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Bowman D, Proctor C, Richards K, Protyniak B. Having Outpatient Major Elective (HOME) Robotic Colon Resection Protocol: A Safe Approach to Ambulatory Colon Resection. Am Surg 2023; 89:6078-6083. [PMID: 37470507 DOI: 10.1177/00031348231189829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Within the past decade, colorectal surgery length of stay (LOS) has decreased from an average of 5-6 days to 2-3 days. However, elective colon resections have yet to become a common procedure with the potential for same-day discharge. During the COVID pandemic, hospital capacity was exceptionally strained and colon resections were delayed due to the lack of inpatient beds available. PURPOSE We sought to create a protocolized ERAS (enhanced recovery after surgery) pathway that would allow for safe and feasible ambulatory colon resections as well as decreasing overall hospital inpatient burden. RESEARCH DESIGN Between November 2020 and March 2022, 15 patients were offered same-day discharges under the HOME protocol. Of the 15 patients, 11 patients agreed to be discharged home the day of surgery and followed prospectively for 30 days. All procedures were performed robotically. STUDY SAMPLE Patients were selected based on level of preoperative health (ASA class 1 and 2), low-risk for loss to follow-up, ability for close family supervision for 3 days postoperatively, and type of procedure (partial colectomy). Close follow-up was achieved with daily telephonic or televideo visits for 3 days post-operatively, as well as a 2-week outpatient clinic follow-up. DATA COLLECTION A total of 11 patient underwent same-day surgery utilizing the protocol, 5 females and 6 males, between the ages of 34 and 62. All patients were ASA class 2. Indications for colon resection were cecal volvulus (1), recurrent sigmmoid diverticulitis (9), and Crohn's disease (1). Primary outcome was readmission rates within the 30-days. RESULTS There were no readmissions or complications during the perioperative 30-day period. There was one emergency department return for pain who was not admitted. Average operative time was 132.1 minutes. CONCLUSION Using a novel enhanced recovery protocol, we demonstrated the feasibility and safety of ambulatory partial colectomy in a highly select small subset of patients.
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Affiliation(s)
- Daman Bowman
- Department of General Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Charles Proctor
- Department of General Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | | | - Bogdan Protyniak
- Department of General Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
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2
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Rakhmanina N, Richards K, Adeline Koay WL. Transient Viremia in Young Adults With HIV After the Switch to Long-Acting Cabotegravir and Rilpivirine: Considerations for Dosing Schedule and Monitoring. J Acquir Immune Defic Syndr 2023; 92:e14-e17. [PMID: 36480701 DOI: 10.1097/qai.0000000000003142] [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: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Natella Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC.,School of Medicine and Health Sciences, The George Washington University, Washington, DC; and.,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
| | - Kristen Richards
- Division of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Wei Li Adeline Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, DC.,School of Medicine and Health Sciences, The George Washington University, Washington, DC; and
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3
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Seervai RNH, Cho WC, Chu EY, Marques-Piubelli ML, Ledesma DA, Richards K, Heberton MM, Nelson KC, Nagarajan P, Torres-Cabala CA, Prieto VG, Curry JL. Diverse landscape of dermatologic toxicities from small-molecule inhibitor cancer therapy. J Cutan Pathol 2021; 49:61-81. [PMID: 34622477 DOI: 10.1111/cup.14145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/16/2021] [Revised: 08/29/2021] [Accepted: 10/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Advances in molecular biology and genetics have contributed to breakthrough treatments directed at specific pathways associated with the development of cancer. Small-molecule inhibitors (Nibs) aimed at a variety of cellular pathways have been efficacious; however, they are associated with significant dermatologic toxicities. METHODS We conducted a comprehensive review of dermatologic toxicities associated with Nibs categorized into the following five groups: (a) mitogen-activated protein kinase; (b) growth factor/multi-tyrosine kinase; (c) cell division/DNA repair; (d) signaling associated with myeloproliferative neoplasms; and (e) other signaling pathways. Prospective phase I, II, or III clinical trials, retrospective literature reviews, systematic reviews/meta-analyses, and case reviews/reports were included for analysis. RESULTS Dermatologic toxicities reviewed were associated with every class of Nibs and ranged from mild to severe or life-threatening adverse skin reactions. Inflammatory reactions manifesting as maculopapular, papulopustular/acneiform, and eczematous lesions were frequent types of dermatologic toxicities seen with Nibs. Squamous cell carcinoma with keratoacanthoma-like features was associated with a subset of Nibs. Substantial overlap in dermatologic toxicities was found between Nibs. CONCLUSIONS Dermatologic toxicities from Nibs are diverse and may overlap between classes of Nibs. Recognition of the various types of toxicities from Nibs is critical for patient care in the era of "oncodermatology/dermatopathology."
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Affiliation(s)
- Riyad N H Seervai
- Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA.,Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA
| | - Woo Cheal Cho
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Y Chu
- Department of Dermatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debora A Ledesma
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristen Richards
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Meghan M Heberton
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan L Curry
- Department of Pathology, Section of Dermatopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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4
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Gill P, Richards K, Cho WC, Nagarajan P, Aung PP, Ivan D, Curry JL, Prieto VG, Torres-Cabala CA. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. Ann Diagn Pathol 2021; 54:151776. [PMID: 34214703 DOI: 10.1016/j.anndiagpath.2021.151776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Localized cutaneous argyria is a rare cutaneous disorder that has been associated with occupational exposure, dental procedures, topical agents, acupuncture, earrings, and nasal piercings. In this paper, we review the current literature on localized cutaneous argyria, highlight its clinical and histologic diagnostic features, and then discuss the clinical and histological differential diagnoses for blue-gray skin and black dermal pigment, respectively. We also discuss the utility of ancillary techniques, such as deeper histologic levels, special stains, darkfield microscopy, and advanced micro-analytical techniques in helping diagnose localized cutaneous argyria. Furthermore, we emphasize that a thorough clinical history and astute clinico-pathologic correlation can be the most important diagnostic techniques in correctly diagnosing this rare disorder. Our review aims serve as a reminder to clinicians and pathologists of the importance of including localized cutaneous argyria in the clinical and histological differential diagnosis of pigmented lesions.
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Affiliation(s)
- Pavandeep Gill
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Kristen Richards
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Woo Cheal Cho
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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5
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Richards K, Geoghegan S, Butler M, Shafi N, Watson D. WS14.2 Potential factors influencing reduced requirements for intravenous antibiotics during the COVID-19 pandemic. J Cyst Fibros 2021. [PMCID: PMC8192164 DOI: 10.1016/s1569-1993(21)00994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nolan S, Thorn CE, Ashekuzzaman SM, Kavanagh I, Nag R, Bolton D, Cummins E, O'Flaherty V, Abram F, Richards K, Fenton O. Landspreading with co-digested cattle slurry, with or without pasteurisation, as a mitigation strategy against pathogen, nutrient and metal contamination associated with untreated slurry. Sci Total Environ 2020; 744:140841. [PMID: 32755776 DOI: 10.1016/j.scitotenv.2020.140841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
North Atlantic European grassland systems have a low nutrient use efficiency and high rainfall. This grassland is typically amended with unprocessed slurry, which counteracts soil organic matter depletion and provides essential plant micronutrients but can be mobilised during rainfall events thereby contributing to pathogen, nutrient and metal incidental losses. Co-digesting slurry with waste from food processing mitigates agriculture-associated environmental impacts but may alter microbial, nutrient and metal profiles and their transmission to watercourses, and/or soil persistence, grass yield and uptake. The impact of EU and alternative pasteurisation regimes on transmission potential of these various pollutants is not clearly understood, particularly in pasture-based agricultural systems. This study utilized simulated rainfall (Amsterdam drip-type) at a high intensity indicative of a worst-case scenario of ~11 mm hr-1 applied to plots 1, 2, 15 and 30 days after grassland application of slurry, unpasteurised digestate, pasteurised digestate (two conditions) and untreated controls. Runoff and soil samples were collected and analysed for a suite of potential pollutants including bacteria, nutrients and metals following rainfall simulation. Grass samples were collected for three months following application to assess yield as well as nutrient and metal uptake. For each environmental parameter tested: microbial, nutrient and metal runoff losses; accumulation in soil and uptake in grass, digestate from anaerobic co-digestion of slurry with food processing waste resulted in lower pollution potential than traditional landspreading of slurry without treatment. Reduced microbial runoff from digestate was the most prominent advantage of digestate application. Pasteurisation of the digestate further augmented those environmental benefits, without impacting grass output. Anaerobic co-digestion of slurry is therefore a multi-beneficial circular approach to reducing impacts of livestock production on the environment.
