16374072 DOI: 10.1159/000090500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 11/11/2005] [Indexed: 11/19/2022]
Abstract
The presence of the vagal tachycardia and the effect of vasoactive intestinal polypeptide in the isolated innervated rat atrium were investigated. The right vagus, or cardiac branch, were stimulated at 4, 8, 16 and 32 Hz, pulse duration 1 ms, 20 V, 30 s before atropine and for 1 min after atropine (3 micromol/l), experiments were carried out in the presence of atenolol (4 micromol/l). No significant vagal tachycardia was observed in the presence of atropine, the greatest increase in heart rate was at 16 Hz which was 3+/-1 beats/min (n = 12 rats) (p = 0.052). Baseline heart rates for the control, 226+/-11 beats/min (n = 12 rats) and atropine experiments, 210+/-8 beats/min (n = 12 rats), were not significantly different (p = 0.24). VIP (0.06, 0.12, 0.24 micromol/l) caused a maximum increase of 27+/-13 beats/min (n = 5 rats) after 6 micromol/l VIP which was not significant, two higher concentrations of VIP failed to increase heart rate further. These results show that the vagal tachycardia is not present and that VIP does not cause a significant tachycardia in the rat.
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Affiliation(s)
- K Hogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin 2, Ireland
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Denlinger LC, Schell K, Angelini G, Green D, Guadarrama A, Prabhu U, Coursin DB, Hogan K, Bertics PJ. A novel assay to detect nucleotide receptor P2X7 genetic polymorphisms influencing numerous innate immune functions. ACTA ACUST UNITED AC 2004; 10:137-42. [PMID: 15120006 DOI: 10.1179/096805104225004040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The importance of accessory signaling pathways amplifying endotoxin responses has recently been highlighted by genetic studies describing LPS-hyporesponsive individuals despite carrying the common allele for TLR4. The nucleotide receptor P2X7 modulates the production of numerous LPS-stimulated inflammatory mediators. We have recently described the largest phenotypic screen known for genetic polymorphisms associated with the nucleotide receptor P2X7, a global regulator of leukocyte function. This required the development of a novel monocyte pore assay with numerous advantages over previous methods and with the potential to facilitate rapid (< 3 h), multiplex analysis of clinical samples. This paper addresses aspects pertinent to the development of the monocyte pore assay, briefly summarizes our results suggesting that P2X7 alleles modulate LPS-stimulated cytokine production, and discusses a model wherein P2X7 may serve as an amplification loop of innate immunity.
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Affiliation(s)
- Loren C Denlinger
- Departments of Medicine and Biomolecular Chemistry, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA.
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Erskine FF, Ellis JR, Ellis KA, Stuber E, Hogan K, Miller V, Moore E, Bartholomeusz C, Harrison BJ, Lee B, Phan KL, Liley D, Nathan PJ. Evidence for synergistic modulation of early information processing by nicotinic and muscarinic receptors in humans. Hum Psychopharmacol 2004; 19:503-9. [PMID: 15378678 DOI: 10.1002/hup.613] [Citation(s) in RCA: 27] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Impairments in early information processing are a hallmark feature of diverse neuropsychiatric disorders including schizophrenia and Alzheimer's disease (AD). Several lines of evidence implicate a dysfunction of the cholinergic system in these disorders, particularly in AD where there is known degeneration in major cholinergic pathways. Inspection time (IT), a measure of early visual information processing speed, has been shown to be sensitive to cholinergic manipulation. The current study employed the IT task to (1) examine the independent roles of nicotinic and muscarinic receptors in modulating information processing and (2) investigate the interaction of nicotinic and muscarinic receptor systems in modulating information processing. Twelve healthy participants completed a randomized, double-blind, placebo-controlled study under four drug conditions; (1) placebo, (2) mecamylamine (15 mg; oral), (3) scopolamine (0.4 mg, s.c.), (4) mecamylamine (15 mg) + scopolamine (0.4 mg). IT measures were examined at baseline and 2.5 h post drug administration. Selective blockade of nicotinic receptors with mecamylamine did not significantly impair IT, whereas selective blockade of muscarinic receptors with scopolamine produced a significant but small impairment in IT. Combined blockade of both receptor types with scopolamine and mecamylamine produced a large impairment in IT performance. The results indicate that both nicotinic and muscarinic receptors are involved in modulating IT, and that the two systems may function synergistically to modulate early visual information processing. These findings suggest that functional abnormalities in both nicotinic and muscarinic systems may underlie deficits in early visual information processing seen in disorders such as Alzheimer's disease and schizophrenia.
