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Aronne LJ, Sattar N, Horn DB, Bays HE, Wharton S, Lin WY, Ahmad NN, Zhang S, Liao R, Bunck MC, Jouravskaya I, Murphy MA. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA 2024; 331:38-48. [PMID: 38078870 PMCID: PMC10714284 DOI: 10.1001/jama.2023.24945] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/11/2023] [Indexed: 01/03/2024]
Abstract
Importance The effect of continued treatment with tirzepatide on maintaining initial weight reduction is unknown. Objective To assess the effect of tirzepatide, with diet and physical activity, on the maintenance of weight reduction. Design, Setting, and Participants This phase 3, randomized withdrawal clinical trial conducted at 70 sites in 4 countries with a 36-week, open-label tirzepatide lead-in period followed by a 52-week, double-blind, placebo-controlled period included adults with a body mass index greater than or equal to 30 or greater than or equal to 27 and a weight-related complication, excluding diabetes. Interventions Participants (n = 783) enrolled in an open-label lead-in period received once-weekly subcutaneous maximum tolerated dose (10 or 15 mg) of tirzepatide for 36 weeks. At week 36, a total of 670 participants were randomized (1:1) to continue receiving tirzepatide (n = 335) or switch to placebo (n = 335) for 52 weeks. Main Outcomes and Measures The primary end point was the mean percent change in weight from week 36 (randomization) to week 88. Key secondary end points included the proportion of participants at week 88 who maintained at least 80% of the weight loss during the lead-in period. Results Participants (n = 670; mean age, 48 years; 473 [71%] women; mean weight, 107.3 kg) who completed the 36-week lead-in period experienced a mean weight reduction of 20.9%. The mean percent weight change from week 36 to week 88 was -5.5% with tirzepatide vs 14.0% with placebo (difference, -19.4% [95% CI, -21.2% to -17.7%]; P < .001). Overall, 300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in period compared with 16.6% receiving placebo (P < .001). The overall mean weight reduction from week 0 to 88 was 25.3% for tirzepatide and 9.9% for placebo. The most common adverse events were mostly mild to moderate gastrointestinal events, which occurred more commonly with tirzepatide vs placebo. Conclusions and Relevance In participants with obesity or overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. Trial Registration ClinicalTrials.gov Identifier: NCT04660643.
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Affiliation(s)
- Louis J. Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York, New York
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Deborah B. Horn
- University of Texas Center for Obesity Medicine and Metabolic Performance, Department of Surgery, University of Texas McGovern Medical School, Houston
| | - Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, Kentucky
| | - Sean Wharton
- McMaster University, and Wharton Weight Management Clinic, York University, Toronto, Ontario, Canada
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Shuyu Zhang
- Eli Lilly and Company, Indianapolis, Indiana
| | - Ran Liao
- Eli Lilly and Company, Indianapolis, Indiana
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Bakhtiarydavijani A, Khalid G, Murphy MA, Johnson KL, Peterson LE, Jones M, Horstemeyer MF, Dobbins AC, Prabhu RK. A mesoscale finite element modeling approach for understanding brain morphology and material heterogeneity effects in chronic traumatic encephalopathy. Comput Methods Biomech Biomed Engin 2021; 24:1169-1183. [PMID: 33635182 DOI: 10.1080/10255842.2020.1867851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic Traumatic Encephalopathy (CTE) affects a significant portion of athletes in contact sports but is difficult to quantify using clinical examinations and modeling approaches. We use an in silico approach to quantify CTE biomechanics using mesoscale Finite Element (FE) analysis that bridges with macroscale whole head FE analysis. The sulci geometry produces complex stress waves that interact with one another to create increased shear stresses at the sulci depth that are significantly larger than in analyses without sulci (from 0.5 to 18.0 kPa). Sulci peak stress concentration regions coincide with experimentally observed CTE sites documented in the literature. HighlightsSulci introduce stress localizations at their depth in the gray matterSulci stress fields interact to produce stress concentration sites in white matterDifferentiating brain tissue properties did not significantly affect peak stresses.
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Affiliation(s)
- A Bakhtiarydavijani
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - G Khalid
- Middle Technical University, Baghdad, Iraq
| | - M A Murphy
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | | | - L E Peterson
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - M Jones
- Institute of Medical Engineering & Medical Physics, Cardiff University, Cardiff, Wales, UK
| | | | - A C Dobbins
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - R K Prabhu
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA.,Department of Agricultural and Biological Engineering, Mississippi State University, MS, USA
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Sood SB, Weatherly AJ, Smith AH, Murphy MA, Conrad SJ, Bichell DP. Vaping Contributing to Postoperative Acute Respiratory Distress Syndrome. Ann Thorac Surg 2021; 112:e169-e171. [PMID: 33497668 DOI: 10.1016/j.athoracsur.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
We report the case of an 18-year-old male patient with a history of bicuspid aortic valve with severe aortic insufficiency who had undergone a Ross procedure 1 year prior but subsequently developed stenosis of the pulmonary homograft necessitating conduit replacement. His postoperative course was complicated by acute respiratory distress syndrome. Bronchoscopy revealed significant mucus plugging without identification of contributing pathogen. Further evaluation revealed a history of electronic cigarette use not identified preoperatively and thought to be largely contributory to his postoperative complications. This case highlights the importance of screening preoperatively for electronic cigarette use and counseling on cessation before surgical procedures.
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Affiliation(s)
- Shawn B Sood
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Allison J Weatherly
- Division of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrew H Smith
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee; Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Madhumita A Murphy
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stephanie J Conrad
- Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David P Bichell
- Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Markwalter DW, Murphy MA, Turnbull JM, Fanning JB. Framing the future: Family preparedness for care transitions of critically ill children. Fam Syst Health 2019; 37:212-223. [PMID: 31328928 DOI: 10.1037/fsh0000431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Improving family centered care in the PICU requires understanding the milestones that families need assistance preparing for as well as factors that facilitate or obstruct preparedness. We present a model of family preparedness for transitions in the PICU based on semistructured interviews with clinicians and families that is designed to improve family centered care through the reduction of failed or traumatic transitions. METHOD We conducted semistructured interviews with 20 clinicians and 25 families in an academic PICU. Transcript analysis focused on identifying factors facilitating or obstructing family preparedness for care transitions. We analyzed interview transcripts for emergent themes and metathemes using grounded theory methodology. RESULTS Family preparedness for care transitions is dependent upon both cognitive and emotional preparedness. Six metathemes form a novel model for understanding the factors influencing both components of preparedness and their interrelationship. Specifically, family preparedness is influenced by (a) individualized backgrounds, coping skills, and support systems as well as the (b) emotional context, (c) care environment, (d) course of care, (e) content of preparatory information, and (f) manner in which care is coordinated to effectively deliver information. We also describe 10 transitional categories that provide context for application of the model. DISCUSSION Cognitive and emotional preparedness for care transitions in the PICU develops through attentiveness to six features. The conceptual model presented here will allow clinicians to support family centered care through interventions to facilitate a shared development of expectations for the future and reduce the risk of failed or traumatic transitions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Murphy MA, Gerhardt HC, Schul J. Leader preference in Neoconocephalus ensiger katydids: a female preference for a nonheritable male trait. J Evol Biol 2017; 30:2222-2229. [PMID: 28976614 DOI: 10.1111/jeb.13188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/24/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022]
Abstract
Female preferences for males producing their calls just ahead of their neighbours, leader preferences, are common in acoustically communicating insects and anurans. While these preferences have been well studied, their evolutionary origins remain unclear. We tested whether females gain a fitness benefit by mating with leading males in Neoconocephalus ensiger katydids. We mated leading and following males with random females and measured the number and quality of F1 , the number of F2 and the heritability of the preferred male trait. We found that females mating with leaders and followers did not differ in the number of F1 or F2 offspring. Females mating with leading males had offspring that were in better condition than those mating with following males suggesting a benefit in the form of higher quality offspring. We found no evidence that the male trait, the production of leading calls, was heritable. This suggests that there is no genetic correlate for the production of leading calls and that the fitness benefit gained by females must be a direct benefit, potentially mediated by seminal proteins. The presence of benefits indicates that leader preference is adaptive in N. ensiger, which may explain the evolutionary origin of leader preference; further tests are required to determine whether fitness benefits can explain the phylogenetic distribution of leader preference in Neoconocephalus. The absence of heritability will prevent leader preference from becoming coupled with or exaggerating the male trait and prevent females from gaining a 'sexy-sons' benefit, weakening the overall selection for leader preference.
