1
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Stone SN, Sheth M, Rydberg L. Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation. PM R 2024. [PMID: 38700148 DOI: 10.1002/pmrj.13194] [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: 10/07/2023] [Revised: 02/28/2024] [Accepted: 03/21/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Shane N Stone
- Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Manasi Sheth
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Leslie Rydberg
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- The Shirley Ryan AbilityLab, Chicago, Illinois, USA
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2
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Tolchin DW, Ankam NS, Rydberg L. Twelve tips for including disability education in undergraduate medical education. Med Teach 2024:1-8. [PMID: 38386799 DOI: 10.1080/0142159x.2024.2317913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Disability is a large and growing minority population worldwide. People with disabilities continue to experience health and healthcare disparities. Despite multiple calls to action to provide disability education within undergraduate medical education as a strategy to mitigate ongoing inequities, robust disability education is not routinely provided across medical schools. This article provides twelve tips that any medical school faculty can utilize to integrate meaningful disability education within existing core medical education.
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Affiliation(s)
- Dorothy W Tolchin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spauling Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, MassGeneral Brigham, Boston, Massachusetts, USA
| | - Nethra S Ankam
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leslie Rydberg
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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3
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Rydberg L, Gilbert A, Rho M, Neal J. Developing residents as educators: A medical education track within a physical medicine and rehabilitation residency program. PM R 2024; 16:102-107. [PMID: 37607128 DOI: 10.1002/pmrj.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/29/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Leslie Rydberg
- Physical Medicine and Rehabilitation and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron Gilbert
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Monica Rho
- Musculoskeletal Medicine, Shirley Ryan AbilityLab, Physical Medicine and Rehabilitation and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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4
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Goodman DA, Jensen A, Fahey K, Walaszek E, Vail C, Nassiri K, Jayabalan P, Oswald M, Rydberg L. Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID-19 pulmonary disease. PM R 2024; 16:25-35. [PMID: 37272798 DOI: 10.1002/pmrj.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/08/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) has introduced a new subset of patients with acute end-stage lung damage for which lung transplantation has been successfully performed. OBJECTIVE To describe the inpatient rehabilitation course of patients who underwent bilateral lung transplant due to severe COVID-19 pulmonary disease. DESIGN Retrospective chart review. SETTING Free-standing, academic, urban inpatient rehabilitation hospital. PARTICIPANTS Seventeen patients aged 28-67 years old (mean 53.9 ± 10.7) who developed COVID-19 respiratory failure and underwent bilateral lung transplant. INTERVENTIONS Patients participated in a comprehensive inpatient rehabilitation program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual. MAIN OUTCOME MEASURES Primary outcome measures of functional improvements, include mobility and self-care scores on section GG of the Functional Abilities and Goals of the Improving Post-Acute Care Transformation Act, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, Mann Assessment of Swallowing Ability (MASA), and Cognition and Memory Functional Independence Measure (FIM) scores. Wilcoxon signed rank sum test was used to evaluate statistical significance of change between admission and discharge scores. RESULTS Fourteen patients completed inpatient rehabilitation. Self-care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6-minute walk distance improved from 174.1 to 467.6 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All functional measures demonstrated statistically significant improvements with p value ≤ .008, except for cognition and memory FIM scores, which did not show a statistically significant difference. A majority (76%) of patients discharged home. CONCLUSION This new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications.
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Affiliation(s)
| | | | - Kyle Fahey
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Amita Resurrection Health, Chicago, IL, United States
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5
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Barker K, Rydberg L, Lanphere J, Malmut L, Neal J, Eickmeyer S. The utility of inpatient rehabilitation in heart transplantation: A review. Clin Transplant 2024; 38:e15182. [PMID: 37922201 DOI: 10.1111/ctr.15182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
Heart transplantation is considered definitive treatment for patients with end-stage heart failure. Unfortunately, medical and functional complications are common after heart transplantation for a variety of reasons, and these may impact the patients' functional recovery. Rehabilitation is often needed post-operatively to improve functional outcomes. This review article aims to discuss the transplanted heart exercise physiology that may affect the rehabilitation process and provide an overview of the functional benefits of inpatient rehabilitation for cardiac and surgical specialties who may be less familiar with post-acute care rehabilitation options for their patients.
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Affiliation(s)
- Kim Barker
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Rydberg
- Northwestern University Feinberg School of Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Laura Malmut
- MedStar National Rehabilitation Network, Washington, USA
- Department of Physical Medicine and Rehabilitation, Georgetown University School of Medicine, Washington, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, USA
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6
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Mattar K, Eickmeyer SM, Babbitt E, Rydberg L. The case for health professional student communication skills training for persons with aphasia. PM R 2023. [PMID: 37854009 DOI: 10.1002/pmrj.13087] [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] [Received: 04/26/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Communication challenges in persons with aphasia may negatively affect their health care. Building effective communication skills is critical for health professional student education, yet communication skills for interacting with persons with aphasia are often not taught or practiced within health care education. A review of the literature found that research is limited but does demonstrate evidence-based training can improve skills for health professional students. Through utilization of workshops, seminars, and standardized patients, medical students and other health professional students can build confidence and skills in successful communication for future encounters with persons with aphasia.
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Affiliation(s)
- Kevin Mattar
- Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine, Kansas, Kansas, USA
| | - Sarah M Eickmeyer
- Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas, Kansas, USA
| | - Edna Babbitt
- Physical Medicine & Rehabilitation, Shirley Ryan AbilityLab; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leslie Rydberg
- Physical Medicine & Rehabilitation, Shirley Ryan AbilityLab; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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7
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Rydberg L, Barker K, Lanphere J, Malmut L, Neal J, Eickmeyer S. Heart transplantation and the role of inpatient rehabilitation: A narrative review. PM R 2023; 15:1351-1360. [PMID: 36565450 DOI: 10.1002/pmrj.12935] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Abstract
Heart transplantation is a definitive treatment option for patients with end-stage heart failure. Medical and functional complications are common after this procedure, and rehabilitation is often needed postoperatively. Physiatrists caring for persons who have received a donor heart must appreciate the surgical background, the physiologic changes expected, as well as the potential medical complications for which they are at risk after heart transplantation. This review summarizes various topics in heart transplantation including the history of the procedure, exercise physiology and functional outcomes, postoperative medical therapy, medical complications, and special considerations for inpatient rehabilitation in this patient population.
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Affiliation(s)
- Leslie Rydberg
- Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim Barker
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Julie Lanphere
- T12 Neuro Specialty Rehab Unit at Intermountain Medical Center, Murray, Utah, USA
| | - Laura Malmut
- MedStar National Rehabilitation Network, Washington, District of Columbia, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Eickmeyer
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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8
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Stone SN, Rydberg L. Creating and confirming observable professional activities (OPAs): A brief report on the practical approach for OPA design for resident education. J Spinal Cord Med 2023; 46:865-869. [PMID: 36972220 PMCID: PMC10446771 DOI: 10.1080/10790268.2023.2191100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
CONTEXT The transition of graduate medical education to competency-based education systems has resulted in exploration of the efficacy of Entrustable Professional Activities (EPAs) and related Observable Practice Activities (OPAs) as evaluation tools. EPAs were introduced to PM&R in 2017, but no OPAs have been reported for a non-procedurally based EPA. The primary aims of this study were to create and form consensus on OPAs for the Spinal Cord Injury EPA. METHODS A Modified Delphi panel of seven experts in the field was utilized to gain consensus on ten PM&R OPAs for the Spinal Cord Injury EPA. RESULTS After the first round of evaluations, most OPAs were evaluated by experts as requiring modifications (30/70 votes to keep, 34/70 votes to modify) with a majority of comments focusing on the specific content of the OPAs. Edits were made, and after the second round, the OPAs were evaluated and determined to be kept (62/70 votes to keep, 6/70 votes to modify) with most edits being about semantics of the OPAs. Ultimately, there was significant difference in all three categories between round 1 and round 2 (P < 0.0001) and 10 OPAs were finalized for use. CONCLUSIONS This study created 10 OPAs that can potentially help provide targeted feedback to residents on their competency in caring for patients with spinal cord injury. With regular usage, OPAs are designed to provide residents with insight into how they are progressing towards independent practice. In the future, studies should aim to assess the feasibility and utility of implementing the newly developed OPAs.