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Affiliation(s)
- F F Erskine
- Neuropsychopharmacology Laboratory, Brain Sciences Institute, Swinburne University, Melbourne, Australia
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Hesse LM, He P, Krishnaswamy S, Hao Q, Hogan K, von Moltke LL, Greenblatt DJ, Court MH. Pharmacogenetic determinants of interindividual variability in bupropion hydroxylation by cytochrome P450 2B6 in human liver microsomes. ACTA ACUST UNITED AC 2004; 14:225-38. [PMID: 15083067 DOI: 10.1097/00008571-200404000-00002] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [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] [Indexed: 11/25/2022]
Abstract
Bupropion is primarily metabolized in human liver by cytochrome P450 (CYP) 2B6, an isoform that shows high interindividual variability in expression and catalysis. The aim of this study was to identify mechanisms underlying this variability through comprehensive phenotype-genotype analysis of a well-characterized human liver bank (n = 54). There was substantial variability in microsomal bupropion hydroxylation activities (over 45-fold) and CYP2B6 protein content (over 288-fold), with excellent correlation between protein and activity values (rs = 0.88). CYP2B6 mRNA levels showed less variability (13-fold) and poorer correlation (rs = 0.44) to CYP2B6 protein resulting from 20-30% of livers that contained substantial CYP2B6 mRNA, but low CYP2B6 protein. Livers were genotyped for the common coding polymorphisms (Q172H, K262R and R487C) and 14 additional variations identified by sequencing of the gene promoter to -3000 bp. Of 14 haplotypes that were inferred, *1A (reference), *1H (-2320t>c; -750t>c) and *6B (-1456t>c; -750t>c; Q172H; K262R) were most common with frequencies of 0.28, 0.20 and 0.26, respectively. Alcohol use history (P = 0.011) and *6B haplotype (P = 0.011) were identified as significant predictors of bupropion hydroxylation. A consideration of the effects of these variables on CYP2B6 mRNA and protein levels suggests that alcohol use is associated with enhanced CYP2B6 gene transcription, but the presence of at least one *6B allele reduces this effect on bupropion hydroxylation at the post-transcriptional level. In conclusion, the results of this study indicate that interindividual variability in bupropion hydroxylation is a consequence of interactions between environmental and genetic influences on CYP2B6 gene function.
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Affiliation(s)
- Leah M Hesse
- Clinical Pharmacology Laboratory, Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
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Affiliation(s)
- Rebecca R Selzer
- Department of Anesthesiology, University of Wisconsin Medical School, Madison, USA
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Nevilie M, Selzer R, Aizenstein B, Maguire M, Hogan K, Walton R, Welsh K, Neri B, de Arruda M. Characterization of cytochrome P450 2D6 alleles using the Invader system. Biotechniques 2002; Suppl:34-8, 40-3. [PMID: 12083395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The cytochrome p450 (CYP) superfamily comprises enzymes that play an essential role in the transformation of medically relevant compounds. Accurate genotyping of polymorphisms in members of this family is drawing increasing interest because certain allelic variants may result in either loss of efficacy or toxic accumulation of therapeutic agents. Debrisoquine 4-hydroxylase, or CYP2D6, is among the most widely studied of the CYPs. The complexity of the CYP2D6 genomic region, including pseudogenes, gene deletions, and gene duplications, has offered numerous challenges to developing a genotyping strategy. We describe a comprehensive CYP2D6 genotyping strategy that employs both a PCR/Invader genotyping assay system and an Invader genomic copy number assay The Invader system is a homogeneous, isothermal, highly specific, and robust signal amplification system. Resultsfrom II CYP2D6 assays in an alle frequency study compare well to published allele frequency values for Caucasians. Further, Invader assays provided unambiguous genotyping determinations for 100% of the 171 samples that yielded a visible PCR product on an agarose gel. A copy number assay yielded only one equivocal result in 205 samples. We identified 17 single-copy individuals and 17 three-copy (or more) individuals.