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Affiliation(s)
- M A Murphy
- Division of Biological Sciences, University of Missouri, Columbia, MO, USA.,Biological Sciences, Salisbury University, Salisbury, MD, USA
| | - H C Gerhardt
- Division of Biological Sciences, University of Missouri, Columbia, MO, USA
| | - J Schul
- Division of Biological Sciences, University of Missouri, Columbia, MO, USA
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Gregory BJ, Chen SM, Murphy MA, Atchley DH, Kamdem LK. Impact of the OATP1B1 c.521T>C single nucleotide polymorphism on the pharmacokinetics of exemestane in healthy post-menopausal female volunteers. J Clin Pharm Ther 2017; 42:547-553. [PMID: 28868654 DOI: 10.1111/jcpt.12569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/04/2017] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE OATP1B1 mediates the transport of a diverse range of amphiphilic organic compounds that include bile acids, steroid conjugates and hormones. This retrospective pharmacogenetic study was conducted to assess the impact of the OATP1B1 c.521T>C single nucleotide polymorphism (SNP) on the pharmacokinetics of the steroidal aromatase inhibitor drug exemestane in healthy volunteers. METHODS Exemestane (25 mg) was administered orally to 14 healthy post-menopausal women. All of the 14 subjects were sampled for pharmacokinetic (PK) analyses and retrospectively genotyped for OATP1B1 c.521T>C (rs 4149056). RESULTS AND DISCUSSION Of the 14 subjects enrolled in the study, five were carriers of the minor C allele (OATP1B1 c.521TC+CC) and the remaining nine were carriers of the OATP1B1 c.521TT genotype. PK was assessed over 8 hours post-dosing. Our results showed statistically significant differences (P=.04) in the plasma exemestane AUC0-8 between the OATP1B1 genotype groups. Our data also showed statistically significant differences (P=.04) in the plasma AUC0-8 of 17-hydroexemestane (the major biologically active metabolite) between the OATP1B1 genotype groups. WHAT IS NEW AND CONCLUSION Our data suggest that the OAPTP1B1 c.521T>C SNP may influence exemestane pharmacokinetics in humans.
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Affiliation(s)
- B J Gregory
- Harding University College of Pharmacy, Searcy, AR, USA
| | - S M Chen
- Fort Defiance Hospital, Fort Defiance, AZ, USA
| | - M A Murphy
- Harding University Physician Program, Searcy, AR, USA
| | - D H Atchley
- University of Pikeville-Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
| | - L K Kamdem
- Harding University College of Pharmacy, Searcy, AR, USA
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Quigley AF, Bulluss KJ, Kyratzis ILB, Gilmore K, Mysore T, Schirmer KSU, Kennedy EL, O'Shea M, Truong YB, Edwards SL, Peeters G, Herwig P, Razal JM, Campbell TE, Lowes KN, Higgins MJ, Moulton SE, Murphy MA, Cook MJ, Clark GM, Wallace GG, Kapsa RMI. Engineering a multimodal nerve conduit for repair of injured peripheral nerve. J Neural Eng 2013; 10:016008. [DOI: 10.1088/1741-2560/10/1/016008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Singh MP, Armstrong J, Murphy MA, Coucher J, Ong B. Is this really pneumothorax? Thorax 2009; 64:276. [PMID: 19252037 DOI: 10.1136/thx.2007.094375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M P Singh
- QE II Jubilee Hospital, Brisbane, QLD 4108, Australia.
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Affiliation(s)
- P D Smith
- St. Vincent's Hospital, 5th Floor Daly Wing, Melbourne, VIC Australia 3065.
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10
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Abstract
BACKGROUND Pain after craniotomy is often under-treated. Opiates carry distinct disadvantages. Non-steroidal anti-inflammatory drugs have an anti-platelet action and carry a bleeding risk. Cyclo-oxygenase 2 inhibitors such as parecoxib are not associated with a bleeding risk and would be welcome analgesics if shown to be effective. METHODS In a prospective double-blind, randomized, placebo-controlled study, we investigated the analgesic effect of a single dose of parecoxib 40 mg given at dural closure in 82 patients undergoing elective craniotomies. Remifentanil was used intraoperatively, and i.v. morphine was titrated to the requirement in the post-anaesthetic unit. On the ward, i.m. morphine 5 mg as required and regular acetaminophen was prescribed. Morphine use and visual analogue pain scores were recorded at 1, 6, 12, and 24 h after surgery. RESULTS Parecoxib reduced pain scores at 6 h and morphine use at 6 and 12 h after operation. However, overall, it had only minimal impact on postoperative analgesia. We found a wide variability in analgesic requirements where 11% of patients required no opioids and 16% required more than 15 mg i.v. morphine 1 h after the surgery. CONCLUSIONS We found only limited evidence to support parecoxib as an analgesic after craniotomy.
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Affiliation(s)
- S J Jones
- Department of Anaesthesia, Vincent's Hospital, PO Box 2900, Fitzroy, Melbourne, VIC 3065, Australia.
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Murphy MA, Hands L. Is arteriovenous shunting involved in the development of varicosities? A study of the intraluminal pressure and oxygen content in varicose veins. Phlebology 2008; 23:137-41. [PMID: 18467623 DOI: 10.1258/phleb.2007.007070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting. METHODS Thirty-nine patients with varicose veins underwent cannulation of varicosities. The pressure and the blood oxygen content within varicosities were measured in different positions and during exercise. Similar measurements were made in the long saphenous veins of 10 control subjects without venous disease. RESULTS Mean pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6 mmHg). Control subjects had similar pressures measured in the long saphenous vein. No pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66 mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity from the heart. Pressure reduction in varicosities after exercise was significantly less than that in control subjects. Recovery time (RT 90) was also significantly shorter than in the control group. Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa (SD 0.9) on standing; these values were not significantly different to samples from control subjects. CONCLUSIONS AV shunting is unlikely to be a causative factor in the development of primary varicose veins.
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Affiliation(s)
- M A Murphy
- Nuffield Department of Surgery, University of Oxford, Level 6, John Radcliffe Hospital, Headington, Oxford OX3 9JL, UK.
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12
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Abstract
The approximately 2.63 Ga Carawine Dolomite, Hamersley Basin, Western Australia, preserves tube structures of probable microbial origin that formed in a low energy environment. The tubes are 0.4-1.8 cm in diameter and at least 10-16 cm long in outcrop. The tubes are defined by dark, 45-microm-thick dolomicritic walls, whereas the tube fill and host rock are composed of 30 microm, cloudy dolomite crystals and rare 170- to 425-microm-wide, dark well-sorted clasts. Closely spaced, rarely discontinuous laminae coat the insides of tubes; less closely spaced, peaked, discontinuous laminae coat the outsides of tubes. The laminae on the outsides of tubes are often intercalated with mammilate structures. The presence of probable microbial coatings on both the insides and the outsides of the tube walls requires that the tubes formed above the sediment-water interface. These tube structures probably formed during gas-charged fluid escape, similar to tubes observed in ancient and modern hydrocarbon seeps and cylindrical water transfer structures in sandstones. The laminae that coat the tubes have very similar geometries to modern biofilms that form in both turbulent and laminar flow, and their geometries probably reflect flow conditions during the fluid escape. The identification of these structures suggests that the preserved interaction between fluid escape and microbial growth in carbonates may be more common than previously thought.
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Affiliation(s)
- M A Murphy
- Department of Geology, University of California, 1 Shields Avenue, Davis, CA 95616, USA.