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Affiliation(s)
- Shane N. Stone
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Leslie Rydberg
- Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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9
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Melamed E, Rydberg L, Ambrose AF, Bhavaraju-Sanka R, Fine JS, Fleming TK, Herman E, Phipps Johnson JL, Kucera JR, Longo M, Niehaus W, Oleson CV, Sampsel S, Silver JK, Smith MM, Verduzco-Gutierrez M. Multi-Disciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2023; 15:640-662. [PMID: 36989078 DOI: 10.1002/pmrj.12976] [Citation(s) in RCA: 3] [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: 10/05/2022] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine/Shirley Ryan AbilityLab, Chicago, IL
| | - Anne Felicia Ambrose
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, New York, NY
| | - Ratna Bhavaraju-Sanka
- Associate Professor Department of Neurology, UT Health San Antonio Joe R. & Teresa Lozano-Long School of Medicine, San Antonio, TX
| | - Jeffrey S Fine
- Department of Rehabilitation Medicine, Rusk Rehabilitation, NYU Langone Health, New York, NY
| | - Talya K Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ
| | - Eric Herman
- Chief Primary Care & Population Health, Department of Family Medicine, OHSU (Oregon Health & Sciences University), Portland, OR
| | | | | | - Michele Longo
- Department of Clinical Neurosciences Tulane University, New Orleans, LA
| | - William Niehaus
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado
| | - Christina V Oleson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, The MetroHealth Rehabilitation Institute, Cleveland, OH
| | | | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, MA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
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10
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Farr E, Goldring A, Vernacchia C, Woo L, Mhatre P, Rydberg L. Should virtual medical student clerkships in Physical Medicine & Rehabilitation continue? PM R 2022; 15:674-680. [PMID: 36580540 DOI: 10.1002/pmrj.12941] [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: 08/26/2022] [Revised: 11/03/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Ellen Farr
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne Goldring
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cara Vernacchia
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Woo
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Priya Mhatre
- Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leslie Rydberg
- Shirley Ryan Ability Lab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Franz CK, Murthy NK, Malik GR, Kwak JW, D'Andrea D, Wolfe AR, Farr E, Stearns MA, Deshmukh S, Tavee JO, Sun F, Swong KN, Rydberg L, Cotton RJ, Wolfe LF, Walter JM, Coleman JM, Rogers JA. The distribution of acquired peripheral nerve injuries associated with severe COVID-19 implicate a mechanism of entrapment neuropathy: a multicenter case series and clinical feasibility study of a wearable, wireless pressure sensor. J Neuroeng Rehabil 2022; 19:108. [PMID: 36209094 PMCID: PMC9547638 DOI: 10.1186/s12984-022-01089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
We diagnosed 66 peripheral nerve injuries in 34 patients who survived severe coronavirus disease 2019 (COVID-19). We combine this new data with published case series re-analyzed here (117 nerve injuries; 58 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (25.1%), common fibular (15.8%), sciatic (13.1%), median (9.8%), brachial plexus (8.7%) and radial (8.2%) nerves at sites known to be vulnerable to mechanical loading. Protection of peripheral nerves should be prioritized in the care of COVID-19 patients. To this end, we report proof of concept data of the feasibility for a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.
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Affiliation(s)
- Colin K Franz
- Shirley Ryan Ability Lab, 26-North, 355 E. Erie Street, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
| | - Nikhil K Murthy
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - George R Malik
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Jean W Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Dom D'Andrea
- Shirley Ryan Ability Lab, 26-North, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - Alexis R Wolfe
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen Farr
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Melanie A Stearns
- Marianjoy Rehabilitation Hospital, Northwestern Medicine, Wheaton, IL, USA
| | - Swati Deshmukh
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jinny O Tavee
- Division of Neurology & Behavioral Health, National Jewish Health, Denver, CO, USA
| | - Fang Sun
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin N Swong
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leslie Rydberg
- Shirley Ryan Ability Lab, 26-North, 355 E. Erie Street, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R James Cotton
- Shirley Ryan Ability Lab, 26-North, 355 E. Erie Street, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa F Wolfe
- Shirley Ryan Ability Lab, 26-North, 355 E. Erie Street, Chicago, IL, 60611, USA.,The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James M Walter
- The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John M Coleman
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Chemistry, Northwestern University, Evanston, IL, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
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12
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Bosques G, Ankam NS, Kasi R, Rydberg L, Sauter C, Therattil M, Tolchin DW. Now Is the Time: A Primer on How to Be a Disability Education Champion in Your Medical School. Am J Phys Med Rehabil 2022; 101:89-96. [PMID: 33496438 DOI: 10.1097/phm.0000000000001703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.
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Affiliation(s)
- Glendaliz Bosques
- From the Department of Physical Medicine and Rehabilitation, McGovern Medical School at University of Texas Health Sciences Center at Houston, Shriners Hospital for Children in Houston, TIRR Memorial Hermann Hospital, Houston, Texas (GB); Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (NSA); Rush Medical College at Rush University Medical Center, Chicago, Illinois (RK); Northwestern University Feinberg School of Medicine and Shirley Ryan Ability Lab, Chicago, Illinois (LR); Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin (CS); Drexel University College of Medicine, Philadelphia, Pennsylvania (MT); and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, Massachusetts (DWT)
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13
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Maley JH, Alba GA, Barry JT, Bartels MN, Fleming TK, Oleson CV, Rydberg L, Sampsel S, Silver JK, Sipes S, Verduzco Gutierrez M, Wood J, Zibrak JD, Whiteson J. Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Breathing Discomfort and Respiratory Sequelae in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2021; 14:77-95. [PMID: 34902224 DOI: 10.1002/pmrj.12744] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Jason H Maley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - George A Alba
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John T Barry
- Good Shepherd Penn Partners, Penn Therapy & Fitness - University City, Philadelphia, PA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Montefiore Health System, Albert Einstein College of Medicine, New York
| | - Talya K Fleming
- JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ
| | - Christina V Oleson
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Case Western Reserve University, Cleveland, OH
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Sipes
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | | | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph D Zibrak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan Whiteson
- Department of Rehabilitation Medicine and Department of Medicine, Rusk Rehabilitation, NYU Langone Health, New York, NY
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14
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Mathews A, Doobay-Persaud A, Rydberg L. The Development of a Novel International Elective in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2021; 100:803-808. [PMID: 33252470 DOI: 10.1097/phm.0000000000001652] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Interest in global health is rising in graduate medical education. Trainees are increasingly seeking high-quality, ethically sound, and educationally robust opportunities for global medical rotations (Int J Gynecol Obstet. 2014;128(2):148-51). When based on best educational practices, these opportunities can provide a unique learning experience for residents in traditional physical medicine and rehabilitation programs. This article describes the development of an international rotation in physical medicine and rehabilitation including specific competency-based physical medicine and rehabilitation global health learning objectives, predeparture training, rotation structure, and postrotation feedback mechanisms. The aim is to present the development of the program as a resource for both residents and program directors to help create and maximize existing rotations at their own institutions. Learners must complete predeparture requirements that include completion of a musculoskeletal rotation and global health didactics intended to provide foundational knowledge in physiatry and global health. Postrotation requirements include the residency program's standardized evaluation form, resident survey, and self-reflection essay. Experience from a novel 4-wk pilot rotation to Punta Gorda, Belize, is described to exemplify Accreditation Council for Graduate Medical Education-based learning objectives as well as the benefits of a formalized rotation structure. Using this unique set of learning objectives and proposed rotation requirements, the authors believe that physical medicine and rehabilitation residency programs can develop valuable global health learning experiences.