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Affiliation(s)
- Matt Nevilie
- Third Wave Technologies, Madison, WI 53719-1256, USA
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Roberts MC, Mickelson JR, Patterson EE, Nelson TE, Armstrong PJ, Brunson DB, Hogan K. Autosomal dominant canine malignant hyperthermia is caused by a mutation in the gene encoding the skeletal muscle calcium release channel (RYR1). Anesthesiology 2001; 95:716-25. [PMID: 11575546 DOI: 10.1097/00000542-200109000-00026] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Malignant hyperthermia (MH) is an inherited disorder of skeletal muscle characterized by hypercarbia, rhabdomyolysis, generalized skeletal muscle contracture, cardiac dysrhythmia, and renal failure, that develops on exposure to succinylcholine or volatile anesthetic agents. All swine and up to 50% of human MH events are thought to be associated with mutations in the calcium release channel of the sarcoplasmic reticulum, also known as the ryanodine receptor (RYR1). Events resembling MH have been reported in other species, but none have undergone genetic investigation to date. METHODS To determine the molecular basis of canine MH, a breeding colony was established with a male, mixed-breed, MH-susceptible (MHS) dog that survived an in vivo halothane-succinylcholine challenge. He was mated to three unaffected females to produce four litters and back-crossed to an affected daughter to produce one litter. One of his MHS sons was mated to an unaffected female to produce an additional litter. Forty-seven dogs were phenotyped with an in vitro contracture test and diagnosed as MHS or MH normal based on the North American in vitro contracture test protocol. Nine microsatellite markers in the vicinity of RYR1 on canine chromosome 1 (CFA01) were tested for linkage to the MHS phenotype. Mutational analysis in two MHS and two MH-normal dogs was performed with direct sequencing of polymerase chain reaction products and of cloned fragments that represent frequently mutated human RYR1 regions. A restriction fragment length polymorphism was chosen to detect the candidate mutation in the pedigree at large. RESULTS Pedigree inspection revealed that MHS in this colony is transmitted as an autosomal dominant trait. FH2294, the marker closest to RYR1, is linked to MHS at a theta = 0.03 with a LOD score of 9.24. A T1640C mutation gives rise to an alanine for valine substitution of amino acid 547 in the RYR1 protein, generating a maximum LOD score of 12.29 at theta = 0.00. All dogs diagnosed as MHS by in vitro contracture test were heterozygous for the mutation, and all MH-normal dogs were homozygous for the T1640 allele. CONCLUSIONS These results indicate that autosomal dominant canine MH is caused by a mutation in the gene encoding the skeletal muscle calcium release channel and that the MHS trait in this pedigree of mixed-breed dogs is in perfect cosegregation with the RYR1 V547A mutation.
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Affiliation(s)
- M C Roberts
- Department of Veterinary Pathobiology, University of Minnesota, Minneapolis, USA
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Stewart SL, Hogan K, Rosenberg H, Fletcher JE. Identification of the Arg1086His mutation in the alpha subunit of the voltage-dependent calcium channel (CACNA1S) in a North American family with malignant hyperthermia. Clin Genet 2001; 59:178-84. [PMID: 11260227 DOI: 10.1034/j.1399-0004.2001.590306.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [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: 11/23/2022]
Abstract
Individuals from a large North American population were screened for the presence of the mutation in the alpha1 subunit of the voltage-dependent calcium channel (CACNA1S) that has recently been associated with malignant hyperthermia (MH). This Arg1086His mutation was screened for in 154 MH normal (MHN) individuals and 112 MH susceptible (MHS) individuals, who were diagnosed by the North American protocol of the in vitro contracture test. PCR and restriction enzyme analysis was used to test for the mutation. The Arg1086His mutation in the CACNA1S was not found in any of the MHN individuals. In contrast, two related individuals (grandfather and grandson, father and son of the MH proband) among the MHS group exhibited this mutation. However, a third MHS individual in the same family (granddaughter, cousin of the grandson) did not exhibit this mutation. These results indicate that this mutation may be associated with MH in this family. Genetic alterations in the CACNA1S associated with MH are present in approximately 1% of this North American MHS population.
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Affiliation(s)
- S L Stewart
- Department of Oncology, Georgetown University, Washington, DC 20007, USA.