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Affiliation(s)
- S Nolan
- Microbiology, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, University Road, Co. Galway, Ireland; Teagasc, Environmental Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - C E Thorn
- Microbiology, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, University Road, Co. Galway, Ireland
| | - S M Ashekuzzaman
- Teagasc, Environmental Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - I Kavanagh
- Teagasc, Environmental Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - R Nag
- School of Biosystems and Food Engineering, UCD, Dublin, Ireland
| | - D Bolton
- Teagasc, Ashtown Food Research Centre, Ashtown, Dublin 15, Ireland
| | - E Cummins
- School of Biosystems and Food Engineering, UCD, Dublin, Ireland
| | - V O'Flaherty
- Microbiology, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, University Road, Co. Galway, Ireland
| | - F Abram
- Microbiology, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, University Road, Co. Galway, Ireland
| | - K Richards
- Teagasc, Environmental Research Centre, Johnstown Castle, Co. Wexford, Ireland
| | - O Fenton
- Teagasc, Environmental Research Centre, Johnstown Castle, Co. Wexford, Ireland.
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Kumar R, Feltch C, Richards K, Morrison J, Rangel A, Janney R, Shayesteh S, Allen R, Banerjee N. 0438 Automatic Nighttime Agitation and Sleep Disruption Detection Using a Wearable Ankle Device and Machine Learning. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.435] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Nighttime agitation behavior such as wandering and restlessness during awake and sleep in people with Alzheimer’s disease (AD) is expensive to manage and adversely affects sleep. Nighttime agitation is mostly noted by subjective caregiver reports. An automated process for this assessment would improve clinical management. Here we report on the RestEaZeTM system that uses an ankle band and machine learning to automatically classify sleep status and nighttime agitation behaviors in older adults with AD.
Methods
We collected data on 7 adults (mean: 81 years, SD: 10.6) with AD. They wore the RestEaZeTM ankle band with a 3-axis accelerometer, a 3-axis gyroscope, and three textile capacitive sensors. A trained Research Assistant (RA) continuously observed for wandering, restlessness, wake, and sleep between 5pm and 7am using the Cohen Mansfield Agitation Inventory (CMAI). We merged, and band-pass filtered the data and divided it into 10-second non-overlapping windows. CMAI labels and time-series features (scaled using StandardScaler) extracted from the RestEaZeTM data were used to train a Random Forest binary classifier. The significant features were extracted based on the impact on the p-value for the classifier. We used the Synthetic Minority Oversampling Technique (SMOTE) to balance the dataset and performed 5-fold cross-validation with a 67-33 train-test split.
Results
We report the sensitivity, specificity, accuracy, and Area-under-the Curve (AUC) for the ROC curve for the classifiers: (1) Sleep/Awake: sensitivity=0.95, specificity=0.87, accuracy=0.92, AUC=0.97; (2) Wandering/Non-Wandering: sensitivity=0.85, specificity=0.99, accuracy=0.98, AUC=0.99; and (3) Restless/Non-Restless: sensitivity=0.84, specificity=0.84, accuracy=0.84, AUC=0.92. The significant features were related to the intensity of movements.
Conclusion
Our preliminary results show the feasibility of using RestEaZeTM for quantitatively measuring nighttime agitation. These can provide clinically useful objective measures of agitation that can be automatically transmitted to clinical or research records with minimal staff time requirements.
Support
The authors acknowledge the funding support from the National Institute on Aging under award R01AG051588 and Arbor Pharmaceuticals for support for Horizant and the matching placebo.
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Affiliation(s)
- R Kumar
- University of Maryland, Baltimore County, Catonsville, MD
| | - C Feltch
- Tanzen Medical, Inc., Baltimore, MD
| | | | | | - A Rangel
- University of Texas, Austin, Austin, TX
| | - R Janney
- University of Texas, Austin, Austin, TX
| | | | - R Allen
- Johns Hopkins University, Baltimore, MD
| | - N Banerjee
- University of Maryland, Baltimore County, Catonsville, MD
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8
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Thomson F, Richards K. 30 The Role of A Virtual Clinic in Reducing Waiting Times for Out-Patient Follow-Up. Age Ageing 2020. [DOI: 10.1093/ageing/afz183.30] [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: 11/12/2022] Open
Abstract
Abstract
Topic
Hospital admissions for older people are increasing with subsequent pressure on out-patient (OP) clinics. By early 2018, 350 patients were waiting up to 6 months for follow-up, with limited capacity in existing clinics. There were concerns regarding potential harm to patients from delayed review of significant results.
Intervention
A working group considered options for managing the OP waiting list. We decided to pilot a fortnightly virtual clinic (VC) where cases were reviewed without the patient present. All patients awaiting results were listed for the VC rather than routine OP. Each VC had 50 patients listed. Patient’s GP received a clear action plan. Clinic rules were modified as issues were identified. Links with other specialities evolved reducing the number of missing results. Data was analysed for 50% of consultations between January 2018 and March 2019.
Improvement
311 VC appointments were reviewed: 207 in 2018 and 104 up to March 2019. Maximum 25 cases could be completed per clinic, additional sessions cleared initial backlog within 3 months. Completion time/case ranged from 2-15 minutes depending on complexity. Main reason for VC was test results: 82% in 2018, increasing to 93% in 2019. 61% in 2018, 80% in 2019 were discharged directly from VC. 20% required a 2nd VC for outstanding results. OP review post-VC fell from 16% in 2018 to just 2% in 2019. General OP requirements fell from 24hrs to 10 hours/ week as a result of VCs, releasing consultants for other clinical areas.
Discussion
VCs are an effective means of reviewing outstanding results from recent admissions and OP consultations. Routine listing of patients with outstanding investigations provides a safety net. Most results are normal and do not require follow-up. Repeat CXRs at 6 weeks continue to be requested for severely frail people who are unlikely to benefit.
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Affiliation(s)
- F Thomson
- Hull University Teaching Hospitals NHS Trust
| | - K Richards
- Hull University Teaching Hospitals NHS Trust
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9
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Chang M, Attebery T, Aziz M, Bhagat P, Blackwell J, Havers N, Helton T, Jackson L, Kramer R, Ladley H, Liu J, Mayhew M, Metzger C, Richards K, Saha P, Simpson D, Fennel B. TCT-1 A Novel Risk-Based Strategy in Adopting New Technology: Pilot Study Assessing Clinical and Quality Outcomes of Real-World Intravascular Ultrasound (IVUS) and Instant Wave-Free Ratio (iFR) Utilization in a Unique Risk-Sharing Program. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Richards K, Sethu C, Tiernan E. Phalangeal fracture leading to digital amputation, sustained during manipulation for Dupuytren's disease as part of clostridial collagenase treatment. Ann R Coll Surg Engl 2019; 101:e102-e104. [PMID: 30855178 DOI: 10.1308/rcsann.2019.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Collagenase injection was approved in Europe for use in the treatment of Dupuytren's disease in 2011. Reported adverse effects include skin tears, swelling, pain and complex regional pain syndrome. Here, we present a case of a rare complication of phalangeal fracture following treatment with collagenase clostridium and the resultant digital amputation. An 81-year-old man was treated for a 25-year history of progressively disabling Dupuytren's disease of his left middle and ring fingers. Nine days post-manipulation he presented with persistent pain and swelling and was diagnosed with a displaced fracture of the proximal phalanx of his ring finger. Following discussion of surgical options and potential outcome, he elected to undergo amputation of the digit. He has experienced good treatment results in his middle finger and has no significant functional impairment as a result of this complication. Those offering collagenase injection in the management of Dupuytren's disease should be aware of this potential complication and it should be included in the consent process.
