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Ghearing GR, Tyrrell M, Black J, Krehel-Montgomery J, Yala J, Adeniyi C, Briggs F, Sajatovic M. Clinical correlates of negative health events and disparities among adults with epilepsy enrolled in a self-management clinical trial. Epilepsy Res 2024; 203:107366. [PMID: 38669777 DOI: 10.1016/j.eplepsyres.2024.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
AIMS Despite advances in care, people with epilepsy experience negative health events (NHEs), such as seizures, emergency department (ED) visits and hospitalizations. This analysis using baseline data from an epilepsy self-management clinical trial targeting people from rural regions and other underserved populations assessed the relationship between demographic and clinical variables vs. NHEs. METHODS Data to evaluate disparities and clinical correlates was collected using patient surveys from a baseline sample of 94 participants in a larger prospective study of 160 individuals with epilepsy who experienced an NHE within the last six months. Demographic characteristics, mental and physical functional status assessed using 36-Item Short Form Health Survey questionnaire version 2 (SF-36v2), depression assessed with the 9-item Patient Health Questionnaire (PHQ-9), quality of life assessed with the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), self-efficacy assessed the Epilepsy Self-Efficacy Scale (ESES), social support assessed with the Multidimensional Scale of Perceived Social Support (MSPSS), self-management assessed with the Epilepsy Self-Management Scale (ESMS), and stigma assessed with the Epilepsy Stigma Scale (ESS) were all examined in association with past 6-month total NHE frequency as well as NHE sub-categories of past 30-day and 6-month seizure counts, self-harm attempts, ED visits and hospitalizations. An exploratory evaluation of NHE correlates in relation to the Rural Urban Continuum Code (RUCC) residence classification compared 3 subgroups of increasing rurality. Descriptive statistics were generated for demographic and clinical variables and NHEs, and exploratory analyses compared the distribution of demographic, clinical, and NHE variables by RUCC categorization. RESULTS The mean age was 38.5 years (SD 11.9), predominantly female (N= 62, 66.0%) and white (N=81, 86.2%). Just a little under half (N=43, 45.7%) of participants had annual incomes of less than $25,000, and 40% (N=38) were rural residents (RUCC >3). The past 6-month NHEs count was 20.4 (SD 32.0). Seizures were the most common NHE with a mean 30-day seizure frequency = 5.4 (SD 11.8) and 6-month seizure frequency of 18.7 (SD 31.6). Other NHE types were less common with a past 6-month self-harm frequency of 0.16 (SD 1.55), ED visit frequency of 0.72 (SD 1.10), and hospitalization frequency of 0.28 (SD 1.02). There were few significant demographic and clinical correlates for total and sub-categories of NHEs. Worse physical health status, as measured by the physical component summary (PCS) of the SF-36v2, was significantly associated with 6-month seizure counts (p=.04). There were no significant differences between the 3 RUCC subgroups on demographic variables. However, past 30-day seizure count, past 6-month seizure count and total past 6-month NHE counts were all higher among individuals from more rural settings (p-values <.01 for each). CONCLUSIONS Rural adults with epilepsy were more likely to have a greater number of seizures and more epilepsy complications in general. Worse physical health function was also associated with more epilepsy complications. However, this analysis found few other demographic and clinical correlates of cumulative NHEs among adults with epilepsy. Additional efforts are needed to investigate health disparities among people with epilepsy who live in rural regions or who have poor physical health function.
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Affiliation(s)
- Gena R Ghearing
- Department of Neurology, Carver College of Medicine University of Iowa Health Center, Iowa City, LA, USA.