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Murphy MA, Richards T, Atkinson C, Perkins J, Hands LJ. Fast Track Open Aortic Surgery: Reduced Post Operative Stay with a Goal Directed Pathway. Eur J Vasc Endovasc Surg 2007; 34:274-8. [PMID: 17587613 DOI: 10.1016/j.ejvs.2007.04.018] [Citation(s) in RCA: 40] [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] [Received: 03/26/2007] [Accepted: 04/22/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Open aortic aneurysm repair is traditionally associated with an extended hospital stay. The aim of this study was to examine the feasibility of reducing post-operative stay through the implementation of a fast-track, goal directed, clinical pathway for elective open aortic surgery. METHODS A fast-track clinical pathway for aortic surgery was introduced in a regional vascular unit in September 2005. The pathway has daily goals and targets discharge for all patients on the 3rd post operative day. This study compares thirty consecutive discharges of unselected patients undergoing elective infra-renal aortic surgery following introduction of the pathway to the thirty consecutive cases preceding its introduction. Reasons for prolonged hospital stay were recorded. RESULTS Six of thirty patients achieved discharge by Day 3. The median hospital stay reduced from 9 (range 4 to 17 days) to 5 days (range 2 to 12 days) following introduction of the pathway. There was one readmission within 30 days and no complications attributable to the pathway implementation. Cardiac complications and home planning were the most common causes of delayed discharge. CONCLUSION Post-operative stay in patients undergoing standard elective open infra-renal aortic surgery can be safely reduced with the introduction of a goal directed pathway.
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Affiliation(s)
- M A Murphy
- University of Oxford University, Nuffield Department of Surgery, UK.
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Shusterman D, Murphy MA. Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness. Indoor Air 2007; 17:328-33. [PMID: 17661929 DOI: 10.1111/j.1600-0668.2007.00482.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED Self-reported non-allergic nasal symptom triggers in non-allergic ('vasomotor') rhinitis overlap with commonly identified environmental exposures in non-specific building-related illness. These include extremes of temperature and humidity, cleaning products, fragrances, and tobacco smoke. Some individuals with allergic rhinitis also report non-allergic triggers. We wished to explore the phenotypic overlap between allergic and non-allergic rhinitis by ascertaining self-reported non-allergic nasal symptom triggers among allergic rhinitics. Sixty subjects without work-related respiratory exposures or symptoms, aged 19-68 years, stratified by age, gender and (skin test-proven) allergic rhinitis status, were queried with regard to self-reported non-allergic nasal symptom triggers (aggregate score 0-8). In this sample, the number of self-reported non-allergic triggers was bimodal, with peaks at 1 and 5. Forty-two percent of seasonal allergic rhinitic subjects reported more than three non-allergic triggers, compared with only 3% of non-allergic non-rhinitics (P < 0.01). Subjects over 35 years were more likely to report one or more non-allergic triggers, particularly tobacco smoke (P < 0.05). Allergic rhinitics reported more non-allergic symptom triggers than did non-allergic, non-rhinitics. As indexed by self-reported reactivity to non-specific physical and chemical triggers, both non-allergic rhinitics and a subset of allergic rhinitics may constitute susceptible populations for non-specific building-related illness. PRACTICAL IMPLICATIONS Judging by self-report, a substantial subset of individuals with allergic rhinitis--along with all individuals with nonallergic rhinitis (by definition)--are hyperreactive to non-allergic triggers. There is overlap between these triggers (elicited in the process of obtaining a clinical diagnosis) and environmental characteristics associated with ''problem buildings.'' Since individuals with self-identified rhinitis report an excess of symptoms in most epidemiologic studies of problem buildings (even in the absence of unusual aeroallergen levels), rhintics may be acting as a ''sentinel'' subgroup when indoor air quality is suboptimal. Together, non-allergic rhinitics plus allergic rhinitics with prominent non-allergic triggers, are thought to constitute approximately one-sixth of the US population.
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MESH Headings
- Adult
- Age Factors
- Aged
- Air Pollutants/adverse effects
- Bronchial Hyperreactivity/epidemiology
- Bronchial Hyperreactivity/etiology
- Bronchial Hyperreactivity/pathology
- Detergents/adverse effects
- Environmental Exposure/adverse effects
- Environmental Exposure/statistics & numerical data
- Household Products/adverse effects
- Humans
- Humidity
- Middle Aged
- Perfume/adverse effects
- Rhinitis/epidemiology
- Rhinitis/etiology
- Rhinitis/pathology
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/pathology
- Risk Factors
- Seasons
- Sex Factors
- Skin/immunology
- Temperature
- Tobacco Smoke Pollution/adverse effects
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Affiliation(s)
- D Shusterman
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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Storfer A, Murphy MA, Evans JS, Goldberg CS, Robinson S, Spear SF, Dezzani R, Delmelle E, Vierling L, Waits LP. Putting the ‘landscape’ in landscape genetics. Heredity (Edinb) 2006; 98:128-42. [PMID: 17080024 DOI: 10.1038/sj.hdy.6800917] [Citation(s) in RCA: 474] [Impact Index Per Article: 26.3] [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: 11/09/2022] Open
Abstract
Landscape genetics has emerged as a new research area that integrates population genetics, landscape ecology and spatial statistics. Researchers in this field can combine the high resolution of genetic markers with spatial data and a variety of statistical methods to evaluate the role that landscape variables play in shaping genetic diversity and population structure. While interest in this research area is growing rapidly, our ability to fully utilize landscape data, test explicit hypotheses and truly integrate these diverse disciplines has lagged behind. Part of the current challenge in the development of the field of landscape genetics is bridging the communication and knowledge gap between these highly specific and technical disciplines. The goal of this review is to help bridge this gap by exposing geneticists to terminology, sampling methods and analysis techniques widely used in landscape ecology and spatial statistics but rarely addressed in the genetics literature. We offer a definition for the term "landscape genetics", provide an overview of the landscape genetics literature, give guidelines for appropriate sampling design and useful analysis techniques, and discuss future directions in the field. We hope, this review will stimulate increased dialog and enhance interdisciplinary collaborations advancing this exciting new field.
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Affiliation(s)
- A Storfer
- School of Biological Sciences, Washington State University, Pullman, WA, USA
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Smith PD, McLean KJ, Murphy MA, Turnley AM, Cook MJ. Seizures, not hippocampal neuronal death, provoke neurogenesis in a mouse rapid electrical amygdala kindling model of seizures. Neuroscience 2005; 136:405-15. [PMID: 16226389 DOI: 10.1016/j.neuroscience.2005.07.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 06/01/2005] [Accepted: 07/21/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE Proliferation of neural precursors adjacent to the granule cell layer of the dentate gyrus has been identified in previous epilepsy models. Convincingly demonstrating that seizure activity is the stimulant for neurogenesis, rather than neuronal death or other insults inherent to seizure models, is difficult. To address this we derived a rapid electrical amygdala kindling model in mice known to be resistant to seizure-induced neuronal death as an experimental model of focal seizures and to analyze subsequent neurogenesis. METHODS Mice were implanted with bipolar electrodes in the left amygdala and given electrical stimulation (3 s, 100 Hz, 1 ms monophasic square wave pulses every 5 min, 40 in total) while being observed and graded for the development of seizures. Neurogenesis in the hippocampus was assessed by counting bromodeoxyuridine-immunoreactive cells co-labeled for astrocyte (glial fibrillary acidic protein) and neuronal nuclear markers. RESULTS Bromodeoxyuridine-reactive cell numbers were three-fold higher in stimulated mice compared with controls at 1 week in the subgranular region and at three weeks extensive co-labeling with neuronal nuclear was noted in cells which had migrated into the body of the granule cell layer, while mice receiving stimulation but failing to kindle did not differ significantly from controls. No increase in neuronal death was detected by terminal deoxynucleotidyl transferase-mediated digoxigenin-11-dUTP nick end labeling, Fluorojade or fluorescent examination of hematoxylin and eosin-stained sections in any inter-group comparison. CONCLUSIONS We propose that this kindling paradigm, not previously applied to mice, demonstrates more convincingly than previously the surge in neurogenesis in response to seizures, and the effects of seizures alone in regard to neuronal injury and regeneration.
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Affiliation(s)
- P D Smith
- Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital, Melbourne, Victoria, Australia.