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Affiliation(s)
- K Richards
- Burns and Plastic Surgery Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - C Sethu
- Plastic and Reconstructive Surgery Department, Salisbury District Hospital, Salisbury , Salisbury , UK
| | - E Tiernan
- Plastic and Reconstructive Surgery Department, Salisbury District Hospital, Salisbury , Salisbury , UK
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Robson G, Hammond-Williams J, Richards K, Dyer C, Camacho R, Sinclair A, Neilson V, Ibude A, Buxton S, Lane S, Maynard L. 13THE FRAILTY FLYING SQUAD HOTLINE: DIRECT REFERRAL FROM PARAMEDICS TO THE ACUTE HOSPITAL FRAILTY SERVICE. REPORT OF AN INITIAL PDSA CYCLE. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Robson
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - J Hammond-Williams
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - K Richards
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - C Dyer
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - R Camacho
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - A Sinclair
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - V Neilson
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - A Ibude
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - S Buxton
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - S Lane
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
| | - L Maynard
- Royal United Hospital NHS Foundation Trust Bath, South Western Ambulance Service NHS Foundation Trust
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Stapley S, Colley S, Richards K. 100DEVELOPMENT OF RECREATIONAL THERAPY ROLE WITHIN THE ELDERLY CARE DEPARTMENT. Age Ageing 2018. [DOI: 10.1093/ageing/afy126.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Stapley
- Hull Royal Infirmary, Department of Elderly Care
| | - S Colley
- Hull Royal Infirmary, Department of Elderly Care
| | - K Richards
- Hull Royal Infirmary, Department of Elderly Care
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Brough HA, Kull I, Richards K, Hallner E, Söderhäll C, Douiri A, Penagos M, Melén E, Bergström A, Turcanu V, Wickman M, Lack G. Environmental peanut exposure increases the risk of peanut sensitization in high-risk children. Clin Exp Allergy 2018; 48:586-593. [DOI: 10.1111/cea.13111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 12/14/2022]
Affiliation(s)
- H. A. Brough
- Paediatric Allergy Group; Department of Women and Children's Heath; School of Life Course Sciences; King's College London; Guys’ Hospital; London UK
- Children's Allergy Service; Guy's and St. Thomas's NHS Foundation Trust; London UK
- Paediatric Allergy Group; School of Immunology & Microbial Sciences; King's College London; Guys' Hospital; London UK
| | - I. Kull
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children's Hospital; Södersjukhuset; Stockholm Sweden
| | - K. Richards
- Paediatric Allergy Group; Department of Women and Children's Heath; School of Life Course Sciences; King's College London; Guys’ Hospital; London UK
- Paediatric Allergy Group; School of Immunology & Microbial Sciences; King's College London; Guys' Hospital; London UK
| | - E. Hallner
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - C. Söderhäll
- Department of Biosciences and Nutrition; Karolinska Institutet; Stockholm Sweden
- Centre of Allergy Research; Karolinska Institutet; Stockholm Sweden
- Department of Women′s and Children′s Health; Karolinska Institutet; Stockholm Sweden
| | - A. Douiri
- Division of Health & Social Care Research; King's College London; London UK
| | - M. Penagos
- Paediatric Allergy Group; Department of Women and Children's Heath; School of Life Course Sciences; King's College London; Guys’ Hospital; London UK
- Paediatric Allergy Group; School of Immunology & Microbial Sciences; King's College London; Guys' Hospital; London UK
| | - E. Melén
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
- Sachs’ Children's Hospital; Södersjukhuset; Stockholm Sweden
| | - A. Bergström
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
- Centre of Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - V. Turcanu
- Paediatric Allergy Group; Department of Women and Children's Heath; School of Life Course Sciences; King's College London; Guys’ Hospital; London UK
- Paediatric Allergy Group; School of Immunology & Microbial Sciences; King's College London; Guys' Hospital; London UK
| | - M. Wickman
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Eskilstuna Sweden
| | - G. Lack
- Paediatric Allergy Group; Department of Women and Children's Heath; School of Life Course Sciences; King's College London; Guys’ Hospital; London UK
- Children's Allergy Service; Guy's and St. Thomas's NHS Foundation Trust; London UK
- Paediatric Allergy Group; School of Immunology & Microbial Sciences; King's College London; Guys' Hospital; London UK
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Sawicka ZS, Phelan F, Richards K, Baxter R, Bennett H. 15THE PICTURE OF FRAILTY AT MID YORKSHIRE. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.15] [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: 11/14/2022] Open
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Jeffery N, Richards K, Athorn K, Morales I. 32IMPLEMENTATION OF A MEDICAL CHECKLIST TOOL TO IMPROVE THE QUALITY OF ELDERLY PATIENT CARE: A QUALITY IMPROVEMENT PROJECT. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.32] [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: 11/12/2022] Open
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Honarpisheh HH, Curry JL, Richards K, Nagarajan P, Aung PP, Torres-Cabala CA, Ivan D, Drucker CR, Cartun R, Prieto VG, Tetzlaff MT. Cutaneous histoplasmosis with prominent parasitization of epidermal keratinocytes: report of a case. J Cutan Pathol 2016; 43:1155-1160. [DOI: 10.1111/cup.12792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/21/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hedieh H. Honarpisheh
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Pathology; Duke University School of Medicine; Durham NC USA
| | - Jonathan L. Curry
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Kristen Richards
- Department of Dermatology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | | | - Phyu P. Aung
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Carlos A. Torres-Cabala
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Doina Ivan
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Carol R. Drucker
- Department of Translational and Molecular Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Richard Cartun
- Department of Pathology; Hartford Hospital; Hartford CT USA
| | - Victor G. Prieto
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Translational and Molecular Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Michael T. Tetzlaff
- Department of Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
- Department of Translational and Molecular Pathology; University of Texas MD Anderson Cancer Center; Houston TX USA
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Housley SN, Garlow AR, Ducote K, Howard A, Thomas T, Wu D, Richards K, Butler AJ. Increasing Access to Cost Effective Home-Based Rehabilitation for Rural Veteran Stroke Survivors. Austin J Cerebrovasc Dis Stroke 2016; 3:1-11. [PMID: 28018979 PMCID: PMC5175468] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION An estimated 750,000 Americans experience a stroke annually. Most stroke survivors require rehabilitation. Limited access to rehabilitation facilities has a pronounced burden on functional outcomes and quality of life. Robotic devices deliver reproducible therapy without the need for real-time human oversight. This study examined the efficacy of using home-based, telerobotic-assisted devices (Hand and Foot Mentor: HM and FM) to improve functional ability and reduce depression symptoms, while improving access and cost savings associated with rehabilitation. METHODS Twenty stroke survivors performed three months of home-based rehabilitation using a robotic device, while a therapist remotely monitored progress. Baseline and end of treatment function and depression symptoms were assessed. Satisfaction with the device and access to therapy were determined using qualitative surveys. Cost analysis was performed to compare home-based, robotic-assisted therapy to clinic-based physical therapy. RESULTS Compared to baseline, significant improvement in upper extremity function (30.06%, p= 0.046), clinically significant benefits in gait speed (29.03%), moderate improvement in depressive symptoms (28.44%) and modest improvement in distance walked (30.2%) were observed. Participants indicated satisfaction with the device. Home-based robot therapy expanded access to post-stroke rehabilitation for 35% of the people no longer receiving formal services and increased daily access for the remaining 65%, with a cost savings of $2,352 (64.97%) compared to clinic-based therapy. CONCLUSION Stroke survivors made significant clinically meaningful improvements in the use of their impaired extremities using a robotic device in the home. Home-based, robotic therapy reduced costs, while expanding access to a rehabilitation modality for people who would not otherwise have received care.