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Affiliation(s)
- Amy Mathews
- From the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas (AM); Departments of Medicine (Hospital Medicine) and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois (AD-P); Center for Global Health Education, Northwestern University Institute for Global Health, Chicago, Illinois (AD-P); Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (LR); and Rehabilitation Institute of Chicago, Chicago, Illinois (LR)
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15
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Farr E, Wolfe AR, Deshmukh S, Rydberg L, Soriano R, Walter JM, Boon AJ, Wolfe LF, Franz CK. Diaphragm dysfunction in severe COVID-19 as determined by neuromuscular ultrasound. Ann Clin Transl Neurol 2021; 8:1745-1749. [PMID: 34247452 PMCID: PMC8351384 DOI: 10.1002/acn3.51416] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022] Open
Abstract
Many survivors from severe coronavirus disease 2019 (COVID-19) suffer from persistent dyspnea and fatigue long after resolution of the active infection. In a cohort of 21 consecutive severe post-COVID-19 survivors admitted to an inpatient rehabilitation hospital, 16 (76%) of them had at least one sonographic abnormality of diaphragm muscle structure or function. This corresponded to a significant reduction in diaphragm muscle contractility as represented by thickening ratio (muscle thickness at maximal inspiration/end-expiration) for the post-COVID-19 compared to non-COVID-19 cohorts. These findings may shed new light on neuromuscular respiratory dysfunction as a contributor to prolonged functional impairments after hospitalization for post-COVID-19.
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Affiliation(s)
- Ellen Farr
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexis R Wolfe
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leslie Rydberg
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachna Soriano
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James M Walter
- The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Lisa F Wolfe
- The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Colin K Franz
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Verduzco-Gutierrez M, Rydberg L, Sullivan MN, Mukherjee D. In This for the Long Haul: Ethics, COVID-19, and Rehabilitation. PM R 2021; 13:325-332. [PMID: 33476491 PMCID: PMC8014259 DOI: 10.1002/pmrj.12554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX
| | - Leslie Rydberg
- Shirley Ryan AbilityLab, Northwestern University, Chicago, IL
| | | | - Debjani Mukherjee
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY
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17
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Malik GR, Wolfe AR, Soriano R, Rydberg L, Wolfe LF, Deshmukh S, Ko JH, Nussbaum RP, Dreyer SD, Jayabalan P, Walter JM, Franz CK. Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome. Br J Anaesth 2020; 125:e478-e480. [PMID: 32948295 PMCID: PMC7473147 DOI: 10.1016/j.bja.2020.08.045] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- George R Malik
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexis R Wolfe
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachna Soriano
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leslie Rydberg
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa F Wolfe
- The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Swati Deshmukh
- Department of Radiology, Northwestern University Feinberg School of MedicineChicago, IL, USA
| | - Jason H Ko
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan P Nussbaum
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sean D Dreyer
- McGaw Medical Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Prakash Jayabalan
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James M Walter
- The Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Colin K Franz
- Shirley Ryan Ability Lab (Formerly the Rehabilitation Institute of Chicago), Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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18
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Eickmeyer SM, Barker KD, Sayyad A, Rydberg L. The Rehabilitation of Patients With Advanced Heart Failure After Left Ventricular Assist Device Placement: A Narrative Review. PM R 2019; 11:64-75. [PMID: 29929019 DOI: 10.1016/j.pmrj.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/17/2018] [Indexed: 01/18/2023]
Abstract
Because more patients with advanced heart failure are receiving a left ventricular assist device (LVAD) as destination therapy or a bridge to transplantation, there is increasing attention on functional outcomes and quality of life after LVAD implantation. Rehabilitation providers in the acute inpatient rehabilitation setting increasingly will treat patients with an LVAD and should understand the exercise physiology, medical management, rehabilitation considerations, and outcomes after rehabilitation for patients with an LVAD. The purpose of this article is to provide the physiatrist with a comprehensive understanding of the rehabilitation of patients with advanced heart failure and LVAD implantation. Changes in relevant organ system physiology and exercise physiology after LVAD are summarized. Safety of rehabilitation and program considerations for acute inpatient rehabilitation are reviewed. Recommendations for medical management and prevention of secondary complications seen in patients with an LVAD are outlined. A discussion of outcomes after acute inpatient rehabilitation, the dual diagnosis of stroke and LVAD placement, and long-term cognitive, functional, and quality-of-life outcomes after LVAD placement is presented.
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Affiliation(s)
- Sarah M Eickmeyer
- Department of Rehabilitation Medicine, University of Kansase-Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160
| | - Kim D Barker
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anjum Sayyad
- Department of Physical Medicine and Rehabilitation, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; Marianjoy Rehabilitation Hospital, Wheaton, Illinois
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Shirley Ryan AbilityLab, Chicago, Illinois
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19
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Oza S, Rydberg L. Poster 379: Knowledge and Perception Towards Rehabilitation Services Among Trainees in Oncology: A National Survey. PM R 2018. [DOI: 10.1016/j.pmrj.2018.09.018] [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: 11/15/2022]
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20
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Ross BS, Ripley D, Ho AM, Rydberg L. Femoral and Lumbar Fractures During Rehabilitation for a Traumatic Spinal Cord Injury in Osteogenesis Imperfecta: A Case Presentation. PM R 2017; 9:1175-1178. [PMID: 28483687 DOI: 10.1016/j.pmrj.2017.04.010] [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] [Received: 11/14/2016] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
Osteogenesis imperfecta (OI) is one of the most common inherited bone disorders. These individuals are high-risk for developing fractures during their lifetime secondary to bone fragility. This case presents a female with type I OI involved in a high speed motor vehicle accident resulting in a traumatic spinal cord injury (SCI) and paraplegia. Inpatient rehabilitation was complicated by fractures of the femur and lumbar spine which impacted her level of independence upon discharge to prevent additional fractures and maintain safety. OI coupled with SCI creates a difficult combination for the rehabilitation team. This case highlights the complexity of this challenge to bring awareness to the rehabilitation team in order to safely maximize independence and minimize and prevent unnecessary injury when designing an interdisciplinary treatment plan. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Brendon S Ross
- Northwestern University/McGaw Medical Center, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Rehabilitation Institute of Chicago, 345 E Superior Street, Suite 1600, Chicago, IL 60611(∗).
| | - David Ripley
- Northwestern University/McGaw Medical Center, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL(†)
| | - Anna M Ho
- Rehabilitation Institute of Chicago, Chicago, IL(‡)
| | - Leslie Rydberg
- Northwestern University/McGaw Medical Center, Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL(§)
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Callander M, Haghighi S, Landtblom AM, Ahlgren CE, Nilsson SI, Rydberg L, Al Khoury H, Rosegren L, Andersen O. Multiple sclerosis immunopathic trait and HLA-DR(2)15 as independent risk factors in multiple sclerosis. Mult Scler 2016; 13:441-5. [PMID: 17463066 DOI: 10.1177/1352458506070264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analysed HLA haplotypes in pairs of 78 sporadic multiple sclerosis (MS) patients and 78 healthy siblings. The presence of 2 oligoclonal IgG bands, detected by immunoblotting of the cerebrospinal fluid in healthy siblings, has previously been defined as MS immunopathic trait (MSIT), based on a cut-off derived from healthy unrelated volunteers. The frequency of MSIT was 17.9% (n=14/78 siblings). The HLA-DR(15)2 allelle was present in 21.4% (n=3/14) of the siblings with MSIT, in 40.6% (n =26/64) of the siblings without MSIT, and in 59% (n =46/78) of the patients with clinically-definite (CD) MS. The distribution of zero, one or two HLA-DR(2)15 alleles was significantly skewed towards a lower allelle count in the siblings with MSIT compared with the group of unrelated siblings with MS (P=0.002), and also lower than their related siblings with MS (P=0.1). These results suggest that the MS susceptibility gene, HLA-DR(2)15 type, does not induce MSIT, and conceivably these are two separate risk factors in the development of MS. The effect of HLA-DR(2)15 and MSIT in sporadic MS appears to be synergistic. Multiple Sclerosis 2007; 13: 441-445. http://msj.sagepub.com
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Affiliation(s)
- M Callander
- Department of Neurology, University Hospital, Linköping, Sweden.