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Bulluss KJ, Wood M, Smith P, Trost N, Murphy MA. Cavernous haemangioma presenting with obstructive hydrocephalus. J Clin Neurosci 2005; 12:660-3. [PMID: 16115549 DOI: 10.1016/j.jocn.2004.11.005] [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: 08/10/2004] [Accepted: 11/15/2004] [Indexed: 11/17/2022]
Abstract
With the development of MRI, the natural history of cavernous haemangiomas has been appreciated. This article describes a series of patients with deep cavernous haemangiomas who have presented with acute hydrocephalus. The diagnosis and treatment options are discussed with a review of the literature.
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Affiliation(s)
- K J Bulluss
- Centre for Clinical Neuroscience and Neurological Research and Department of Radiology, St Vincent's Hospital, Melbourne, Australia
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18
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Costello TG, Cormack JR, Mather LE, LaFerlita B, Murphy MA, Harris K. Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy. Br J Anaesth 2005; 94:848-51. [PMID: 15817709 DOI: 10.1093/bja/aei135] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Levobupivacaine is an effective local anaesthetic agent for nerve blockade with less systemic toxicity than racemic bupivacaine. The safety and efficacy of levobupivacaine for scalp blockade during awake craniotomy have not been addressed previously. METHODS Serial arterial plasma levobupivacaine concentrations following scalp blockade were measured to 2 h in 10 patients booked for awake craniotomy for epilepsy or tumour surgery. Bilateral scalp blockade providing surgical anaesthesia was achieved with a mean dose of 177 mg (2.5 mg kg(-1), range 1.6-3.2 mg kg(-1)) of levobupivacaine (0.5%, 5 mg ml(-1)) with epinephrine (5 microg ml(-1)) added immediately before the block insertion. RESULTS The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) microg ml(-1) [mean (SD)] with a mean time to peak plasma concentration of 12 (4) min. There were no episodes in any of the 10 patients of symptoms or signs suggestive of either CNS or CVS toxicity. CONCLUSIONS This study demonstrated a relatively rapid rise of plasma levobupivacaine concentration without evidence of cardiovascular or central nervous system sequelae in a sample population of patients who may be particularly prone to perioperative seizures.
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Affiliation(s)
- T G Costello
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia
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Murphy MA, Handa A. Re: Anatomy: a must for teaching the next generation. J. Older. Surg J R Coll Surg Edinb Irel 2:2, 79-90. Surgeon 2004; 2:303-4; author reply 304. [PMID: 15570863 DOI: 10.1016/s1479-666x(04)80125-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Carne RP, O'Brien TJ, Kilpatrick CJ, MacGregor LR, Hicks RJ, Murphy MA, Bowden SC, Kaye AH, Cook MJ. MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004; 127:2276-85. [PMID: 15282217 DOI: 10.1093/brain/awh257] [Citation(s) in RCA: 248] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Most patients with non-lesional temporal lobe epilepsy (NLTLE) will have the findings of hippocampal sclerosis (HS) on a high resolution MRI. However, a significant minority of patients with NLTLE and electroclinically well-lateralized temporal lobe seizures have no evidence of HS on MRI. Many of these patients have concordant hypometabolism on fluorodeoxyglucose-PET ([18F]FDG-PET). The pathophysiological basis of this latter group remains uncertain. We aimed to determine whether NLTLE without HS on MRI represents a variant of or a different clinicopathological syndrome from that of NLTLE with HS on MRI. The clinical, EEG, [18F]FDG-PET, histopathological and surgical outcomes of 30 consecutive NLTLE patients with well-lateralized EEG but without HS on MRI (HS-ve TLE) were compared with 30 consecutive age- and sex-matched NLTLE patients with well-lateralized EEG with HS on MRI (HS+ve TLE). Both the HS+ve TLE group and the HS-ve TLE patients had a high degree of [18F]FDG-PET concordant lateralization (26 out of 30 HS-ve TLE versus 27 out of 27 HS+ve TLE). HS-ve TLE patients had more widespread hypometabolism on [18F]FDG-PET by blinded visual analysis [odds ratio (OR = + infinity (2.51, -), P = 0.001]. The HS-ve TLE group less frequently had a history of febrile convulsions [OR = 0.077 (0.002-0.512), P = 0.002], more commonly had a delta rhythm at ictal onset [OR = 3.67 (0.97-20.47), P = 0.057], and less frequently had histopathological evidence of HS [OR = 0 (0-0.85), P = 0.031]. There was no significant difference in surgical outcome despite half of those without HS having a hippocampal-sparing procedure. Based on the findings outlined, HS-ve PET-positive TLE may be a surgically remediable syndrome distinct from HS+ve TLE, with a pathophysiological basis that primarily involves lateral temporal neocortical rather than mesial temporal structures.
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Affiliation(s)
- R P Carne
- Victorian Epilepsy Centre, St Vincent's Hospital, Victoria, Australia.
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Abstract
Synovial cysts have been well reported as a cause of sciatica, with a sudden acute exacerbation being attributed to haemorrhage and subsequent enlargement of the cyst. Cyst formation is attributed to facet joint degeneration associated with a defect or rupture of the joint capsule. The mechanisms of haemorrhage have not been well described previously. Two cases of haemorrhagic synovial cysts causing acute exacerbation of sciatica are described. Both cases were directly attributable to manipulation of degenerate spines. The MRI and histopathological findings are discussed and we propose a mechanism whereby excessive stress on a degenerate revascularized synovium leads to haemorrhage within synovial cysts.
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Affiliation(s)
- Y Y Wang
- Department of Neurosurgery, Pathology and Radiology, St. Vincents Hospital, Melbourne, Vic., Australia
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Shusterman D, Balmes J, Avila PC, Murphy MA, Matovinovic E. Chlorine inhalation produces nasal congestion in allergic rhinitics without mast cell degranulation. Eur Respir J 2003; 21:652-7. [PMID: 12762352 DOI: 10.1183/09031936.03.00049102] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Seasonal allergic rhinitic (SAR) subjects are more sensitive to nasal irritants than nonrhinitic (NR) subjects; however, the mechanism underlying this difference is unclear. This study sought to determine whether irritant-induced nasal congestion involves mast cell degranulation. Eight SAR and eight NR subjects were exposed to both 1.0 parts per million chlorine and filtered air in separate visits; exposures were via nasal mask and lasted 15 min. Rhinomanometry was performed before, immediately after and 15 min after exposure. Following > or = 2 weeks, exposures and symptom reporting were repeated with nasal lavage, rather than rhinomanometry, pre- and postexposure. A separate substudy using rye grass antigen provided a positive control. Mast cell tryptase was measured in nasal lavage fluid from both substudies using an automated fluoroenzyme immunoassay. Chlorine provocation significantly increased nasal airway resistance in SAR but not NR subjects. Conversely, tryptase levels in nasal lavage fluid were unaffected. Nasal allergen challenge significantly increased both nasal obstruction and nasal lavage tryptase in SAR subjects. Irritant-induced nasal congestion is more pronounced among seasonal allergic rhinitic than nonrhinitic subjects. However, unlike nasal allergen challenge, the mechanism of response to chlorine does not appear to involve mast cell degranulation.
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Affiliation(s)
- D Shusterman
- Dept of Medicine, University of California, San Francisco, CA, USA.
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Abstract
Gram-positive bacterial meningitis frequently complicates ventriculo-peritoneal (VP) shunts used for hydrocephalus. Linezolid, an oxazolidinone, is active against Gram-positive cocci, and has excellent CSF penetration. We present a 22-year-old woman who was cured of a Staphylococcus epidermidis VP shunt infection via shunt removal and intravenous linezolid.