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Affiliation(s)
- S N Housley
- Department of Physical Therapy, Georgia State University, USA
| | - A R Garlow
- Department of Physical Therapy, Georgia State University, USA
| | - K Ducote
- Department of Physical Therapy, Georgia State University, USA
| | - A Howard
- Department of Physical Therapy, Georgia State University, USA
| | - T Thomas
- Department of Physical Therapy, Georgia State University, USA
| | - D Wu
- Department of Physical Therapy, Georgia State University, USA
| | - K Richards
- Department of Physical Therapy, Georgia State University, USA
| | - A J Butler
- Department of Physical Therapy, Georgia State University, USA; Department of Veteran's Affairs, Atlanta Rehabilitation Research and Development Center of Excellence, USA; Neuroscience Institute, Joint Center for Advanced Brain Imaging, Center for Behavioral Neuroscience, Georgia State University, USA
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Abstract
BACKGROUND Although most commonly encountered in patients with human immunodeficiency virus infection, disseminated Mycobacterium avium complex (MAC) is becoming more common in patients receiving immunosuppressive medications. Disseminated MAC with skin lesions may occur, and several presentations have been reported, including panniculitis, cutaneous granulomas, pustules, ulcerations, and erythematous skin lesions. OBJECTIVES The objective of this report is to describe an unusual presentation of MAC that is unlikely to be encountered frequently in the outpatient dermatology setting, especially in a patient without human immunodeficiency virus infection. METHODS The authors present a case of disseminated MAC infection with cutaneous manifestations in an iatrogenically immunocompromised patient. CONCLUSIONS Diagnosis of MAC infection is challenging given the varied clinical presentations and the difficulty in culturing MAC. In addition, the acid-fast stain is nonspecific. Clinicians should remember to consider MAC infection in patients with acid-fast-positive skin lesions, as the selection of appropriate antibiotic therapy is species specific.
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Affiliation(s)
- Ramya Kollipara
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | - Lauren Campbell
- Center for Clinical Studies, Houston, TX, USA Dermatological Association of Texas, Houston, TX, USA
| | - Stephen Tyring
- Center for Clinical Studies, Houston, TX, USA University of Texas Health Science Center, Houston, TX, USA Dermatological Association of Texas, Houston, TX, USA
| | - Steven Mays
- University of Texas Health Science Center, Houston, TX, USA
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Mace CS, Folwell A, Richards K. 25PATIENT SURVEY INVESTIGATING CATERING CHOICES ON ‘CARE FOR THE ELDERLY’ WARDS. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.25] [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: 11/14/2022] Open
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Folwell A, Maslen H, Parsons K, Davidson R, Richards K. 30REDUCING PRESCRIBING ERRORS THROUGH PERSONALISED FEEDBACK. Age Ageing 2015. [DOI: 10.1093/ageing/afv106.30] [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: 11/14/2022] Open
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21
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Richards K, Forouhi P, Johnston A, Malata CM. Pre-operative thrombotic complications of neoadjuvant chemotherapy for breast cancer: Implications for immediate breast reconstruction. Ann Med Surg (Lond) 2015; 4:80-4. [PMID: 25834732 PMCID: PMC4372642 DOI: 10.1016/j.amsu.2014.11.001] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/01/2014] [Accepted: 11/04/2014] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED Thrombotic complications arising during the treatment of breast cancer can impact the breast reconstruction pathway. We set out to review the details of cases of thromboembolism occurring during neoadjuvant chemotherapy and peri-operatively to study the impact of the event and its management on subsequent breast reconstruction. METHODS We retrospectively reviewed the medical records of seven patients who had experienced a thrombotic event during their treatment of breast cancer between 2008 and 2012, who then proceeded to breast reconstruction. We recorded size and grade of tumour, neoadjuvant chemotherapeutic regimen, details of port insertion, planned reconstruction, thrombotic event and its management and the surgery performed and outcome. RESULTS All patients received chemotherapy via central venous access and went on to present with local symptomatic thrombosis. They were managed with anticoagulant regimens at the time of mastectomy and reconstruction, which were unique for each patient. The results revealed delays to surgery and modifications to planned reconstruction. DISCUSSION The majority of patients developing thrombotic complications go on to achieve successful reconstruction. There is significant variation in the anticoagulation management in this patient group. Identification of optimal anticoagulant regimes and the possibilities for prophylaxis may prove key in informing surgeons when planning the reconstructive process. CONCLUSION An awareness of the effects of thrombotic events in this patient group is important in terms of developing an understanding of its impact on the performance of reconstruction, on the management of anticoagulation peri-operatively and on monitoring for post-operative complications.
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Affiliation(s)
- K Richards
- Clinical School of Medicine, Cambridge University, UK
| | - P Forouhi
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Johnston
- Department of Anaesthesia and ICU, Cambridge University Hospitals NHS Foundation Trust, UK
| | - C M Malata
- Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK ; Plastic & Reconstructive Surgery Depatment, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK ; Postgraduate Medical Institute at Anglia Ruskin University, Cambridge, Chelmsford, UK
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Innocenti F, Gillis N, Parker J, Hayes N, Eberhard D, Richards K, Auman J, Seiser E. 163 Interrogation of pharmacogenes in cancer patients using targeted DNA sequencing. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70289-8] [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: 10/24/2022]
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Seiser E, Gillis N, Parker J, Hayes D, Eberhard D, Richards K, Auman J, Innocenti F. Pharmacogenetic Evaluation of Targeted Dna Sequencing in Cancer Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.45] [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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24
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Rascati K, Richards K, Lopez D, Cheng LI, Wilson J. Progression to insulin for patients with diabetes mellitus on dual oral antidiabetic therapy using the US Department of Defense Database. Diabetes Obes Metab 2013; 15:901-5. [PMID: 23531154 DOI: 10.1111/dom.12103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/14/2013] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
AIM To compare 'progression to insulin' for three cohorts on oral antidiabetic medication combinations: metformin/sulphonylurea (Met/SU), metformin/thiazolidinedione (Met/TZD) and sulphonylurea/thiazolidinedione (SU/TZD). METHODS Retrospective cohort analysis design was used. The subjects were US nationwide members of military and their families. A total of 5608 patients who were on antidiabetic monotherapy for at least 1 year before adding a second agent to their medication regimen between October 2001 and September 2008 participated in this study. Mean age ranged from 64 to 71 years among the cohorts. Cox regression compared the progression to insulin, adjusting for demographics, months of follow-up and co-morbidities [measured with Chronic Disease Score (CDS)]. RESULTS By the end of the 2- to 6-year follow-up period, 14.3% of the Met/TZD cohort, 23.6% of the Met/SU cohort and 28.2% of the SU/TZD cohort had insulin added to their regimen. Those in the Met/SU cohort had a 1.8 times higher probability of progression to insulin than those in the Met/TZD cohort [odds ratio (OR) = 1.80, 95% confidence interval (CI) = 1.51-2.14), and those in the SU/TZD cohort had a 2.5 times higher probability of progression to insulin than those in the Met/TZD cohort (OR = 2.51, 95% CI = 2.04-3.08). CONCLUSION When sensitizers were paired (Met/TZD), a lower percentage of patients progressed to insulin during the study period, as opposed to patients who used a combination of a secretagogue with a sensitizer (SU/TZD or Met/SU).