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22
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Haghighi S, Andersen O, Nilsson S, Rydberg L, Wahlström J. A linkage study in two families with multiple sclerosis and healthy members with oligoclonal CSF immunopathy. Mult Scler 2016; 12:723-30. [PMID: 17262999 DOI: 10.1177/1352458506070972] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We studied two extended families in which not only multiple sclerosis (MS) segregates, but also approximately 18% of the cerebrospinal fluid (CSF) investigated blood relatives have ‘MS immunopathic trait’, an oligoclonal CSF immunopathy similar to that seen in MS, but with no neurological symptoms. Both families fit a genetic model for autosomal dominant inheritance for MS immunopathic trait, although with reduced penetrance in family A. In order to identify genetic factors of importance for the development of MS immunopathic trait, we performed a genome scan using the CHLC/Weber Screening Set (ver 6A), with 285 successful markers, to test the hypothesis that a single gene is causing the MS immunopathic trait in these families. Using a parametric method, we identified regions with suggestive linkage at chromosome 6q12 with a LOD-score of 2.4, putative linkage with LOD-score 1.5 at chromosome 6p21 (HLA region), putative linkage at chromosome 12q24 with a LOD-score of 1.7 and suggestive linkage at chromosome 19q13.2 with a LOD-score of 1.8. The LOD-score at chromosome 19q13.2 increased to 2.2 when only family A was analysed. In family A, all MS patients and two of five individuals with MS immunopathic trait had HLA DRB1*(15) and in family B, all blood relatives had the rare HLA type DRB1*0103, which is associated with other autoimmune diseases. We suggest that DRB1*0103 is a necessary but not sufficient condition for the susceptibility for MS immunopathic trait in this family.
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Affiliation(s)
- S Haghighi
- Institute of Clinical Neuroscience, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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McCormick ZL, Lynch M, Liem B, Jacobs G, Hwang P, Hornby TG, Rydberg L, Roth E. Feasibility for developing cardiovascular exercise recommendations for persons with motor-complete paraplegia based on manual wheelchair propulsion; A protocol and preliminary data. J Spinal Cord Med 2016; 39:45-9. [PMID: 25582138 PMCID: PMC4725791 DOI: 10.1179/2045772314y.0000000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Center for Disease Control, American Heart Association, and American College of Sports Medicine recommendations for duration and intensity of exercise are based on the amount of energy expenditure required to maintain cardiovascular health in able body individuals; 1000 Kilocalories (Kcals) per week of energy expenditure has been demonstrated to achieve this effect. Manual wheelchair propulsion (MWP) represents a practical and accessible form of exercise for individuals with paraplegia. OBJECTIVE To describe a method to determine the duration of MWP required to expend 1000 Kcals, when performed by individuals with paraplegia due to motor-complete spinal cord injury (SCI). STUDY DESIGN Cross-sectional study. SETTING Rehabilitation Research Laboratory. PARTICIPANTS Sixteen adults with motor complete T3-T12 paraplegia (body mass index < 35, duration of paraplegia > 3 months). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Indirect calorimetry during MWP was measured in order to calculate caloric expenditure per minute. These data were used to calculate the number of minutes of MWP required to expend 1000 Kcal in one week. RESULTS During MWP, participants expended 3.3 ± 1.0 Kcal/minute. Based on this figure, 1000 Kcal of energy expenditure in one week would require 303 minutes of MWP per week, or 43.3 minutes per day, 7 days per week. CONCLUSIONS Our data suggest that it is feasible to create a practical and accessible exercise recommendation based on manual wheelchair propulsion for individuals with paraplegia due to motor-complete SCI. Larger studies are needed in order to develop accurate exercise recommendations for persons with SCI.
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Affiliation(s)
- Zachary L. McCormick
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern McGaw Medical Center, Chicago, IL, USA,Correspondence to: Zachary L. McCormick, The Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Meaghan Lynch
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern McGaw Medical Center, Chicago, IL, USA
| | - Brian Liem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Geneva Jacobs
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern McGaw Medical Center, Chicago, IL, USA
| | - Peter Hwang
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA
| | - Thomas George Hornby
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elliot Roth
- Department of Physical Medicine and Rehabilitation, The Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Lynch MM, McCormick Z, Liem B, Jacobs G, Hwang P, Hornby TG, Rydberg L, Roth EJ. Energy Cost of Lower Body Dressing, Pop-Over Transfers, and Manual Wheelchair Propulsion in People with Paraplegia Due to Motor-Complete Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2015; 21:140-8. [PMID: 26364283 DOI: 10.1310/sci2102-140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/11/2022]
Abstract
BACKGROUND Energy required for able-bodied individuals to perform common activities is well documented, whereas energy associated with daily activities among people with spinal cord injury (SCI) is less understood. OBJECTIVE To determine energy expended during several basic physical tasks specific to individuals with paraplegia due to motor-complete SCI. METHODS Sixteen adults with motor-complete SCI below T2 level and duration of paraplegia greater than 3 months were included. Oxygen consumption (VO2), caloric expenditure, and heart rate were measured at rest and while participants performed lower body dressing (LBD), pop-over transfers (POTs), and manual wheelchair propulsion (MWP) at a self-selected pace. These data were used to calculate energy expenditure in standard metabolic equivalents (METs), as defined by 1 MET = 3.5 mL O2/kg/min, and in SCI METs using the conversion 1 SCI MET = 2.7 mL O2/kg/min. RESULTS VO2 at rest was 3.0 ± 0.9 mL O2/kg/min, which equated to 0.9 ± 0.3 standard METs and 1.1 ± 0.4 SCI METs in energy expenditure. LBD required 3.2 ± 0.7 METs and 4.1 ± 0.9 SCI METs; POTs required 3.4 ± 1.0 METs and 4.5 ± 1.3 SCI METs; and MWP required 2.4 ± 0.6 METs and 3.1 ± 0.7 SCI METs. CONCLUSIONS Resting VO2 for adults with motor-complete paraplegia is 3.0 mL O2/kg/min, which is lower than standard resting VO2 in able-bodied individuals. Progressively more energy is required to perform MWP, LBD, and POTs, respectively. Use of the standard METs formula may underestimate the level of intensity an individual with SCI uses to perform physical activities.