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Affiliation(s)
- C J Gill
- Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston, MA 02111, USA
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Murphy MA, O'Brien TJ, Cook MJ. Insertion of depth electrodes with or without subdural grids using frameless stereotactic guidance systems--technique and outcome. Br J Neurosurg 2002; 16:119-25. [PMID: 12046729 DOI: 10.1080/02688690220131886] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [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: 10/17/2022]
Abstract
Over recent years frameless stereotactic systems have begun replacing framed systems for many neurosurgical procedures. However, little has been published regarding the use of these systems to guide intracranial electrode implantation for epilepsy surgery patients. Here we report our experience utilising such a system to insert depth electrodes and subdural grid electrodes. The SteathStation Image-Guided System (SSIGS) (Sofamor Danek, Memphis TN.) was used to insert bilateral depth electrodes in 13 patients, of whom 5 also underwent the insertion of subdural grids or strip electrodes. Initially, a surgical plan based on an entry and target point on axial and sagittal images was performed for the insertion of electrodes. Navigational views, using three-planar images, were then performed to determine which structures the electrodes would pass through to be correctly placed in the amygdala and hippocampus. The correct site of electrode implantation was confirmed post-operatively by spiral CT scans in 4 patients (which were then co-registered to the pre-implantation MRI using a surface matching technique) and the other 9 patients by post-implantation MRI. The SSIGS was found to have a mean registration error of 2.0 mm (range 1.8-2.5) in 10 cases; in the 3 cases where the error was greater than 2.5 mm a surfacemerge technique was used with a mean error 0.9 (0.8-1.00). The post-implantation MRI or CT-MRI co-registration confirmed an accurate electrode placement in the mesial temporal region in all cases. Seizure onset lateralisation was achieved in 11 patients, all of whom went onto formal resections based on these results. The only long-term complication was a case of osteomyelitis which required removal of the bone flap. 73% of patients had an excellent seizure outcome. Frameless stereotactic systems can be safely used to intracranial electrodes, avoid the disadvantages of the framed system and have the added advantage of the surgeon being able to visualise the trajectory and to adjust this to avoid vital structures. As well they eliminate surgical obstruction to the insertion of subdural grids at the same operation, which may be caused by a framed system.
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Affiliation(s)
- M A Murphy
- Department of Neurosurgery (MAM), University of Melbourne, St Vincent's Hospital, Melbourne, Australia.
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Murphy MA, Joyce WP, Condron C, Bouchier-Hayes D. A reduction in serum cytokine levels parallels healing of venous ulcers in patients undergoing compression therapy. Eur J Vasc Endovasc Surg 2002; 23:349-52. [PMID: 11991698 DOI: 10.1053/ejvs.2002.1597] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION vascular endothelial growth factor (VEGF) and tumour necrosis factor alpha (TNF(alpha)) have been specifically implicated in the tissue damage associated with chronic venous disease (CVD). Furthermore, production of both factors is known to be upregulated in vessel wall cells subject to hypertension. The aim of this study was to determine the local venous levels of VEGF and TNF(alpha) in limbs with venous ulcers before and after treatment with graduated compression. PATIENTS AND METHODS eight patients with venous ulcers and 8 patients with varicose veins only were included in the study. For ulcer patients, serum samples were taken from the superficial veins in lower limbs and repeated after 4 weeks of treatment with 4-layered graduated compression. Serum from the arms of the same patients served as controls. Determination of the concentrations of VEGF and TNF(alpha) proteins were performed with sandwich enzyme-linked immunosorbent assays. RESULTS both groups of patients had elevated levels of VEGF and TNF(alpha). In patients with venous ulcers there was a reduction in the levels of both cytokines to below control values with treatment. These changes correlated with healing of the ulcers as determined by reduction in ulcer size. CONCLUSION these data, for the first time, suggest a central role for both TNF(alpha) and VEGF in the pathogenesis of venous ulceration which may constitute a causative link between venous hypertension and tissue pathology.
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Affiliation(s)
- M A Murphy
- Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland
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Reitman D, Currier RO, Hupp SD, Rhode PC, Murphy MA, O'Callaghan PM. Psychometric characteristics of the Parenting Scale in a head start population. J Clin Child Psychol 2001; 30:514-24. [PMID: 11708239 DOI: 10.1207/s15374424jccp3004_08] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Examined the reliability, construct, and concurrent validity of the Parenting Scale (PS), a brief instrument designed to measure dysfunctional parenting practices for parents of young children. In Study 1, 183 primarily African American mothers and their Head Start children completed the PS. The PS, which consists of 3 subscales--Laxness, Overreactivity, and Verbosity--was subjected to confirmatory factor analysis (CFA). Neither the original 3-factor structure, nor a 2-factor structure consisting of the original Laxness and Overreactivity factors, fit the data. A subsequent exploratory factor analysis yielded a 2-factor solution that was generally consistent with the Overreactivity and Laxness subscales identified by Arnold, O'Leary, Wolff, and Acker (1993). The 2-factor CFA solution was replicated with a sample of 216 similar mothers, and the 5-item Overreactivity and Laxness subscales retained internal consistencies above .70. Analysis of the convergent validity of the modified PS and its 2 subscales revealed moderate associations with measures of permissiveness, authoritarianism, involvement, and limit setting. Scores on the PS were not correlated significantly with measures of social desirability, maternal education level, or parent report of internalizing behavior problems. Concurrent validity evidence was obtained by correlating the PS with measures of parenting satisfaction and support, parenting stress, maternal depression, and measures of externalizing child behavior problems.
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Blesofsky WA, Mowen K, Arduini RM, Baker DP, Murphy MA, Bowtell DD, David M. Regulation of STAT protein synthesis by c-Cbl. Oncogene 2001; 20:7326-33. [PMID: 11704862 DOI: 10.1038/sj.onc.1204919] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2001] [Revised: 08/07/2001] [Accepted: 08/14/2001] [Indexed: 11/08/2022]
Abstract
Many cytokines and growth factors induce transcription of immediate early response genes by activating members of the Signal Transducers and Activators of Transcription (STAT) family. Although significant progress has been made in understanding the events that lead to the activation of STAT proteins, less is known about the regulation of their expression. Here we report that murine embryonic fibroblasts derived from c-Cbl-deficient mice display significantly increased levels of STAT1 and STAT5 protein. In contrast, STAT2 and STAT3 expression, as well as the levels of the tyrosine kinases Jak1 and Tyk2, appear to be regulated independently of c-Cbl. Interestingly, the half-life of STAT1 was unaffected by the presence of c-Cbl, indicating that c-Cbl acts independently of STAT1 degradation. Further analysis revealed similar levels of STAT1 mRNA, however, a dramatically increased rate of STAT1 protein synthesis was observed in c-Cbl-deficient cells. Thus, our findings demonstrate an additional control mechanism over STAT1 function, and also provide a novel biological effect of the Cbl protein family.
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Affiliation(s)
- W A Blesofsky
- Department of Biology and UCSD Cancer Center, University of California San Diego, La Jolla, California 92093-0322, USA
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Abstract
OBJECTIVE To sample the amount and scope of information available on the internet about three common surgical conditions, identify the sources, and to examine the relevance of the web to the surgical community. DESIGN Internet search. SETTING General hospital, Republic of Ireland. MATERIAL Three arbitrarily chosen conditions were sought--varicose veins, inguinal hernia, and gallstones. Four commonly used search engines--Yahoo, Altavista, Excite and Lycos, were used to search worldwide, and then sites restricted to the UK and Republic of Ireland. MAIN OUTCOME MEASURES Quality and quantity of information available. RESULTS All four search engines retrieved patient-orientated information on the three conditions. The sites accessed from the web page matches generally presented a comprehensive summary of the condition including aetiology, risk factors and clinical features, but gave variable amounts of information on treatment options, surgical complications, comparisons between treatments, and expected outcomes. Online health magazines provided most of the information sites. CONCLUSION The internet offers easily-accessible patient-orientated information. Surgeons should make more use of it to satisfy patients' increasing need for information.
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Affiliation(s)
- M A Murphy
- Department of Surgery, Cavan General Hospital, Republic of Ireland
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Imamichi T, Murphy MA, Imamichi H, Lane HC. Amino acid deletion at codon 67 and Thr-to-Gly change at codon 69 of human immunodeficiency virus type 1 reverse transcriptase confer novel drug resistance profiles. J Virol 2001; 75:3988-92. [PMID: 11264389 PMCID: PMC114891 DOI: 10.1128/jvi.75.8.3988-3992.2001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The potential roles of an amino acid deletion at codon 67 (Delta67) and a Thr-to-Gly change at codon 69 (T69G) in the reverse transcriptase of human immunodeficiency virus (HIV) type 1 in drug sensitivity and relative replication fitness were studied. Our results suggest that the Delta67 and T69G changes can be categorized as mutations associated with multidrug resistance. The combination of both mutations with an L74I change (Delta67+T69G/L74I) leads to a novel 3'-azido-3'-deoxythymidine resistance motif and compensates for impaired HIV replication.