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Affiliation(s)
- K Rascati
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
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Mozen D, Slawson D, Dalton W, Littleton M, Schetzina K, Williams C, McKeehan T, Wu T, Richards K. Development of physical activity components for a peer delivered intervention to reduce obesity: Team up for healthy living. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tsai KY, Vin H, Leung M, Chitsazzadeh V, Ojeda S, Dwyer D, Richards K, Stewart L, Curry J, Kim KB, Ciurea A, Duvic M, Prieto V, Ullrich S, Flores E. Suppression of apoptosis by BRAF inhibitors through off-target inhibition of JNK signaling. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8537 Background: The advent of targeted therapy has revolutionized the treatment of cancer. The mutant BRAFV600E protein is found in over 50% of melanomas and thyroid carcinomas, resulting in elevated kinase activity, increased mitogen-activated protein kinase (MAPK) pathway signaling, and cell proliferation. Vemurafenib and PLX4720 were designed to selectively inhibit the BRAF kinase, and clinical trials of vemurafenib in metastatic melanoma have demonstrated a response rate of over 50% and an overall survival advantage over standard dacarbazine therapy. Approximately 20-30% of individuals treated with vemurafenib develop cutaneous squamous cell carcinoma (cSCC) highlighting the importance of understanding toxicities associated with this drug. Paradoxical ERK activation in BRAF wild-type, RAS-mutant cells is thought to be the major mechanism by which this occurs, as evidenced by the presence of RAS mutations in 60% of such lesions. Methods: Using a combination of BRAF-wild-type cSCC cell lines, primary human keratinocytes, as well as a UV mouse model of cSCC and human cSCC samples, we identified novel effects of BRAFi on apoptosis. Results: Here we show an unexpected and novel effect of vemurafenib and PLX4720 in suppressing apoptosis through the inhibition of multiple off-target kinases. JNK signaling and apoptosis are suppressed in cSCC lesions arising in vemurafenib-treated patients as well as in irradiated mouse skin. This occurs independently of paradoxical ERK signaling and in the presence of MEK inhibitor. Treatment with PLX4720 greatly accelerates the development of UV-induced cSCC in mice without Ras mutations. Kinome screening identified ZAK and MKK4 (MEK4 / MAP2K4) kinases as inhibited by vemurafenib, leading to suppression of MKK4 and MKK7 (MAP2K7) phosphorylation. Knockdown of inhibited off-target kinases recapitulates these anti-apoptotic effects of vemurafenib. Conclusions: Our results implicate suppression of JNK signaling, independent of ERK activation, as an additional, complementary mechanism of adverse effects of vemurafenib. This has broad implications for combination therapies with other modalities that induce apoptosis and for the long-term use of vemurafenib in the adjuvant setting.
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Affiliation(s)
| | - Harina Vin
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Marco Leung
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - Sandra Ojeda
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - David Dwyer
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - Larissa Stewart
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Jonathan Curry
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Kevin B. Kim
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Ana Ciurea
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Madeleine Duvic
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Victor Prieto
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Stephen Ullrich
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Elsa Flores
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Khan F, Richards K, Rashid RM. Hyaluronic acid filler for a depressed scar. Dermatol Online J 2012; 18:15. [PMID: 22630585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
The use of filler for depressed scars has been documented but is rare in the literature. We present a case of a patient treated with hyaluronic acid fillers at the site of a long-standing depressed scar.
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Shah N, Bhojwani D, Silverman L, Whitlock J, Richards K, Stetler-Stevenson M, Buzoianu M, Ibrahim R, Pastan I, Wayne A. A Novel Anti-CD22 Immunotoxin, Moxetumomab Pasudotox (HA22, CAT-8015): Activity in Pediatric Patients with Relapsed Acute Lymphoblastic Leukemia (ALL) After Allogeneic Hematopoietic Stem Cell Transplantation (SCT). Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shah N, Loeb D, Khuu H, Stroncek D, Raffeld M, Delbrook C, Richards K, Baird K, Levine J, Leitman S, Mackall C, Fry T, Wayne A. A Pilot Trial of WT1 Peptide-Loaded Allogeneic Dendritic Cell (DC) Vaccination and Donor Lymphocyte Infusion (DLI) for WT1-Expressing Hematologic Malignancies and Post-Transplant Relapse. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.163] [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: 10/14/2022]
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Bilimoria KY, Wang X, Cohen ME, Hall BL, Richards K, Merkow RP, Pisters PW, Ko CY. Do cancer centers need to assess quality and outcomes? Introducing a customized ACS-NSQIP for oncology (Onc-NSQIP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
475 Background: To identify quality improvement opportunities, hospitals can use ACS NSQIP to compare their risk-adjusted performance to other hospitals. However, Cancer Centers have few opportunities to compare their outcomes to similar hospitals for oncologic operations. Our objective was to develop an oncology-specific version of ACS NSQIP (Onc-NSQIP) and determine whether it could be useful for Cancer Centers. Methods: From ACS-NSQIP (2006-2009), patients undergoing major colorectal (n=34,858; 221 hospitals) and pancreatic (n=7,667; 65 hospitals) as well as esophageal, gastric, and soft tissue operations for malignancy were identified. Risk-adjusted postoperative outcomes were assessed with regression models adjusting for demographics, comorbidities, and operative procedure. Relative rankings of NCI-designated Comprehensive Cancer Centers in ACS NSQIP among the other ACS NSQIP hospitals were compared. Results: Cancer Center outcomes varied widely for colorectal and pancreas. For overall colorectal morbidity, Cancer Centers were ranked in the top third (n=4), middle third (n=7), and bottom third (n=10). For colorectal 30-day mortality, Cancer Centers were ranked in the top (n=14), middle (n=3), and bottom third (n=4). For overall pancreatic morbidity, Cancer Centers were ranked in the top (n=5), middle (n=7), and bottom third (n=7). For pancreatic 30-day mortality, Cancer Centers were ranked in the top (n=5), middle (n=6), and bottom third (n=8). Similar results were observed for colorectal and pancreas for DVT/PE, SSI, reoperation, and length of stay. Onc-NSQIP models were comparable to standard ACS NSQIP models. At least some Cancer Centers were statistical outliers for most outcomes (P<0.05). Results were similar for other malignancies. Conclusions: Cancer Center outcomes varied as much as other ACS NSQIP hospitals, demonstrating need for quality assessment. Without standardized risk-adjusted outcomes comparisons, Cancer Centers cannot accurately assess their outcomes to identify quality improvement targets. ACS NSQIP's new platform allows customization so hospitals can compare surgical oncology-specific risk-adjusted processes and outcomes. No significant financial relationships to disclose.
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Affiliation(s)
- K. Y. Bilimoria
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - X. Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - M. E. Cohen
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - B. L. Hall
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - K. Richards
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - R. P. Merkow
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - P. W. Pisters
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - C. Y. Ko
- University of Texas M. D. Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St. Louis, St. Louis, MS; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Slatter JG, Templeton IE, Castle JC, Kulkarni A, Rushmore TH, Richards K, He Y, Dai X, Cheng OJ, Caguyong M, Ulrich RG. Compendium of gene expression profiles comprising a baseline model of the human liver drug metabolism transcriptome. Xenobiotica 2009; 36:938-62. [PMID: 17118915 DOI: 10.1080/00498250600861728] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Oligonucleotide microarrays were used to study the variability of pharmacokinetics and drug metabolism (PKDM)-related gene expression in 75 normal human livers. The objective was to define and use absorption, distribution, metabolism and excretion (ADME) gene expression variability to discern co-regulated genes and potential surrogate biomarkers of inducible gene expression. RNA was prepared from donor tissue and hybridized on Agilent microarrays against an RNA mass balanced pool from all donors. Clustering of PKDM gene sets revealed donors with distinct patterns of gene expression that grouped genes known to be regulated by the nuclear receptor, pregnane X-receptor (PXR). Fold range metrics and frequency distributions from the heterogeneous human population were used to define the variability of individual PKDM genes in the 75 human livers and were placed in context by comparing expression data with basal ADME gene expression variability in an inbred and diet/environment controlled population of 27 Rhesus livers. The most variable genes in the hepatic transcriptome were mainly related to drug metabolism, intermediary metabolism, inflammation and cell cycle control. Unique patterns of expression across 75 individuals of inducible ADME gene expression allowed their expression to be correlated with the expression of many other genes. Correlated genes for AhR, CAR and PXR responsive genes (CYP1A2, CYP2B6 and CYP3A4) were identified that may be co-regulated and, therefore, provide clues to the identity of surrogate gene or protein markers for CYP induction. In conclusion, microarrays were used to define the variable expression of hepatic ADME genes in a diverse human population, the expression variability of ADME genes was compared with the expression variability in an inbred population of Rhesus monkeys, and genes were defined that may be co-regulated with important inducible CYP genes.