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Affiliation(s)
- Meaghan M Lynch
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zachary McCormick
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian Liem
- University of Washington Medical Center, Seattle, Washington
| | - Geneva Jacobs
- Brooks Rehabilitation Hospital, Jacksonville, Florida
| | - Peter Hwang
- Howard A. Rusk Rehabilitation Center, Columbia, Missouri
| | - Thomas George Hornby
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leslie Rydberg
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elliot J Roth
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Mathews A, Rydberg L. Poster 284 Osteochondroma after Ankle-Foot Orthosis Use: A Case Report. PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.320] [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: 10/23/2022]
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26
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Maneyapanda M, Rydberg L. Poster 191 Evaluation of a Formal Mentorship Program in Physical Medicine & Rehabilitation. PM R 2015. [DOI: 10.1016/j.pmrj.2015.06.230] [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: 10/23/2022]
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Chu SK, McCormick Z, Hwang S, Sliwa JA, Rydberg L. Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices. PM R 2014; 6:1008-12. [DOI: 10.1016/j.pmrj.2014.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/03/2014] [Accepted: 05/03/2014] [Indexed: 01/31/2023]
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Mattie R, McCormick Z, Rydberg L. A Case of Progressive Multifocal Leukoencephalopathy due to HIV/AIDS with Functional Improvement After Acute Inpatient Rehabilitation. PM R 2013. [DOI: 10.1016/j.pmrj.2013.08.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cushman D, Rydberg L. A General Rehabilitation Inpatient With Exercise-Induced Vasculitis. PM R 2013; 5:900-2. [DOI: 10.1016/j.pmrj.2013.04.015] [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] [Received: 02/02/2013] [Revised: 04/03/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
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Karvelas K, Rydberg L, Oswald M. Electrodiagnostics and clinical correlates in acquired polyneuropathies. PM R 2013; 5:S56-62. [PMID: 23542775 DOI: 10.1016/j.pmrj.2013.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022]
Abstract
Peripheral neuropathies result from a variety of inherited and acquired pathologies. They display an assortment of clinical signs and symptoms and present with a broad range of severity. Electrodiagnosis can play a key role in the evaluation of a suspected peripheral neuropathy. A peripheral nerve disorder is first suspected on the basis of history and physical examination findings. Electrodiagnosis is then used to confirm the diagnosis and to characterize the peripheral neuropathy, providing information about its distribution, pathophysiologic process (demyelinating vs axonal), and chronicity.
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Friman S, Nordén G, Lennerling A, Fehrman-Ekholm I, Felldin M, Hansson S, Rydberg L, Holgersson J, Rizell M, Kvarnström N, Gustafsson B, Gäbel M, Olausson M, Mjörnstedt L. Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden. Clin Transpl 2011:119-125. [PMID: 22755408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.
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Affiliation(s)
- S Friman
- Sahlgrenska University Hospital, Gothenburg, Sweden.
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Mikaelsson M, Nilsson IM, Cedergren B, Jonsson S, Rydberg L, Wiechel B. The use of desmopressin (DDAVP) in the preparation of improved factor VIII concentrate. Scand J Haematol Suppl 2009; 40:93-101. [PMID: 6433478 DOI: 10.1111/j.1600-0609.1984.tb02550.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
BACKGROUND AND OBJECTIVE The basis of blood group A(1) and A(2) phenotypes has been debated for many decades, and still the chemical basis is unresolved. The literature generally identifies the glycolipid chemical differences between blood group A(1) and A(2) phenotypes as being poor or no expression of A type 3 and A type 4 structures on A(2) red cells, although this assertion is not unanimous. MATERIALS AND METHODS Using purified glycolipids and specific monoclonal antibodies, we revisited the glycolipid basis of the A(1) and A(2) phenotypes. Purified glycolipids were extracted from four individual A(1) and four individual A(2) blood units. One blood unit from an A weak subgroup was also included. Monoclonal anti-A reagents including those originally used to define the basis of A(1) and A(2) phenotypes were used in a thin layer chromatography - enzyme immunoassay to identify the presence of specific glycolipids. RESULTS A type 3 glycolipid structures were found to be present in large amounts in all phenotypes. In contrast, the A type 4 glycolipid structure was virtually undetectable in the A(2) phenotype, but was present in the A(1) and A subgroup samples. CONCLUSION The major glycolipid difference between the A(1) and A(2) phenotypes is the dominance of A type 4 glycolipids in the A(1) phenotype.
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Affiliation(s)
- L Svensson
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden.
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Diswall M, Angström J, Schuurman HJ, Dor FJMF, Rydberg L, Breimer ME. Glycolipid studies in small intestine and pancreas of alpha1,3-galactosyltransferase knockout miniature swine: alpha1,3GALT-KO animals lack alphaGAL antigens and contain novel blood group H compounds. Transplant Proc 2008; 40:543-6. [PMID: 18374124 DOI: 10.1016/j.transproceed.2008.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
BACKGROUND To avoid hyperacute rejection of xeno-organs, alpha1,3-galactosyltransferase knock-out (GalT-KO) pigs have been produced. However, Galalpha1,3Gal (Gal) determinant elimination may expose cryptic carbohydrate antigens and/or generate new antigens that might interfere with the human immune response. METHODS Glycolipids isolated from small intestine and pancreas of two GalT-KO and one wild-type (WT) pig were tested for immune reactivity with antibodies on thin-layer chromatograms after separation by high-performance liquid chromatography, and selected fractions were analysed by proton NMR spectroscopy. RESULTS Immunostaining using purified human anti-Gal Abs revealed that tissues from WT animals express large amounts of Gal-antigens whereas GalT-KO tissues lacked these antigens. Proton NMR spectroscopy on small intestine fractions revealed both linear and branched nona- and decaglycosylceramides, respectively, with terminal Gal-epitopes. In corresponding GalT-KO fractions, Gal-epitopes seemed to be replaced by terminal alpha1,2fucoses. Two novel branched blood group H compounds was found in the GalT-KO intestine. CONCLUSIONS The structural complexity of alphaGal-terminating antigens in the WT organs is very high. Knockout of alpha1,3GalT by gene-targeting results in elimination of Gal-determinants. In addition structurally novel alpha1,2fucose-terminated blood group H compounds were identified in the GalT-KO tissue. These compounds are not expected to be recognized by the human immune system.
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Affiliation(s)
- M Diswall
- Department of Surgery, Sahlgrenska University Hospital/campus Ostra, Göteborg, Sweden.
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Skogsberg U, Breimer ME, Friman S, Mjörnstedt L, Mölne J, Olausson M, Rydberg L, Svalander CT, Bäckman L. Successful ABO-incompatible liver transplantation using A2 donors. Transplant Proc 2007; 38:2667-70. [PMID: 17098033 DOI: 10.1016/j.transproceed.2006.07.025] [Citation(s) in RCA: 22] [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: 11/25/2022]
Abstract
INTRODUCTION The longer waiting time for a liver graft among patients with blood group O makes it necessary to expand the donor pool for these patients. We herein have reported our experience with ABO-incompatible liver transplantation using A(2) donors to blood group O recipients. PATIENTS AND METHODS Between 1996 to 2005, 10 adult blood group O recipients received 10 A(2) cadaveric grafts. Mean recipient age was 52 +/- 7.7 years (mean +/- SD). The initial immunosuppression was induction with antithymocyte globulin (n = 2), interleukin-2-receptor antagonists (n = 3), or anti-CD20 antibody (rituximab, n = 1), followed by a tacrolimus-based protocol. No preoperative plasmapheresis, immunoadsorption, or splenectomies were performed. RESULTS Patient and graft survival was 10/10 and 8/10, respectively, at 8.5 months median follow-up (range 10 days to 109 months). Two patients were retransplanted because of bacterial arteritis (n = 1) and portal vein thrombosis (n = 1). The six acute rejections, which occurred in four patients, were all reversed by steroids or increased tacrolimus dosages. The pretransplant anti-A titers against A(1) red blood cells were 1:128 (NaCl technique) and 1:8 to 1024 (IAT technique). The maximum postoperative titers were 1:64 to 4000 (NaCl) and 1:256 to 32000 (IAT). CONCLUSION The favorable outcome of A(2) to O grafting, with a patient survival of 10/10 and graft survival of 8/10, makes it possible to consider this blood group combination also in nonurgent situations. There was no hyperacute rejection or increased rate of rejections. Anti-A/B titer changes seem to not play a significant role in the monitoring of A(2) to O liver transplantation.