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Hogan K, Orme S. Psychiatric home treatment. Treatment at home is nationwide and successful. BMJ 2000; 321:178. [PMID: 10950549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
In 1981 the Commonwealth Government established the Australian Institute of Sport (AIS). The Australian Sports Commission (ASC) which administers the AIS has 2 objectives: (1) excellence in sports performances; and (2) increased participation in sports and sports activities. State-based institutes of sport have also been established with the same or very similar objectives. Federal policy directs the bulk of the ASC budget to elite athlete programs. A smaller proportion goes towards community participation. The official reason is based on the notion of the 'trickle-down' or 'demonstration' effect. That is, a flow-on of benefits to the broader community in the form of increased participation as a direct result of elite sports success. The aims of this study were to determine the (1) spending pattern to elite sports programs for the 5 Olympics 1976/77 to 1995/96, (2) evidence for the two ASC objectives having been met, and (3) expected medal tally at the 2000 Olympic Games. Results show funding (in 1998 dollars), has accelerated from about $1.2 million (1976/77) to $106 million in (1997/98), particularly since the Games were awarded to Sydney. The total amount spent on elite athletes was $0.918 billion. In the period 1980-96 Australia won 25 gold and 115 total Olympic medals. This equates to approximately $37 million per gold and $8 million per medal in general. There was a significant linear relationship between money spent and total medals won. This was also found when all medal types were analysed independently. The predicted medal tally in 2000 (based on the cost per medal and the expenditure towards Sydney) indicates the medal count will be about 14+/-1 gold, 15+/-2 silver and 33+/-4 bronze. Based on our nation's record of international sporting achievement, there is little doubt we have fulfilled the ASC's first objective. Current data on physical activity patterns of Australians suggest the second objective has not been met. Focusing attention on and achieving the first objective does not appear to have any bearing on the second objective. It is time to revisit the notion that elite sporting success leads to greater mass participation as a result of the so-called 'trickle-down' effect.
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Affiliation(s)
- K Hogan
- School of Physical Education, Exercise and Sport Studies, University of South Australia
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Hogan K, Laravuso RB. Is the system at fault, or its players? Anesthesiology 2000; 92:1494-5. [PMID: 10781302 DOI: 10.1097/00000542-200005000-00049] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Data from the Functional Independence Measure (FIM) are important outcome measures in the stroke population undergoing rehabilitation. The FIM consists of 18 scales scored from 1 to 7; higher numbers mean greater ability. Several different scores can be obtained from the FIM: a total score (sum of all the scales), individual scale scores, and a physical and cognitive score (a two-dimensional interpretation). Research has shown that FIM data can have multidimensional components. That implies different groupings of scales may exist and with this the possibility of developing more sophisticated and robust measures within stroke populations. This study examined the multidimensional aspects of FIM using an urban sample of ischemic and hemorrhagic stroke patients. We found a three-dimensional FIM solution for both stroke groups that included self-care, cognitive function, and toileting as the major grouping of scales. These findings confirm a multidimensional nature of FIM scores and show a condition-specific pattern of FIM scores in stroke patients. This knowledge will help nurses, clinicians, and researchers develop more sensitive ways of recording care outcomes; improved prediction of stroke outcomes may also emerge from this knowledge.
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Affiliation(s)
- S J Cavanagh
- College of Nursing, Wayne State University, Detroit, MI 48201, USA.
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Abstract
The structure of the gene encoding the human brain beta1 subunit of voltage dependent calcium channels (CACNB1) was determined by comparison of its genomic sequence with beta1 cDNA sequence. CACNB1 is distributed over 25 kb and contains 13 exons. Alternative splicing of CACNB1 RNA occurs within the central domain at exon 7, and the 3' domain at exon 13, producing the variably expressed beta1a, beta1b and beta1c isoforms. Exon/intron boundaries and exon lengths are conserved for the nine exons shared by the beta1 and related brain beta3 and beta4 genes.
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Affiliation(s)
- K Hogan
- Department of Anesthesiology, University of Wisconsin, Madison 53792, USA.
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Zaragoza L, Hogan K. The integrated exposure uptake biokinetic model for lead in children: independent validation and verification. Environ Health Perspect 1998; 106 Suppl 6:1551-6. [PMID: 9860914 PMCID: PMC1533463 DOI: 10.1289/ehp.98106s61551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The U.S. Environmental Protection Agency employs a model, the integrated exposure biokinetic (IEUBK) model for lead in children, for the assessment of risks to children posed by environmental lead at hazardous waste sites. This paper describes results of an effort to verify the consistency of the documentation with the computer model and to test the computer code using a group that is independent from those involved in the model development. This review concluded that the IEUBK model correctly calculates the equations specified in the IEUBK model theory documentation. However, several issues were identified on model documentation, model performance, and the C++ programming language code (i.e., IEUBK model source code) documentation. These issues affect the ability of an independent reviewer to understand the workings of the IEUBK model but not the model's reliability. As a result of these findings, recommendations have been provided for updating documentation to the model as well as associated adjustments to the model documentation.
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Affiliation(s)
- L Zaragoza
- Office of Solid Waste and Emergency Response, U.S. Environmental Protection Agency, Washington, DC 20460, USA.