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Affiliation(s)
- T Imamichi
- Laboratory of Molecular Retrovirology, Clinical Services Program, Science Applications International Corporation-Frederick, National Cancer Institute-Frederick, Frederick, Maryland 21702-1201, USA.
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Bateman ST, Doctor A, Price B, Murphy MA, Thompson JE, Zurakowski D, Taylor GA, Arnold JH. Optimizing intrapulmonary perfluorocarbon distribution: Fluoroscopic comparison of mode of ventilation and body position. Crit Care Med 2001; 29:601-8. [PMID: 11373428 DOI: 10.1097/00003246-200103000-00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Partial liquid ventilation with the perfluorochemical, perflubron, has been shown to improve lung mechanics and enhance gas exchange in the treatment of severe acute lung injury. However, the most effective strategy to provide optimal intrapulmonary distribution of perflubron has not been fully accessed. The objective of this study was to examine the effect of body position (supine vs. rotational) and mode of ventilation (conventional mechanical ventilation [CMV] vs. high-frequency oscillatory ventilation [HFOV]) on perflubron distribution and oxygenation improvement. DESIGN Prospective, randomized, animal trial. SETTING Research laboratory at a university medical center. SUBJECTS Twenty healthy piglets (4.5-6.6 kg). INTERVENTIONS Subjects underwent repetitive saline lavage to achieve a uniform degree of lung injury and then were randomized to either CMV or were converted to HFOV. Within each ventilator group, animals were randomized to supine positioning (S) or rotational positioning with alternation between supine and prone position (R) during incremental dosing of three 5-mL/kg doses of perflubron. MEASUREMENTS AND MAIN RESULTS Arterial blood gas tensions, hemodynamic variables, and the oxygenation index were recorded after each dose of 5 mL/kg. Lateral cinefluoroscopic images after each dose were digitized for computer analysis of density. A density index was calculated for a 2-cm2 window in three dorsal and three ventral lung regions. Uniformity of distribution was calculated by comparing the mean density among the six regions. Oxygenation improvements were compared between groups. There were no significant differences in hemodynamic variables or gas exchange after lung injury in the four groups. Rotational positioning produced significantly more uniform perflubron distribution during both CMV and HFOV. This effect was independent of the mode of ventilation. The mean ventral density index was affected by rotating position and HFOV mode of ventilation after 10 mL/kg of perflubron, and rotating position was affected only after 15 mL/kg of perflubron. There was a significant reduction in the oxygenation index from baseline to end lavage in both CMV groups, as well as all of the animals that were rotated. CONCLUSION Perflubron is more uniformly dispersed when dosed in a rotational fashion with alternation between supine and prone position during incremental dosing. This effect is independent of mode of ventilation. There was no relationship between oxygenation improvements and nondependent perflubron distribution. CMV and rotating dosing both led to a significant decrease in the oxygenation index after a 15 mL/kg dose of perflubron. This information has important impact on the future development of dosing strategies and clinical trial design.
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Affiliation(s)
- S T Bateman
- Department of Anesthesia, Children's Hospital and Harvard Medical School, Boston, MA, USA
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Shusterman D, Murphy MA, Balmes J. The influence of sex, allergic rhinitis, and test system on nasal sensitivity to airborne irritants: a pilot study. Environ Health Perspect 2001; 109:15-19. [PMID: 11171519 PMCID: PMC1242045 DOI: 10.1289/ehp.0110915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
"Nasal irritant sensitivity" is an important construct in environmental health science; functional measures, however, lack standardization. We performed duplicate measures of nasal irritant perceptual acuity on 16 subjects (evenly divided by sex and seasonal allergy status) using two different test compounds: carbon dioxide (CO2) (detection) and n-propanol (localization). The a priori hypotheses included a) allergic rhinitics will display lower perceptual thresholds than nonrhinitics; b) females will display lower perceptual thresholds than males; and c) estimates of perceptual acuity using the two test systems will be positively correlated. We obtained CO2 detection thresholds using an ascending concentration series, presenting 3-sec pulses of CO2, paired with air in random order, by nasal cannula. We obtained localization thresholds by simultaneously presenting stimuli (ascending concentrations of n-propanol vapor in air) and blanks (saturated water vapor in air) to opposite nostrils, with laterality randomized. In terms of test-retest reliability, individual replicate measures for CO2 detection thresholds correlated more closely than did the localization thresholds of volatile organic compounds (VOC) (r = 0.65 and r = 0.60, respectively). As an intertest comparison, log-transformed individual mean CO2 and VOC measures were positively correlated with an r of 0.63 (p < 0.01). In univariate analyses, sex predicted both log-transformed CO2 and VOC thresholds (females being more "sensitive"; p < 0.05 and 0.001, respectively). Nasal allergies predicted sensory testing results only in the multivariate analysis, and then only for VOC localization (p < 0.05). The question of population variation in nasal irritant sensitivity (as well as the generalizability of results across test compounds) deserves further attention.
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Affiliation(s)
- D Shusterman
- Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, California 94804, USA.
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Murphy MA, Pescatello LS, Tortora BC, Coble DA. SELF-REPORTED PHYSICAL FUNCTION AND MEASURES OF PHYSICAL PERFORMANCE IN COMMUNITY-DWELLING OLDER ADULTS. J Geriatr Phys Ther 2001. [DOI: 10.1519/00139143-200124010-00009] [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: 11/08/2022]
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Doerfler E, Moscicki H, Murphy MA. Should childless NPs cover? Adv Nurse Pract 1999; 7:24. [PMID: 10887778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Lee PS, Wang Y, Dominguez MG, Yeung YG, Murphy MA, Bowtell DD, Stanley ER. The Cbl protooncoprotein stimulates CSF-1 receptor multiubiquitination and endocytosis, and attenuates macrophage proliferation. EMBO J 1999; 18:3616-28. [PMID: 10393178 PMCID: PMC1171440 DOI: 10.1093/emboj/18.13.3616] [Citation(s) in RCA: 234] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Colony-stimulating factor-1 (CSF-1) activation of the CSF-1 receptor (CSF-1R) causes Cbl protooncoprotein tyrosine phosphorylation, Cbl-CSF-1R association and their simultaneous multiubiquitination at the plasma membrane. The CSF-1R is then rapidly internalized and degraded, whereas Cbl is deubiquitinated in the cytoplasm without being degraded. We have used primary macrophages from gene-targeted mice to study the role of Cbl. Cbl-/- macrophages form denser colonies and, at limiting CSF-1 concentrations, proliferate faster than Cbl+/+ macrophages. Their CSF-1Rs fail to exhibit multiubiquitination and a second wave of tyrosine phosphorylation previously suggested to be involved in preparation of the CSF-1-CSF-1R complex for endocytosis. Consistent with this result, Cbl-/- macrophage cell surface CSF-1-CSF-1R complexes are internalized more slowly, yet are still lysosomally degraded, and the CSF-1 utilization by Cbl-/- macrophages is reduced approximately 2-fold. Thus, attenuation of proliferation by Cbl is associated with its positive regulation of the coordinated multiubiquitination and endocytosis of the activated CSF-1R, and a reduction in the time that the CSF-1R signals from the cell surface. The results provide a paradigm for studies of the mechanisms underlying Cbl attenuation of proliferative responses induced by ligation of receptor tyrosine kinases.
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Affiliation(s)
- P S Lee
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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Abstract
This prospective study was designed to measure the costs and benefits of using a laser rather than electrocautery for soft tissue resection during arthroscopic shoulder decompression. Forty-nine shoulders with refractory Neer stage II impingement (persistent fibrosis and tendinitis) were divided into 2 groups. The composition of the 2 groups was similar with regard to sex, worker's compensation status, dominant arm involvement, duration of symptoms, and length of conservative treatment. In one group, electrocautery was used to ablate the bursa and periosteum, release the coracoacromial ligament, and maintain hemostasis. In the other group, a laser was used in place of electrocautery. Patients had been evaluated preoperatively with 2 functional scoring systems. The patients were reexamined at 1 week and at 1, 2, 3, 6, and 12 months after surgery. There were no differences between the groups with regard to functional outcome or satisfaction. There was also no difference in terms of estimated blood loss or operative time. However, there was a statistically significant difference in total hospital charges between groups, with the laser group having a 23% higher hospital bill. On the basis of these results, it is concluded that there was no medical benefit to laser-assisted arthroscopic subacromial decompression but there was an increased monetary cost.