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Affiliation(s)
- U Skogsberg
- Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
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Olausson M, Mjörnstedt L, Nordén G, Rydberg L, Mölne J, Bäckman L, Friman S. Successful combined partial auxiliary liver and kidney transplantation in highly sensitized cross-match positive recipients. Am J Transplant 2007; 7:130-6. [PMID: 17227562 DOI: 10.1111/j.1600-6143.2006.01592.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [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: 01/25/2023]
Abstract
Combined liver and renal transplantations can be performed against a positive cross-match, indicating that the liver protects the kidney from the harmful HLA antibodies. This led us to the hypothesis that a partial auxiliary liver graft may have a similar protective effect when performed together with the kidney in highly sensitized patients. Seven patients, with broadly reacting HLA antibodies and positive crossmatches, were transplanted with a partial liver and a kidney from the same donor. In one of the cases a living donor was used. We performed lymphocytotoxic and flow cross-matches before and after the transplantation. Cross-matches turned negative after grafting in five of seven cases. The kidney function was excellent, without rejections, during the follow-up (24-60 months) in these patients. In two cases the cross-match remained positive after transplantation, one with a never-functioning renal graft and the other with an early graft failure, probably due to humoral rejection. A simultaneous transplantation of a partial auxiliary liver graft from the same donor, with the sole purpose of protecting the kidney from harmful lymphocytotoxic antibodies, can be performed successfully despite a positive cross-match and may thus be a new option of treatment for highly sensitized patients waiting for a kidney transplant.
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Affiliation(s)
- M Olausson
- Department of Transplantation and Liver Surgery, Sahlgrenska Universith Hospital, Göteborg, Sweden
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Svensson L, Rydberg L, Hellberg A, Gilliver LG, Olsson ML, Henry SM. Novel glycolipid variations revealed by monoclonal antibody immunochemical analysis of weak ABO subgroups of A. Vox Sang 2005; 89:27-38. [PMID: 15938737 DOI: 10.1111/j.1423-0410.2005.00642.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The chemical basis of the subgroups of A is largely unknown. We used thin-layer chromatography immunochemical staining techniques together with a range of characterized monoclonal reagents to analyse glycolipids isolated from a variety of weak subgroups. MATERIALS AND METHODS Glycolipids isolated from red cells collected from nine genetically defined individuals of the rare subgroups of A, including a novel A(3) allele (A(2) 539G>A) not described previously, were subjected to a highly sensitive thin-layer chromatographic immunochemical analysis. RESULTS Semicharacterized monoclonal antibodies revealed that, in addition to the expected quantitative differences between common phenotypes and the weak subgroups, qualitative glycolipid differences (or at least an apparent qualitative basis), caused by major changes in the ratios of different structures exist. Specifically it was found that the weakest A-expressing samples (A(el) phenotype) appeared to express an unusual A structure in the 8-12 sugar region. Variable expression of several structures in one of the A weak samples were suggestive of novel blood group A structures. CONCLUSIONS Although no structural characterization could be undertaken, the results are clearly indicative that the variant glycosyltransferases of the rare ABO subgroups are not only inefficient, but they may potentially synthesize novel ABO structures.
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Affiliation(s)
- L Svensson
- Blood Centre, Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rydberg L, Ascher H, Krantz M, Kullberg-Lindh C, Olausson M, Svalander C, Breimer ME. Characterization of the humoral immune response in two paediatric patients transplanted with split livers from ABO-incompatible living-related donors: appearance of cytomegalovirus-induced ABO antibodies. Transfus Med 2005; 15:137-44. [PMID: 15859981 DOI: 10.1111/j.0958-7578.2005.00550.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Two blood group O paediatric patients, 12 and 6 months old, were transplanted with liver segments from their blood group A2Le (a(-)b+) Se and blood group A1Le (a(-)b+) Se fathers, respectively. Recipient anti-A antibody titres were reduced prior to transplantation by blood exchange. Both patients had rejection episodes in the post-transplant period that were reversed by anti-rejection therapy. No anti-A antibody titre rise occurred concomitant with these rejections. Postoperatively both patients had cytomegalovirus (CMV) infections, and simultaneous with these infections, a strong increase in anti-A antibody titres was seen, but no rejection occurred. The anti-A antibody titre increase seemed to be specific for A antigens, because the anti-B and anti-alphaGal (anti-pig) antibody titres did not show any changes. CMV infection is a serious cause of morbidity and mortality in immunosuppressed patients, and the virus can influence glycosylation of infected cells. Whether this can explain the importance of the infection in relation to the increase in titre remains to be elucidated.
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Affiliation(s)
- L Rydberg
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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Abstract
Complement activation and generation of pro-inflammatory cytokines occur during storage of blood components. Prestorage leucocyte filtration of platelet concentrates and red cells diminishes the accumulation of leucocyte-derived cytokines during storage, however, transfusion reactions are not eliminated. We investigated inflammatory mediator release during storage of plasma and whole blood and the effect of prestorage leucocyte filtration of plasma. Twenty-four blood units were collected from healthy blood donors and stored for 35 days. Eight units were stored as whole blood, eight units as plasma and eight units as prestorage filtered plasma. Samples were collected weekly for analyses of potassium, leucocytes, free plasma haemoglobin, complement activation (C3a and SC5b-9) and pro-inflammatory cytokines [interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-alpha]. Elevated levels of C3a and SC5b-9 were registered in filtered plasma, from the beginning of storage. C3a levels increased during storage. There was a higher rate of change during storage in C3a (P < 0.01) and SC5b-9 (P < 0.05) in plasma compared with filtered plasma. Interleukin (IL)-8 is released in whole blood. The cytokine levels generated in plasma and filtered plasma were low. Complement activation is present in whole blood, plasma and filtered plasma during storage. Prestorage filtration of plasma activates the complement cascade but does not influence cytokine generation.
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Affiliation(s)
- M Hyllner
- Department of Anaesthesiology & Intensive Care, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden.
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Olausson M, Mjörnstedt L, Nordén G, Rydberg L, Lindner P, Bäckman L, Friman S. Auxiliary liver and combined kidney transplantation prevents hyperacute kidney rejection in highly sensitized patients. Transplant Proc 2002; 34:3106-7. [PMID: 12493389 DOI: 10.1016/s0041-1345(02)03577-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Olausson
- Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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Abstract
The most important transplantation antigen system in solid organ transplantation is the ABO histo-blood group system. Crossing the ABO barrier in solid organ transplantation is usually not done except for emergency liver transplantations. Early experiences of crossing the ABO barrier in renal transplantation were very disappointing. In the 1970s, clinical trials were started transplanting kidneys of subgroup A2 into blood group O recipients. The tissues of the A2 subgroup expresses reduced amount of A antigens compared to subgroup A1 and the recipients had no special pretreatment and standard immunosuppression. A number of early graft losses were experienced but the trial also resulted in several long time surviving grafts. A few centres have adapted the concept of A2 to non A kidney transplantations with successful results, when the recipient anti-A titres are low or reduced prior to transplantation. In the early 1980s one group successfully transplanted A1 and B kidneys from living related donors across the ABO-barrier using an immunosuppressive protocol consisting of quadruple drugs and splenectomy and this protocol was adapted by a few other groups. In Japan, where cadaver donors are available in very limited number, the largest number of ABO-incompatible transplantations have been performed. Altogether more than 300 ABO-incompatible kidney transplantations have been performed in more than 40 centres since 1989. ABO-incompatible liver transplantations have been performed mainly in emergency cases and the results have generally been inferior to ABO-compatible grafts. In children below the age of three years, liver transplantations across the ABO-barrier have been quite successful especially with living related donors. Very few ABO-incompatible heart/heart-lung/lung-transplantations have been reported with a few successful cases, but the majority have been failures. Recently a series of ABO-incompatible heart transplants performed in small children have been reported with a high success rate.