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Hogan K, Marcus A, Smith R, White P. Integrated exposure uptake biokinetic model for lead in children: empirical comparisons with epidemiologic data. Environ Health Perspect 1998; 106 Suppl 6:1557-67. [PMID: 9860915 PMCID: PMC1533426 DOI: 10.1289/ehp.98106s61557] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The concept of model validation is evolving in the scientific community. This paper addresses the comparison of observed and predicted estimates as one component of model validation as applied to the integrated exposure uptake biokinetic (IEUBK) model for lead in children. The IEUBK model is an exposure (dose)-response model that uses children's environmental lead exposures to estimate risk of elevated blood lead (typically > 10 micrograms/dl) through estimation of lead body burdens in a mass balance framework. We used residence-specific environmental lead measurements from three epidemiologic datasets as inputs for the IEUBK model to predict blood lead levels, and compared these predictions with blood lead levels of children living at these residences. When the IEUBK modeling focused on children with representative exposure measurements, that is, children who spent the bulk of their time near the locations sampled, there was reasonably close agreement between observed and predicted blood lead distributions in the three studies considered. Geometric mean observed and predicted blood lead levels were within 0.7 microgram/dl, and proportions of study populations expected to be above 10 micrograms/dl were within 4% of those observed.
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Affiliation(s)
- K Hogan
- Office of Prevention, Pesticides and Toxic Substances, U.S. Environmental Protection Agency, Washington, DC 20460, USA.
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Abstract
Fatal destruction of skeletal muscle coincident with exposure to specific drugs used during anethesia has been recognized as a potentially heritable disorder for more than 30 years. Variable expressivity and incomplete penetrance of the clinical malignant hyperthermia phenotype, together with inherent drawbacks of the in-vitro contracture test confounded efforts to discover the underlying pathogenesis until the application of molecular genetic techniques. On the basis of linkage analysis and mapping of positional candidate genes, mutant alleles at loci on chromosomes 1q, (dihydropyridine-sensitive L-type calcium channel-A1S); 3q, 5p, 7q (dihydropyridine-sensitive L-type calcium channel-LA2), and 19q (ryanodine receptor) are now believed to account for up to 50% of human malignant hyperthermia susceptibility. Although inconsistent genotype-phenotype correlations and doubts regarding the causality of each mutant allele persist, the definition of malignant hyperthermia and relevance of molecular genetic data to the problems of family counseling, population screening, and improved resolution of the malignant hyperthermia phenotype must now be appraised in view of significant locus and allelic genetic heterogeneity.
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Affiliation(s)
- K Hogan
- Department of Anesthesiology, University of Wisconsin, Madison 53792, USA.
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Van Calcar SC, Harding CO, Lyne P, Hogan K, Banerjee R, Sollinger H, Rieselbach RE, Wolff JA. Renal transplantation in a patient with methylmalonic acidaemia. J Inherit Metab Dis 1998; 21:729-37. [PMID: 9819702 DOI: 10.1023/a:1005493015489] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Renal insufficiency is frequently reported in mutase-deficient methylmalonic acidaemia. We present a case report of a patient with mut- methylmalonic acidaemia who developed chronic tubulointerstitial nephropathy during adolescence. At 24 years of age, she developed end-stage renal failure and underwent renal transplantation. Both plasma and urine methylmalonic acid levels decreased significantly with improved renal function following transplantation. Complications included cyclosporin toxicity and development of diabetes. Renal, metabolic, and clinical status remained improved at 3 years after the kidney transplant.
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Hogan K, Thomopoulos M. Do IDSs really benefit from affiliating with managed care plans? Healthc Financ Manage 1998; 52:36-8. [PMID: 10176446] [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: 04/13/2023]
Abstract
Integrated delivery systems (IDSs) affiliate with HMOs primarily to gain access to patients enrolled in managed care plans. Outright ownership of an HMO offers an IDS additional advantages, including opportunities to create a more seamless care process, improve patient outcomes, draw on the HMOs' experience in reducing costs, and administer health management and delivery at a significantly lower cost than the industry standard. The current trend toward IDS ownership of HMOs suggests that the line between providers and payers is blurring. Some states have encouraged this trend by enacting legislation that allows IDSs to act as insurers. Recent data indicate that IDSs with HMO components tend to be more vertically integrated than those without such components. These data suggest that close alignment with an HMO may be a key element in the effort to achieve vertical integration.
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Affiliation(s)
- K Hogan
- SMG Marketing Group, Chicago, IL, USA
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