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Biagi JJ, Herbert KE, Smith C, Abdi E, Leahy M, Falkson C, Wolf M, Januszewicz H, Seymour JF, Richards K, Matthews JP, Dale B, Prince HM. A phase II study of dexamethasone, ifosfamide, cisplatin and etoposide (DICE) as salvage chemotherapy for patients with relapsed and refractory lymphoma. Leuk Lymphoma 2009; 46:197-206. [PMID: 15621802 DOI: 10.1080/10428190400014884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The 4-day combination of dexamethasone, ifosfamide, cisplatin, and etoposide (DICE) is a salvage regimen for lymphoma. We report a prospective phase II multi-center trial of a modified DICE regimen in relapsed or refractory Hodgkin (HL) or non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), constituting a single day of intravenous administration followed by 3 days of oral administration, aimed at reducing inpatient days without losing efficacy. Forty patients (median age 56, range 25 - 79) were included: 28 (70%) NHL, 9 (23%) HL and 3 (8%) CLL. Fifty-three per cent had received 2 prior treatment regimens. International Prognostic Index (IPI) was 2 in 75% of NHL patients. Patients aged 55 and those with previous autologous stem cell transplantation (ASCT) started on a lower-dose regimen, with dose escalation possible in 2 patients. Overall response rate was 41%. Thirty-eight per cent of patients had stable disease. With a median of 3.1 years of follow-up, estimated progression-free survival (PFS) and overall survival (OS) rates at 3 years were 15% and 43% respectively. OS was longer in the < 55 compared to the 55 age cohort (P = 0.0091), longer for HL than NHL (P = 0.59 and 0.039 respectively) and longer for Low/Low-Int IPI than High/High-Int IPI (P = 0.0074 and 0.0009 respectively). Median duration of inpatient stay was 3 days. There were no treatment-related deaths. In conclusion, this modification of DICE is an effective and well tolerated salvage regimen, even in this poor prognosis group of patients. Further clinical studies of DICE in first relapse and in older patients, possibly with the addition of rituximab, are warranted.
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Affiliation(s)
- J J Biagi
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Beare R, Richards K, Murphy S, Petrou S, Reutens D. An assessment of methods for aligning two-dimensional microscope sections to create image volumes. J Neurosci Methods 2008; 170:332-44. [DOI: 10.1016/j.jneumeth.2008.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Actuarial analysis of stoma complications (problematic stomas) is lacking. The objectives of this audit were: to identify the incidence of stoma complications within the UK; to highlight any dissimilarity of incidence from centre to centre; to ascertain if the height of the stoma (distance of stoma lumen from the skin) at the time of fashioning is a predisposing factor to problems; and finally to initiate much needed research. METHOD Commencing 1st January 2005, stoma care services nationwide (256) were invited to audit prospectively their next 50 enteric stomas or for a period of 1 year which ever came first. The definition of a problematic stoma being one, which needed one or more accessories to keep the patient clean and dry for a minimum period of 24 h. The incident is to have happened within 3 weeks of surgery. Factors taken into account were: type of stoma, height of stoma within 48 h of surgery; emergency or elective procedure, problem identified, BMI, gender and underlying diagnosis of the patient. The identities of the participating centres are confidential. RESULTS Of the 256 hospital-based stoma care services within the UK, 93 (36%) participated. A total of 3970 stomas were recorded, of which 1329 (34%) were identified as problematic. Sixty-two centres reported 45-50 stomas with a range of complications 6-96%. The loop ileostomy was found to be the stoma which causes most problems. A stoma of <10 mm is a predisposing factor to complications and problems are more likely to occur following an emergency procedure. More men than women have stomas formed, but have significantly fewer problems and there is no significant difference between underlying diagnoses. CONCLUSION The stoma height, stoma type and gender of the patient are significant risk factors identified in this audit. The BMI of patient did not affect the outcome. Patients undergoing an emergency procedure are more likely to have a problematic stoma. The significant variation of complications from centre to centre indicates surgical technique as being the key factor in stoma formation and subsequent quality of life for the patient.
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Affiliation(s)
- J Cottam
- Clinical Nurse Specialist (Colorectal/Stoma Care), Bedford Hospital, NHS Trust, Kempston Road, Bedford MK42 9DJ, UK.
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36
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Erhardt M, Vetter G, Gilmer D, Bouzoubaa S, Richards K, Jonard G, Guilley H. Subcellular localization of the Triple Gene Block movement proteins of Beet necrotic yellow vein virus by electron microscopy. Virology 2005; 340:155-66. [PMID: 16023167 DOI: 10.1016/j.virol.2005.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 06/01/2005] [Accepted: 06/07/2005] [Indexed: 11/16/2022]
Abstract
The Triple Gene Block proteins TGBp1, TGBp2, and TGBp3 of Beet necrotic yellow vein virus (BNYVV) are required for efficient cell-to-cell spread of the infection. The TGB proteins can drive cell-to-cell movement of BNYVV in trans when expressed from a co-inoculated BNYVV RNA 3-based 'replicon'. TGBp2 and TGBp3 expressed from the replicon were nonfunctional in this assay if they were fused to the green fluorescent protein (GFP), but addition of a hemagglutinin (HA) tag to their C-termini did not incapacitate movement. Immunogold labeling of ultrathin sections treated with HA-specific antibodies localized TGBp2-HA and TGBp3-HA to what are probably structurally modified plasmodesmata (Pd) in infected cells. A similar subcellular localization was observed for TGBp1. Large gold-decorated membrane-rich bodies containing what appear to be short fragments of endoplasmic reticulum were observed near the cell periphery. The modified gold-decorated Pd and the membrane-rich bodies were not observed when the TGB proteins were produced individually in infections using the Tobacco mosaic virus P30 protein to drive cell-to-cell movement, indicating that these modifications are specific for TGB-mediated movement.
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Affiliation(s)
- M Erhardt
- Institut de Biologie Moléculaire des Plantes du CNRS et de l'Université Louis Pasteur, 67084 Strasbourg, France
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Lauber E, Jonard G, Richards K, Guilley H. Nonregulated expression of TGBp3 of hordei-like viruses but not of potex-like viruses inhibits beet necrotic yellow vein virus cell-to-cell movement. Arch Virol 2005; 150:1459-67. [PMID: 15770352 DOI: 10.1007/s00705-005-0516-y] [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] [Received: 08/25/2004] [Accepted: 01/20/2005] [Indexed: 10/25/2022]
Abstract
Plant viruses containing a Triple Gene Block (TGB) movement protein gene cassette fall into two classes. We have shown previously that the third TGB protein (TGBp3) of beet necrotic yellow vein virus (BNYVV; Class 1) and peanut clump virus (Class 1) inhibit BNYVV intercellular movement when expressed from a co-inoculated BNYVV RNA 3-based replicon. Here we show that autonomous expression of TGBp3's of four other Class 1 viruses of various genera also inhibits BNYVV movement. No such effect was observed for four Class 2 virus TGBp3's, suggesting that the roles of Class 1 and 2 TGBp3's in movement differ significantly.
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Affiliation(s)
- E Lauber
- Institut de Biologie Moléculaire des Plantes du CNRS et de l'Université Louis Pasteur, Strasbourg, France
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38
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Jefford M, Mileshkin L, Richards K, Thomson J, Matthews JP, Zalcberg J, Jennens R, McLachlan SA, Wein S, Antill Y, Clarke DM. Rapid screening for depression--validation of the Brief Case-Find for Depression (BCD) in medical oncology and palliative care patients. Br J Cancer 2004; 91:900-6. [PMID: 15305199 PMCID: PMC2409870 DOI: 10.1038/sj.bjc.6602057] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Depression in oncology patients is under-recognised and associated with poor outcomes. Screening can increase case recognition. The Brief Case-Find for Depression (BCD) is a four-question, interviewer-administered instrument that has been previously validated in a general medical setting. The primary aim of this study was to validate the BCD in a medical oncology/palliative care setting, primarily by comparing its association with physical illness measures and with the Primary Care Evaluation of Mental Disorders (PRIME-MD), the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS). Eligible adult oncology patients gave informed consent and completed the above measures and a pain scale. Agreement between the BCD and other instruments was assessed. Construct validity was determined by comparing depressed/nondepressed patients with respect to performance status, symptoms, pain score and functional impairment. A total of 100 patients had a median age of 58 (range 21–90) and ECOG performance status (PS) 2 (0–4). In all, 60% had metastatic disease. The therapeutic goal was curative/adjuvant in 39% and palliative in 61%. Prevalence of depression according to the various measures was: BCD 34%, PRIME-MD 12%, BDI 19% and HADS 14%. In total, 45% of patients responded positively to a single-item screening question. The BCD showed fair agreement with the PRIME-MD (kappa=0.21), moderate agreement with the BDI (kappa=0.43) and fair agreement with the HADS (kappa=0.27). Against the PRIME-MD diagnosis of depression, the BCD had greater sensitivity, but lesser specificity and overall agreement, compared with the BDI and depression scale of the HADS. Patients with probable depression (according to BCD) had inferior PS (P=0.0064), increased pain (P=0.045) and greater impairment of functioning (PRIME-MD: P=0.0003). There was no association with gender, age, disease status or therapeutic goal. Depression is common in oncology patients. The BCD is a quick, easy-to-administer screen for depression, which has reasonable psychometric properties in this population.