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Affiliation(s)
- L Rydberg
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Magnusson S, Strokan V, Mölne J, Nilsson K, Rydberg L, Breimer ME. Blocking of human anti-pig xenoantibodies by soluble GAL alpha 1-3Gal and Gal alpha 1-2Gal disaccharides; studies in a pig kidney in vitro perfusion model. Transpl Int 2001; 13:402-12. [PMID: 11140238 DOI: 10.1007/s001470050722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depletion of anti-pig xenoantibodies reduces cell cytotoxicity of human serum to pig endothelial cells and lymphocytes. The aim of this study was to test, in a pig kidney xenoperfusion model, the ability of soluble alpha Gal terminated disaccharides to prevent the hyperacute rejection process in an organ. Porcine kidneys were perfused with whole human blood lacking saccharide and blood supplemented with Gal alpha 1-3GAL, Gal alpha 1-2Gal and lactose. Parameters evaluated were, urine production, renal blood flow, vascular resistance, renal clearance, blood cell counts, xenoantibody titers, complement activation and histopathology. The blood flow was higher in the Gal alpha 1-3Gal (155 +/- 31 ml/min x 100 g-1 kidney tissue) group compared to Gal alpha 1-2Gal (138 +/- 16), lactose (92 +/- 78) and controls (69 +/- 16), When calculated as percent of the blood flow value at 1 min, the blood flow at 30 min was 157% for the Gal alpha 1-3Gal and for 187% the Gal alpha 1-2Gal. The corresponding values for the lactose and control groups were 102% and 74%, respectively. Urine production in the lactose/control groups was lower (0.7 ml/min x 100 g-1 kidney tissue) compared to Gal alpha 1-3Gal (3.0) and Gal alpha 1-2Gal (3.7). Urine sodium excretion was reduced in the lactose/control groups, compared to the Gal alpha alpha 1-groups during the perfusions. An increase in urine potassium excretion was found in the Gal alpha alpha 1-groups while a reduction occurred in the lactose/control experiments. An initial 40-50% reduction in platelet count was observed in all groups while the leukocyte count showed a continuous decrease. Immunohistochemistry revealed less deposition of IgM, IgG, C3 and C1 q in the Gal alpha alpha 1-saccharide groups compared to the lactose/control groups. Soluble Gal alpha a1-disaccharides improved both functional and histological parameters. However, significant pathological changes were still present indicating that this approach to inhibit HAR must be used in combination with additional therapeutic approaches such as solid phase xenoantibody immunoadsorption and blocking of complement activation.
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Affiliation(s)
- S Magnusson
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Universitets Sjukhuset, 41345 Göteborg, Sweden
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Rydberg L, Mölne J, Strokan V, Svalander CT, Breimer ME. Histo-blood group A antigen expression in pig kidneys--implication for ABO incompatible pig-to-human xenotransplantation. Scand J Urol Nephrol 2001; 35:54-62. [PMID: 11291690 DOI: 10.1080/00365590151030840] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE There is a relative shortage of donor organs for clinical transplantation, and the use of animal organs is being considered. A clinical trial was performed connecting pig kidneys to the circulation of a dialysis patient. MATERIAL AND METHODS A pig kidney was, after plasmapheresis, extracorporeally connected to the circulation of a volunteer dialysis patient. The patient was of blood group B and the pig of blood group A. RESULTS The experiment gave rise to a strong humoral immune response where the xenoantibodies were shown to be of immunoglobulin G (IgG), IgM and IgA immunoglobulin classes, recognizing mainly the Gal alpha1-3Gal epitope and the anti-A antibodies was exclusively of IgM type, recognizing the blood group A trisaccharide. Immunohistological examinations of blood group A pig kidneys revealed that blood group A antigens are located in the distal tubules, thin and thick tubules of Henle and the epithelium of the collecting ducts but absent in proximal tubules, glomeruli, large vessels and capillaries. In the perfused kidney, a patchy destruction of tubular cells was found and these segments stained positive for blood group A antigens and had a codeposition of human IgM antibodies and complement components. Tubular segments which were apparently normal were all negative for blood group A antigens but strongly expressed the Gal alpha1-xenoantigen. CONCLUSION In this patient, challenged simultaneously with carbohydrate antigen epitopes representing both the ABO and the xenobarrier, the humoral immune response differed concerning the immunoglobulin classes induced. The low remaining anti-A titre after plasmapheresis was probably sufficient to cause destruction of A antigen-positive tubular cells, while the corresponding Gal alpha1-xenoantigen-positive cells were structurally intact. This case confirms that in future xenotransplantation, matching for the ABO system has to be undertaken in the same way as in human allotransplantation.
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Affiliation(s)
- L Rydberg
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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Kobayashi T, Suzuki A, Yokoyama I, Abe M, Hayashi S, Nagasaka T, Namii Y, Kato T, Tokoro T, Liu D, Nakao A, Matsuda H, Morozumi K, Breimer ME, Rydberg L, Groth CG, Tibell A, Korsgren O, Takagi H. Immunogenicity of Hanganutziu-Deicher antigens in pig-to-human xenotransplantation. Transplant Proc 2000; 32:874. [PMID: 10936253 DOI: 10.1016/s0041-1345(00)01019-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Kobayashi
- Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan
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Magnusson S, Hallberg E, Mânsson J, Romano E, Rydberg L, Strokan V, Svensson L, Breimer ME. Ganglioside xenoantigens in pig lymphocytes and aorta. Transplant Proc 2000; 32:848-50. [PMID: 10936239 DOI: 10.1016/s0041-1345(00)01005-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kobayashi T, Yokoyama I, Suzuki A, Abe M, Hayashi S, Matsuda H, Morozumi K, Breimer ME, Rydberg L, Groth CG, Tibell A, Korsgren O, Takagi H, Nakao A. Lack of antibody production against Hanganutziu-Deicher (H-D) antigens with N-glycolylneuraminic acid in patients with porcine exposure history. Xenotransplantation 2000; 7:177-80. [PMID: 11021662 DOI: 10.1034/j.1399-3089.2000.00056.x] [Citation(s) in RCA: 28] [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] [Indexed: 11/23/2022]
Abstract
The significance of non-alphagalactosyl antigens remains unclear in pig-to-primate xenotransplantation. Hanganutziu-Deicher (H-D) antigens with terminal N-glycolylneuraminic acid (NeuGc) are widely expressed on endothelial cells of mammalian species, with the exception of humans. As baboons and monkeys also express H-D antigens, a pig-to-non-human primate experimental model cannot resolve the question of whether H-D antigens can elicit a potent humoral response in human recipients. The purpose of this study was to elucidate the clinical significance of H-D antigens by examining the sera from patients who have been previously exposed to porcine tissue. After the digestion of porcine aortic endothelial cells (PAEC) by neuraminidase, NeuGc and N-acetylneuraminic acid (NeuAc) were quantitated by HPLC. IgG and IgM antibody levels against H-D antigens were measured by NeuGc-GM3-coated ELISA plates in the sera of patients who had undergone ex vivo kidney perfusion 1 to 3 weeks and 2 years previously (n=2) or had been injected with fetal porcine islets 2 months previously (n= 10). HPLC determined that 9.7x 10(7) NeuAc and 6.3x 10(7) NeuGc residues per cell were released from PAEC by neuraminidase, while 25.7x 10(7) NeuAc and an undetectable level of NeuGc were released from human aortic endothelial cells (HAEC). No significant elevation of IgG or IgM antibody levels against NeuGc-GM3 was observed in sera from patients with a history of porcine exposure. Considering the active production of antibody against the foreign galactosyl antigens after pig-to-human xenotransplantation, some production of antibodies against the equally foreign H-D antigens would be expected, because large amounts of NeuGc terminated saccharides are present in the pig endothelial cell surface. However, no production of antibodies directed to H-D antigens could be found in patients exposed to porcine tissue. Further studies are warranted to explain why H-D antigens do not elicit a significant antibody production.