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Affiliation(s)
- M A Murphy
- Minneapolis Sports Medicine Center, MN 55454, USA
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Terry GL, Baldwin TM, Morgan SE, Murphy MA, Wainner RS, Clayton RL, Underwood FB. The effect of stimulatory electrode placement on F-wave latency measurements. Electromyogr Clin Neurophysiol 1998; 38:411-8. [PMID: 9809228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to compare the effects of two commonly used stimulating electrode placements on F-wave latency. SUBJECTS Fifty healthy subjects aged 20 to 47 years were tested. METHODS F-waves were obtained from median and ulnar nerves bilaterally. A total of 200 nerves were tested. RESULTS A paired t-test indicated a statistically significant difference in F-wave latency between the two stimulating electrode placements. Stepwise linear regression equations demonstrated that our results were consistent with previously published studies. CONCLUSION AND DISCUSSION Although a statistically significant difference exists between the two techniques, the magnitude of the difference is not likely to be clinically important. Therefore, the most important factor may be to use a consistent technique when investigating potential neuropathies.
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Murphy MA, Schnall RG, Venter DJ, Barnett L, Bertoncello I, Thien CB, Langdon WY, Bowtell DD. Tissue hyperplasia and enhanced T-cell signalling via ZAP-70 in c-Cbl-deficient mice. Mol Cell Biol 1998; 18:4872-82. [PMID: 9671496 PMCID: PMC109072 DOI: 10.1128/mcb.18.8.4872] [Citation(s) in RCA: 304] [Impact Index Per Article: 11.7] [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: 02/08/2023] Open
Abstract
The c-Cbl protein is tyrosine phosphorylated and forms complexes with a wide range of signalling partners in response to various growth factors. How c-Cbl interacts with proteins, such as Grb2, phosphatidylinositol 3-kinase, and phosphorylated receptors, is well understood, but its role in these complexes is unclear. Recently, the Caenorhabditis elegans Cbl homolog, Sli-1, was shown to act as a negative regulator of epidermal growth factor receptor signalling. This finding forced a reassessment of the role of Cbl proteins and highlighted the desirability of testing genetically whether c-Cbl acts as a negative regulator of mammalian signalling. Here we investigate the role of c-Cbl in development and homeostasis in mice by targeted disruption of the c-Cbl locus. c-Cbl-deficient mice were viable, fertile, and outwardly normal in appearance. Bone development and remodelling also appeared normal in c-Cbl mutants, despite a previously reported requirement for c-Cbl in osteoclast function. However, consistent with a high level of expression of c-Cbl in the hemopoietic compartment, c-Cbl-deficient mice displayed marked changes in their hemopoietic profiles, including altered T-cell receptor expression, lymphoid hyperplasia, and primary splenic extramedullary hemopoiesis. The mammary fat pads of mutant female mice also showed increased ductal density and branching compared to those of their wild-type littermates, indicating an unanticipated role for c-Cbl in regulating mammary growth. Collectively, the hyperplastic histological changes seen in c-Cbl mutant mice are indicative of a normal role for c-Cbl in negatively regulating signalling events that control cell growth. Consistent with this view, we observed greatly increased intracellular protein tyrosine phosphorylation in thymocytes following CD3epsilon cross-linking. In particular, phosphorylation of ZAP-70 kinase in thymocytes was uncoupled from a requirement for CD4-mediated Lck activation. This study provides the first biochemical characterization of any organism that is deficient in a member of this unique protein family. Our findings demonstrate critical roles for c-Cbl in hemopoiesis and in controlling cellular proliferation and signalling by the Syk/ZAP-70 family of protein kinases.
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Affiliation(s)
- M A Murphy
- Trescowthick Research Laboratories, Peter MacCallum Cancer Institute, Melbourne 3000, Parkville 3050, Victoria, Australia
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Shusterman DJ, Murphy MA, Balmes JR. Subjects with seasonal allergic rhinitis and nonrhinitic subjects react differentially to nasal provocation with chlorine gas. J Allergy Clin Immunol 1998; 101:732-40. [PMID: 9648699 DOI: 10.1016/s0091-6749(98)70302-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nasal irritation and associated symptoms (nasal congestion, rhinorrhea, and sinus headache) are important elements of the response to indoor and outdoor air pollution. Marked interindividual variability in such symptoms has been suggested clinically and epidemiologically, but little experimental data exist on this issue. OBJECTIVE We sought to test the hypothesis that subjects with seasonal allergic rhinitis (SAR) exhibit a more marked physiologic response (congestion) after nasal irritant provocation than do nonrhinitic subjects. METHODS We studied eight subjects with SAR and eight nonrhinitic subjects; subjects with SAR were studied out of season. In a single-blind crossover study, subjects had their nasal airway resistance (NAR) measured in triplicate before, immediately after, and 15 minutes after a 15-minute exposure to either filtered air or 0.5 ppm chlorine in filtered air, administered through a nasal mask in a climate-controlled chamber. Log-transformed NAR values were analyzed in a repeated-measures analysis of variance model, with confirmatory testing using paired t tests. RESULTS The net (chlorine minus air day) percent change in NAR from baseline (before exposure) to immediately after exposure was +24% in the SAR group and +3% in the nonrhinitic group (p < 0.05). The corresponding net changes from baseline to 15 minutes after exposure were +21% in the SAR group and -1% in the nonrhinitic group (p < 0.05). CONCLUSIONS The observed augmented nasal congestive response of subjects with SAR versus nonrhinitic subjects to a controlled low-level chemical irritant provocation is consistent with epidemiologic surveys showing a higher prevalence of nasal symptoms among subjects with SAR than nonrhinitic subjects in environments involving irritant air pollutants.
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Affiliation(s)
- D J Shusterman
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA
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Murphy MA, Grosof DH, Hart WM. Congenital optic tract syndrome: magnetic resonance imaging and scanning laser ophthalmoscopy findings. J Neuroophthalmol 1997; 17:226-30. [PMID: 9427172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lesions of the optic tract produce a distinctive pattern of optic atrophy and visual field loss and may be due to either congenital or acquired causes. We report a case of a congenital optic tract syndrome and correlate the magnetic resonance imaging findings with the appearance of nerve fiber layer defects found by confocal scanning laser ophthalmoscopy.
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Affiliation(s)
- M A Murphy
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA
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Murphy MA, Hart WM, Olk RJ. Bilateral diffuse uveal melanocytic proliferation simulating an arteriovenous fistula. J Neuroophthalmol 1997; 17:166-9. [PMID: 9304528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bilateral diffuse uveal melanocytic proliferation is a rare paraneoplastic syndrome that causes visual loss in patients with systemic carcinoma. We report the case of a patient with this syndrome whose initial presentation and striking anterior segment findings mimicked that of an arteriovenous fistula.
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Affiliation(s)
- M A Murphy
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
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Murphy MA, Thirkill CE, Hart WM. Paraneoplastic retinopathy: a novel autoantibody reaction associated with small-cell lung carcinoma. J Neuroophthalmol 1997; 17:77-83. [PMID: 9176775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We present the case of a 74-year-old man with rapidly progressive bilateral visual loss, optic disc pallor, retinal arteriolar attenuation, and an abnormal electroretinogram with a 90% reduction in cone function and a 50% reduction in rod function. He was examined for a suspected cancer-associated retinopathy (CAR). Although he was found not to have expressed the previously reported 23-kd CAR antibody, high titers were found of an antibody to a 60-kd retinal protein, which as yet remains unidentified. An initial clinical search for an underlying cancer was unsuccessful, but 2 months later a mediastinal mass was found on chest x-rays, and biopsy confirmed a diagnosis of small-cell lung carcinoma. Combined therapy with oral corticosteroids and plasmapheresis resulted in a recovery of vision from counting fingers to 20/200 in the right eye and 20/40 to 20/25 in the left eye. Conventional chemotherapeutic management of the small-cell lung carcinoma was instituted, and the modest visual recovery was maintained. The visual improvement as well as lung tumor regression were accompanied by a decline in antibody titers from 1:2,000 pretreatment to 1:200 during the course of therapy. The absence of reactivity with the previously described 23-kd retinal antigen of the CAR syndrome does not exclude the diagnosis of paraneoplastic retinopathy in patients fitting the clinical profile of this disease.