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Affiliation(s)
- M Jefford
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria 8006, Australia.
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Goldstein RE, Martin WH, Richards K. Minimally invasive radioguided parathyroidectomy (MIRP). MINERVA CHIR 2003; 58:269-79. [PMID: 12955045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The technique of parathyroidectomy has traditionally involved a bilateral exploration of the neck with the intent of visualizing 4 parathyroid glands and resecting pathologically enlarged glands. Parathyroid scanning using technetium-99m sestamibi has evolved and can now localize 80% to 90% of parathyroid adenomas. The technique of minimally invasive radioguided parathyroidectomy (MIRP) is a surgical option for most patients with primary hyperparathyroidism and a positive preoperative parathyroid scan. The technique makes use of a hand-held gamma probe that is used intraoperatively to guide the dissection in a highly directed manner with the procedure often performed under local anesthesia. The technique results in excellent cure rates while allowing most patients to leave the hospital within a few hours after the completion of the procedure. Current data also suggest the procedure can decrease hospital charges by approximately 50%. This technique may significantly change the management of primary hyperparathyroidism.
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Affiliation(s)
- R E Goldstein
- Kenneth vonRoenn MD Family Chair in Surgical, Endocrinology and Professor of Surgery, University of Louisville, KY 40202, USA.
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Abstract
Measures of cognition are often used to define and measure the progress of dementia and outcomes of intervention. This paper examines whether measures of psychosocial disability used with those of cognition are more useful than measures of cognition alone, particularly in early dementia. A measure of cognition and two instruments of caregiver burden, used as routine clinical outcome measures of three types of Old Age Psychiatry dementia services, were examined. All cases with dementia in a memory clinic (MC; n = 149), a community mental health service for older people (CMHT; n = 120) and a specialist dementia day hospital (DH; n = 118), in one NHS district were followed up at 12 months. Measures of cognition (MMSE), behaviour, caregiver coping (Problem Checklist; PC) and caregiver mood (Hospital Anxiety and Depression Scale; HAD) were taken at baseline (MC, n = 48; CMHT, n = 113; DH, n = 55) and at follow-up (MC, n = 35; CMHT, n = 34; DH, n = 23). At baseline, all three groups had an average MMSE score of "mild impairment" but measures of behaviour and caregiver burden showed subtle between-group differences. At the 12-month follow-up, cognition remained stable in all groups, but the frequency of day-to-day problems increased and caregiver mood deteriorated in families receiving DH support. The use of psychosocial measures of disability in conjunction with those of cognition, are important in the definition and longitudinal measurement of intervention and support in early dementia.
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Affiliation(s)
- K Richards
- Hull & East Riding Community NHS Trust, Hull, UK
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Abstract
AIMS Blood transfusions are often given to surgical patients. This study was designed to assess whether acute normovolaemic haemodilution (ANH) reduces exposure to allogeneic blood, affects clinical outcome and hospital stay, and is feasible in colorectal surgery. METHODS All ASA 1 and 11 patients undergoing colectomies performed between 1997 and 1999 were identified retrospectively from our colorectal cancer database to ascertain our current peri and postoperative transfusion practice. Twenty-six selected patients subsequently underwent ANH during colectomy surgery. The number of patients and units transfused were identified. RESULTS One hundred and twenty-three of 317 (39%) patients identified from our colorectal cancer database were transfused a total of 328 units (median 2, range 1-7). Of the 26 patients undergoing ANH, 4 (15%) were transfused a total of 13 units (median 3, range 2-5). The reduction in number of patients transfused was statistically significant (P=0.017). ANH increased anaesthetic time by a median of 19 min. There were no complications associated with ANH and the median hospital stay was 9 days (range 6-13). CONCLUSIONS In this pilot study of selected patients, ANH is a feasible and effective method of reducing allogeneic blood exposure in major colorectal surgery. A prospective randomised controlled trial is now urgently required.
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Affiliation(s)
- G Sanders
- Colorectal Unit, Department of Surgery, Derriford Hospital, Plymouth, UK
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Mesibov R, Bonham KJ, Doran N, Meggs J, Munks SA, Otley HM, Richards K. INVERTEBR SYST 2002; 16:655. [DOI: 10.1071/it01036] [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: 11/23/2022]
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Erhardt M, Dunoyer P, Guilley H, Richards K, Jonard G, Bouzoubaa S. Beet necrotic yellow vein virus particles localize to mitochondria during infection. Virology 2001; 286:256-62. [PMID: 11485394 DOI: 10.1006/viro.2001.0931] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fluorescent beet necrotic yellow vein virus (BNYVV) particles were produced by replacing part of the readthrough domain of the minor coat protein P75 with the green fluorescent protein (GFP). The recombinant virus was functional in plants and P75-GFP was incorporated at one end of the rod-shaped virions. Laser scanning confocal microscopy and transmission electron microscopy showed that virus-like particles, almost certainly authentic BNYVV virions, localized to the cytoplasmic surface of mitochondria at early times postinfection but relocated at later times to semiordered clusters in the cytoplasm. This is the first report of specific targeting of plant virus particles to the mitochondria in vivo.
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Affiliation(s)
- M Erhardt
- Institut de Biologie Moléculaire des Plantes, CNRS and Université Louis Pasteur, 12 Rue du Général Zimmer, 67084 Strasbourg Cedex, France
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Abstract
AIMS Fungal infection of diabetic foot ulcers has not been described. We analysed the features of 17 patients with diabetic foot ulcers probably infected with fungi. METHODS Seventeen patients were identified with clinically infected foot ulcers, (i) which had failed to heal despite prolonged antibiotic therapy and intensive podiatric care, (ii) from which Candida spp. was isolated or hyphae +/- yeasts were visualized in material from ulcers or surrounding skin. RESULTS Multiple ulcers arising simultaneously were present in 10 patients (59%), preceded by blistering in seven cases. Single ulcers with markedly ulcerated margins were present in seven (41%) patients and were preceded by blisters in two. All 17 cases had neuropathy and 15 (88%) had severe peripheral vascular disease. All ulcers responded to antifungal therapy. CONCLUSIONS Candida spp. is associated with two distinctive patterns of protracted ulceration in diabetic feet which improve following systemic antifungal therapy. Diabet. Med. 18, 567-572 (2001)
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Affiliation(s)
- A H Heald
- Department of Endocrinology, Hope Hospital, Salford, UK
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Abstract
Training is associated with improved responses to suicidal individuals, but it is not clear whether any training helps or whether the training needs to be in psychology. The authors compared beginning and advanced psychology graduate students and practicing psychologists to nursing graduate students. A total of 139 participants in these 4 groups read a vignette about Pat, who had either contemplated suicide or never contemplated suicide, then completed questions about how they would respond to a distressed telephone call from Pat, how suicidal they thought Pat was, and how good a no-suicide contract would be for Pat. Advanced students and psychologists were more helpful in their responses than beginning graduate students, who were more helpful than nursing graduate students. However, all participants noticed whether Pat had contemplated suicide, and all were faintly positive about no-suicide contracts.
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Affiliation(s)
- K Richards
- University of Southern Mississippi, Hattiesburg, Mississippi, USA.