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Affiliation(s)
- T Kobayashi
- Department of Surgery II, Nagoya University School of Medicine, Japan
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Lind T, Rydberg L, Kylebäck A, Jonsson A, Andersson T, Hasselgren G, Holmberg J, Röhss K. Esomeprazole provides improved acid control vs. omeprazole In patients with symptoms of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2000; 14:861-7. [PMID: 10886041 DOI: 10.1046/j.1365-2036.2000.00813.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Esomeprazole (Nexium) is a new proton pump inhibitor for the treatment of acid-related diseases. METHODS In this double-blind crossover study, 38 patients with gastro-oesophageal reflux disease (GERD) symptoms were randomized to esomeprazole 40 and 20 mg and omeprazole 20 mg once daily for 5 days. On day 5 of each dosing period, 24-h intragastric pH and pharmacokinetic variables were measured. RESULTS Thirty-six patients aged 29-58 (mean 45) years completed the study. Esomeprazole 40 and 20 mg maintained intragastric pH > 4 for (mean) 16.8 and 12.7 h, respectively, vs. 10.5 h for omeprazole 20 mg (P < 0.001 and P < 0. 01). Twenty-four-hour median intragastric pH was significantly higher with esomeprazole 40 mg (4.9) and 20 mg (4.1) than with omeprazole 20 mg (3.6) (P < 0.001 and P < 0.01). Area under the plasma concentration-time curve (AUC) was 80% higher for esomeprazole 20 mg vs. omeprazole, while that for esomeprazole 40 mg was more than five times higher (each P < 0.0001). Interpatient variability in intragastric pH and AUC was less with esomeprazole than with omeprazole. Esomeprazole was well tolerated and there were no safety concerns. CONCLUSIONS Esomeprazole provides more effective acid control than omeprazole, with reduced interpatient variability, thereby offering the potential for improved efficacy in acid-related diseases.
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Affiliation(s)
- T Lind
- Department of Surgery, Kärnsjukhuset, Skövde, Sweden.
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Rydberg L, Ruth M, Lundell L. Characteristics of secondary oesophageal peristalsis in operated and non-operated patients with chronic gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol 2000; 12:739-43. [PMID: 10929899 DOI: 10.1097/00042737-200012070-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Secondary oesophageal peristalsis contributes to oesophageal volume clearance and may be impaired in a significant proportion of patients with chronic gastro-oesophageal reflux disease (GORD). This study aimed to investigate the triggering of secondary peristalsis in chronic GORD patients compared to those previously operated on with anti-reflux surgery. PATIENTS AND METHODS Healthy volunteers, chronic GORD patients with proven oesophagitis and patients successfully operated on with anti-reflux surgery (> 3 years ago) were investigated. Secondary peristalsis was elicited by oesophageal distension by a bolus of air (10 ml) injected rapidly into the mid-portion of the oesophagus. The peristaltic characteristics in the distal oesophagus were assessed by use of stationary manometry. RESULTS The primary peristaltic amplitude in the distal third of the oesophagus was significantly higher (P < 0.002) in the non-operated GORD cases than in those recruited for surgery. Furthermore, a difference in the frequency of failed primary peristalsis was revealed (2.1 versus 8.4%) between the non-operated and operated patients. Secondary peristalsis occurred in 65 +/- 13.2% (mean +/- SE) of the healthy subjects on stimulation, which was a higher figure than in the GORD patients. In patients investigated after successful anti-reflux surgery, a secondary peristaltic wave was elicited in only 26 +/- 7.2% of the attempts, which was significantly lower than the 46 +/- 7.7% seen in non-operated GORD patients (P < 0.05). A direct comparison between motor characteristics of primary and secondary peristalsis revealed that the latter amplitudes were significantly lower both in the non-operated and in the operated cases (P < 0.005). CONCLUSIONS The triggering of secondary peristalsis seems to be impaired in chronic GORD patients. Investigating similar patients > 3 years after successful anti-reflux surgery revealed an even lower prevalence of secondary peristaltic waves, implying persistence of the abnormality after surgery and consistent with other evidence that GORD is associated with a primary defect in oesophageal motor function.
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Affiliation(s)
- L Rydberg
- Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
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Rydberg L. [Future transfusion specialists, supervisors of quality and safety]. Lakartidningen 2000; 97:2870-5. [PMID: 10885225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- L Rydberg
- Blodcentralen, Sahlgrenska Universitetssjukhuset, Göteborg
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Larson G, Svensson L, Hynsjö L, Elmgren A, Rydberg L. Typing for the human lewis blood group system by quantitative fluorescence-activated flow cytometry: large differences in antigen presentation on erythrocytes between A(1), A(2), B, O phenotypes. Vox Sang 2000; 77:227-36. [PMID: 10717603 DOI: 10.1159/000031132] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lewis phenotyping by hemagglutination is an unreliable routine method for Lewis antigen designation. Now genomic typing of the Lewis gene is available. Additionally, flow cytometry has been used for typing. We wanted to compare the results of Lewis typing in healthy individuals using the three methods. MATERIALS AND METHODS Ninety-three randomly selected plasma donors were genotyped for inactivating Secretor (FUT2) G428A and Lewis (FUT3) T59G, T202C, C314T, G508A and T1067A point mutations. All Le(a+b-) individuals (nonsecretors) were homozygous for the FUT2 G428A mutation and all Le(a-b-) individuals had inactivating mutations on both FUT3 alleles. Fixed erythrocytes were analyzed by fluorescence-activated flow cytometry and the results were compared with hem- agglutination and genotypic data. Antigen availability was expressed as median fluorescence intensity and as percentage positive cells with fluorescence intensities > or =10(2). RESULTS Using an anti-Le(a) reagent a mean of 99% of erythrocytes from Le(a+b-) individuals and 1% of erythrocytes from Le(a-b-) or Le(a-b+) individuals were stained positive. Using an anti-Le(b) reagent, a mean of 71% of erythrocytes from A(1), 95% from B and 99% from O and A(2) Le(a-b+) individuals and less than 10% of erythrocytes from Le(a-b-) or Le(a+b-) individuals were stained positive. After papain treatment 100% of the erythrocytes from A(1) and A(1)B Le(a-b+) individuals stained positive without increase in background staining. The flow cytometric technique revealed large differences in staining intensities, within each ABO Le(a-b+) subgroup which was not directly correlated to plasma donation frequencies nor to Secretor or Lewis genotypes. CONCLUSION Flow cytometry may prove valuable as a Lewis blood group typing technique but also as a research tool when investigating Lewis phenotypes of human erythrocytes.
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Affiliation(s)
- G Larson
- Department of Clinical Chemistry and Transfusion Medicine, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
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