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Affiliation(s)
- M A Murphy
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA
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Greenberg F, Lewis RA, Potocki L, Glaze D, Parke J, Killian J, Murphy MA, Williamson D, Brown F, Dutton R, McCluggage C, Friedman E, Sulek M, Lupski JR. Multi-disciplinary clinical study of Smith-Magenis syndrome (deletion 17p11.2). Am J Med Genet 1996; 62:247-54. [PMID: 8882782 DOI: 10.1002/(sici)1096-8628(19960329)62:3<247::aid-ajmg9>3.0.co;2-q] [Citation(s) in RCA: 203] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Smith-Magenis syndrome (SMS) is a multiple congenital anomaly, mental retardation (MCA/MR) syndrome associated with deletion of chromosome 17 band p11.2. As part of a multi-disciplinary clinical, cytogenetic, and molecular approach to SMS, detailed clinical studies including radiographic, neurologic, developmental, ophthalmologic, otolaryngologic, and audiologic evaluations were performed on 27 SMS patients. Significant findings include otolaryngologic abnormalities in 94%, eye abnormalities in 85%, sleep abnormalities (especially reduced REM sleep) in 75%, hearing impairment in 68% (approximately 65% conductive and 35% sensorineural), scoliosis in 65%, brain abnormalities (predominantly ventriculomegaly) in 52%, cardiac abnormalities in at least 37%, renal anomalies (especially duplication of the collecting system) in 35%, low thyroxine levels in 29%, low immunoglobulin levels in 23%, and forearm abnormalities in 16%. The measured IQ ranged between 20-78, most patients falling in the moderate range of mental retardation at 40-54, although several patients scored in the mild or borderline range. The frequency of these many abnormalities in SMS suggests that patients should be evaluated thoroughly for associated complications both at the time of diagnosis and at least annually thereafter.
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Affiliation(s)
- F Greenberg
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, Steiner CP, Trimble MB, Weisenberger JP. Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 1995; 83:641-7. [PMID: 7674014 DOI: 10.3171/jns.1995.83.4.0641] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.9] [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: 01/26/2023]
Abstract
Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.
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Affiliation(s)
- I H Kalfas
- Department of Neurosurgery, Cleveland Clinic Foundation, Ohio, USA
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Abstract
Antibiotics are frequently prophylactically administered in surgical procedures to reduce the incidence of infection. The penetration of antibiotics into lumbar discs has been studied with mixed results, but penetration into cervical discs has not been reviewed. In this study, we examined the penetration of two commonly used antibiotics, oxacillin and cefazolin, into cervical discs. Eighteen patients with a total of 30 discs removed were studied. Two groups, each consisting of four patients with five discs removed, received either 1 g of oxacillin or 1 g of cefazolin by a single, preoperative intravenous infusion. Two other groups, each consisting of five patients with 10 discs removed, received either 2 g of oxacillin or 2 g of cefazolin, also by a single, preoperative intravenous infusion. A blood specimen, from which serum antibiotic levels were determined, was obtained from each patient simultaneously with each discectomy. The time interval between the antibiotic infusion and discectomy/phlebotomy was also recorded. Antibiotic levels were detected in all discs removed but were quantifiable in only 12. Nine of these 12 had been exposed to cefazolin. Of these nine discs, one was from a patient who had received 1 g whereas the other eight were from patients who had received 2 g of cefazolin. This represents 80% of the removed discs exposed to 2 g of cefazolin (10 discs total) and 20% exposed to 1 g (5 discs total). The remaining three discs with quantifiable antibiotic levels had been exposed to 2 g of oxacillin, which represents 30% of the discs (10 total) exposed to that dose of oxacillin. Although cervical disc space infections are rare, they are serious.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R L Rhoten
- Department of Neurological Surgery, Cleveland Clinic Foundation, Ohio, USA
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Graveley EA, Murphy MA. Nursing informatics. Making financial management come alive. Comput Nurs 1995; 13:217-20. [PMID: 7585303] [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: 01/26/2023]
Abstract
The authors describe integration of nursing informatics concepts and computer-based instructional strategies in a financial management course for graduate level nursing administration students. Major components include: 1) computer-based instruction for financial management theory; 2) spreadsheet used for decision support; 3) utilization of forecasting software; and 4) evaluation of learning involving computer use.
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Affiliation(s)
- E A Graveley
- UTHSCSA School of Nursing, San Antonio, TX 78284-7948, USA
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Abstract
The Million Behavioral Health Inventory was administered to 67 individuals with chronic low back pain who participated in a rehabilitation program on pain and stress. Base-rate scores from the 20 scales, submitted to cluster analysis using Ward's minimum variance method, gave four subtypes. Discriminant analysis accurately classified 98.51% of the sample. The discriminant functions were interpreted and labeled as I: somatic distress and II: inhibition-dependency. The groups were then examined for differences and similarities with respect to those dimensions, and the groups were labeled I-introversive, II-denial/minimizers, III-conformers, and IV-severe psychophysiological reaction. The types were next compared across medical, vocational, and demographic data. With the exception of sex of subject, no other data were significant by type. The results were discussed, and recommendations for research were made.
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Gabram SG, Schwartz RJ, Jacobs LM, Lawrence D, Murphy MA, Morrow JS, Hopkins JS, Knauft RF. Clinical management of blunt trauma patients with unilateral rib fractures: a randomized trial. World J Surg 1995; 19:388-93. [PMID: 7638994 DOI: 10.1007/bf00299166] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [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: 01/26/2023]
Abstract
Optimal pain management is essential in blunt trauma patients sustaining significant chest trauma. The purpose of this randomized prospective trial was to measure the difference in pulmonary function in nonintubated patients with unilateral multiple rib fractures receiving two modalities of pain relief: systemic narcotic medications alone or local anesthetics given by intrapleural catheter (IPCs). Forty-two patients were randomized to receive systemic narcotic medications or IPCs for pain control. The patients with IPCs statistically had more compromised pulmonary function as measured by forced vital capacity (FVC) on admission; however, they tended toward a greater objective improvement of FVC on discharge. When analyzing a cohort of severely impaired patients (initial FVC < 20%), half of the systemic medication patients compared to only 10% of the IPC group failed and required another mode of therapy. Catheter complications were minor and did not contribute to overall morbidity. The IPC patients had fewer failures than the systemic medication patients.
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Affiliation(s)
- S G Gabram
- Department of Emergency Medicine/Trauma, Hartford Hospital, Connecticut 06115, USA
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Murphy MA, Trimble MB, Piedmonte MR, Kalfas IH. Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery 1994; 34:93-6. [PMID: 8121574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A controversial point in the management of patients undergoing anterior cervical discectomy is whether an interbody bone graft should be used. Proponents of interbody grafting claim that without a graft, the disc height and the area of the foramina at that level will decrease postoperatively with the potential for persistent symptoms and/or the development of a radiculopathy. Using a two-dimensional digital planimeter, we measured the cross-sectional area (cm2) of cervical foramina on preoperative and postoperative oblique films in patients undergoing anterior cervical discectomy. Group A patients underwent the insertion of an interbody graft after the discectomy; Group B patients did not. Our results indicate that in all the patients in Group A, there was a statistically significant increase in the area of the foramina (P < 0.001) and in Group B, a statistically significant decrease (P = 0.0005). However, when the absolute change in magnitude of the foramina was measured, without respect to an increase or decrease, there was no statistically significant difference (P > 0.8). There was no statistically significant difference (P = 1.000) in the outcome between the two groups. From an anatomical standpoint, our data support the insertion of an interbody graft if the surgeon wishes to increase the area of the foramen. However, the overall magnitude of change is not significant, which may be a factor in why the clinical outcome is similar in both groups.
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Affiliation(s)
- M A Murphy
- Department of Neurological Surgery, Cleveland Clinic Foundation, Ohio
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