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Abstract
BACKGROUND Intervention for challenging behaviour of residents living in care homes is a neglected area of research. Pharmacological methods of management are widespread, although support for their efficacy is, on the whole, poor. AIMS There is little research on non-pharmacological methods of management and the present study aimed to add to the small literature in this area, by examining the meaning of behaviour for a given resident, within a functional analytic experimental framework. METHODS The study involved a systematic manipulation of specific trigger situations to evaluate their influence on challenging behaviour, using a single case experimental design. RESULTS Five residents with agitated and aggressive behaviour were successfully managed. The difficulties in engaging staff in the use of non-pharmacological, rather than pharmacological, methods and the scope for future randomised trials using psychological and environmental interventions to manage challenging behaviour, are discussed.
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Affiliation(s)
- E Moniz-Cook
- Department of Clinical Psychology, School of Medicine, University of Hull, Hull HU3 2SG, UK.
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Erhardt M, Morant M, Ritzenthaler C, Stussi-Garaud C, Guilley H, Richards K, Jonard G, Bouzoubaa S, Gilmer D. P42 movement protein of Beet necrotic yellow vein virus is targeted by the movement proteins P13 and P15 to punctate bodies associated with plasmodesmata. Mol Plant Microbe Interact 2000; 13:520-528. [PMID: 10796018 DOI: 10.1094/mpmi.2000.13.5.520] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cell-to-cell movement of Beet necrotic yellow vein virus (BNYVV) is driven by a set of three movement proteins--P42, P13, and P15--organized into a triple gene block (TGB) on viral RNA 2. The first TGB protein, P42, has been fused to the green fluorescent protein (GFP) and fusion proteins between P42 and GFP were expressed from a BNYVV RNA 3-based replicon during virus infection. GFP-P42, in which the GFP was fused to the P42 N terminus, could drive viral cell-to-cell movement when the copy of the P42 gene on RNA 2 was disabled but the C-terminal fusion P42-GFP could not. Confocal microscopy of epidermal cells of Chenopodium quinoa near the leading edge of the infection revealed that GFP-P42 localized to punctate bodies apposed to the cell wall whereas free GFP, expressed from the replicon, was distributed uniformly throughout the cytoplasm. The punctate bodies sometimes appeared to traverse the cell wall or to form pairs of disconnected bodies on each side. The punctate bodies co-localized with callose, indicating that they are associated with plasmodesmata-rich regions such as pit fields. Point mutations in P42 that inhibited its ability to drive cell-to-cell movement also inhibited GFP-P42 punctate body formation. GFP-P42 punctate body formation was dependent on expression of P13 and P15 during the infection, indicating that these proteins act together or sequentially to localize P42 to the plasmodesmata.
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Affiliation(s)
- M Erhardt
- Institut de Biologie Moléculaire des Plantes du CNRS et de l'Université Louis Pasteur, Strasbourg, France
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Brault V, Mutterer J, Scheidecker D, Simonis MT, Herrbach E, Richards K, Ziegler-Graff V. Effects of point mutations in the readthrough domain of the beet western yellows virus minor capsid protein on virus accumulation in planta and on transmission by aphids. J Virol 2000; 74:1140-8. [PMID: 10627524 PMCID: PMC111448 DOI: 10.1128/jvi.74.3.1140-1148.2000] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/1999] [Accepted: 10/21/1999] [Indexed: 11/20/2022] Open
Abstract
Point mutations were introduced into or near five conserved sequence motifs of the readthrough domain of the beet western yellows virus minor capsid protein P74. The mutant virus was tested for its ability to accumulate efficiently in agroinfected plants and to be transmitted by its aphid vector, Myzus persicae. The stability of the mutants in the agroinfected and aphid-infected plants was followed by sequence analysis of the progeny virus. Only the mutation Y201D was found to strongly inhibit virus accumulation in planta following agroinfection, but high accumulation levels were restored by reversion or pseudoreversion at this site. Four of the five mutants were poorly aphid transmissible, but in three cases successful transmission was restored by pseudoreversion or second-site mutations. The same second-site mutations in the nonconserved motif PVT(32-34) were shown to compensate for two distinct primary mutations (R24A and E59A/D60A), one on each side of the PVT sequence. In the latter case, a second-site mutation in the PVT motif restored the ability of the virus to move from the hemocoel through the accessory salivary gland following microinjection of mutant virus into the aphid hemocoel but did not permit virus movement across the epithelium separating the intestine from the hemocoel. Successful movement of the mutant virus across both barriers was accompanied by conversion of A59 to E or T, indicating that distinct features of the readthrough domain in this region operate at different stages of the transmission process.
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Affiliation(s)
- V Brault
- Station de Recherche "Grandes Cultures," INRA, Colmar 68021 Cedex, France
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Li Kam Wa TC, Mansur AH, Britton J, Williams G, Pavord I, Richards K, Campbell DA, Morton N, Holgate ST, Morrison JF. Association between - 308 tumour necrosis factor promoter polymorphism and bronchial hyperreactivity in asthma. Clin Exp Allergy 1999; 29:1204-8. [PMID: 10469028 DOI: 10.1046/j.1365-2222.1999.00638.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF) is a pivotal cytokine in the inflammation underlying asthma. The TNF gene is located in the polymorphic HLA class 3 region on chromosome 6p. Several polymorphisms in this region have been described and associated with alteration of TNF secretion in vitro. OBJECTIVE In this study we tested the hypothesis that two such polymorphisms, lymphotoxin alpha NcoI B*1 and -308 TNF2 may be components of the genetic predisposition to asthma. METHODS Five hundred and fifty-six random individuals were studied, comprising approximately equal numbers of asthmatic subjects, with or without atopy, and a nonatopic nonasthmatic control group. In addition, 355 subjects (172 asthmatics) from 60 multiplex families were typed at the LTalpha NcoI locus. RESULTS There was an association between allele two of the -308 TNF polymorphism and bronchial hyperreactivity (OR 2.12, 95% CI 1.04-4.32, P = 0.036). However, there was no association with LTalpha NcoI alleles. To determine whether this was influenced by linkage disequilibrium within the MHC, 91 subjects with bronchial hyperreactivity and 85 control subjects were typed for class 2 and 3 alleles. Following identification of the extended TNF2 haplotype, we found no independent association of these alleles with BHR. CONCLUSIONS We conclude that the -308 TNF2 promoter polymorphism may form a component of the genetic predisposition to BHR in asthma.
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Affiliation(s)
- T C Li Kam Wa
- Molecular Medicine Unit, Clinical Sciences Building, St James's University Hospital, Leeds, UK
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50
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Newcomer JW, Selke G, Melson AK, Hershey T, Craft S, Richards K, Alderson AL. Decreased memory performance in healthy humans induced by stress-level cortisol treatment. Arch Gen Psychiatry 1999; 56:527-33. [PMID: 10359467 DOI: 10.1001/archpsyc.56.6.527] [Citation(s) in RCA: 400] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Glucocorticoids (GCs) can regulate hippocampal metabolism, physiologic functions, and memory. Despite evidence of memory decreases during pharmacological GC treatment, and correlations between memory and cortisol levels in certain disease conditions, it remains unclear whether exposure to the endogenous GC cortisol at levels seen during physical and psychological stress in humans can inhibit memory performance in otherwise healthy individuals. METHODS Randomized, double-blind, placebo-controlled comparison of 2 fixed oral doses of cortisol (40 mg/d and 160 mg/d using split doses to approximate circadian rhythm) given for 4 days to matched groups of healthy subjects (n = 51). Lower-dose treatment approximated cortisol exposure during mild stress, whereas the higher dose approximated cortisol exposure during major stress. Cognitive testing and plasma sampling were done at baseline, after 1 and 4 days of treatment, and after a 6-day washout period, hypothesizing dose-dependent decreases in verbal declarative memory. RESULTS Cortisol treatment at the higher dose produced reversible decreases in verbal declarative memory without effects on nonverbal memory, sustained or selective attention, or executive function. A significant interaction between time and treatment condition for paragraph recall was explained by treatment-induced differences in performance after 4 treatment days, with lower immediate and delayed recall performance during higher-dose cortisol treatment compared with lower-dose treatment and placebo. CONCLUSIONS Several days of exposure to cortisol at doses and plasma concentrations associated with physical and psychological stress in humans can-similar to pharmacological GC treatment-reversibly decrease specific elements of memory performance in otherwise healthy individuals.
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Affiliation(s)
- J W Newcomer
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA.
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