| | - Maegan Tyrrell
- Department of Neurology, Carver College of Medicine University of Iowa Health Center, Iowa City, LA, USA
| | - Jessica Black
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jacqueline Krehel-Montgomery
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Joy Yala
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Clara Adeniyi
- Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Farren Briggs
- Department of Public Health Services, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine University Hospitals Case Medical Center, Cleveland, OH, USA
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Smith L, Thomas N, Arnold A, Bell R, Zayed H, Tyrrell M, Padayachee S. A Comparison of Computed Tomography Angiography and Colour Duplex Ultrasound Surveillance Post Infrarenal Endovascular Aortic Aneurysm Repair: Financial Implications and Impact of Different International Surveillance Guidelines. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.095] [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: 11/25/2022]
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Blixen C, Ghearing G, Wade O, Colon-Zimmerman K, Tyrrell M, Sajatovic M. Engaging stakeholders in the refinement of an evidence-based remotely delivered epilepsy self-management program for rural populations. Epilepsy Behav 2021; 118:107942. [PMID: 33845345 PMCID: PMC8107125 DOI: 10.1016/j.yebeh.2021.107942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
A growing body of research supports self-management approaches that can improve outcomes in people living with epilepsy (PLWE). An evidence-based remotely delivered self-management program (SMART) that was successfully delivered in an urban/suburban setting has the potential to be particularly helpful to PLWE who live in rural communities, where heavy stigma burden and limited access to healthcare is common. In this Phase 1 exploratory study, focus groups of key rural stakeholders (PLWE, family members, care providers) were used to: (1) gather information on factors that may impede or facilitate participation in SMART and (2) elicit overall perceptions of the program, as well as suggestions and feedback for refining it for implementation in Phase 2 of the randomized controlled study (RCT). Qualitative data analysis revealed that focus group participants identified geographic and social isolation, and the more limited access to epilepsy care, as the major barriers to epilepsy self-management for rural populations. However, they felt strongly that SMART could fill an epilepsy care gap in rural communities, and provided suggestions for recruitment and retention strategies of subjects, as well as improvement/modifications to the program curriculum for the Phase 2 RCT.
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Affiliation(s)
- Carol Blixen
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Gena Ghearing
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Owen Wade
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Kari Colon-Zimmerman
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maegan Tyrrell
- Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA
| | - Martha Sajatovic
- Department of Psychiatry and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Psychiatry & Neurology and Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Kelly J, Patel A, Onadim I, Abisi S, Bell R, Tyrrell M, Sallam M, Salih M, Mayr M, Bradbury E, Cho J, Gworzdz A, Booth T, Smith A, Modarai B. O15: DISRUPTION OF THE BLOOD-SPINAL CORD BARRIER PREDICTS PERMANENT PARAPLEGIA AFTER THORACOABDOMINAL AORTIC ANEURYSM REPAIR. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Paraplegia post-thoracoabdominal aortic aneurysm (TAAA) repair remains both a devastating and poorly understood complication. We related temporal changes in cellular and protein composition of cerebrospinal fluid (CSF) to neurological outcomes after TAAA repair to gain mechanistic insights driving paraplegia.
Method
Patients undergoing TAAA repair (open or endovascular) with a CSF drain were prospectively recruited between 2016-2018. CSF was collected pre-operatively and 24-hourly until removal. Daily neurological examinations were performed by blinded neurologists to the study. CSF cell content was characterised by flow cytometry and proteome analysed by tandem-mass-tag proteomics. An in-vivo rat model was modified using 15 minutes of aortic occlusion to produce consistent paraplegia. Rats were analysed neuro-behaviourally and histologically.
Result
CSF was analysed from 52 patients (age: 70.27+/-11.4; 66% male; open (n=9), endovascular (n=43)). 12 developed paraplegia of whom 5 remained permanently-paraplegic. Demographics were comparable between paraplegics, those who recovered and without post-op neurology. Permanent paraplegia was associated with a significant infiltration of CSF CD45+ leucocytes (P<0.0001). Levels of ADVS-1 was >3-fold higher in permanent-paraplegics CSF versus those who recovered (P=0.0008). ADVS-1 >15ng/ml predicted permanent paraplegia with 100% specificity. Pre-treatment with ADVS-1 inhibition significantly improved walking (<0.001) and increased astrocytic staining in the lateral corticospinal, reticulospinal and rubrospinal tracts versus controls (P=0.03, 0.04, 0.04 respectively).
Conclusion
Permanent paraplegia is associated with shedding of ADVS-1 from parenchymal cord into CSF and blood/spinal-cord barrier disruption leading to cord oedema/leucocyte infiltration. Pre-treatment with ADVS-1 inhibition led to neurobehavioural and histological improvements offering translational hope for this devastating complication.
Take-home message
ADVS-1 is a novel biomarker of paraplegia where accurate biomarkers have proven challenging but more importantly it has proven a therapeutic target with genuine translational potential.
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EL-Sayed T, Patel A, Saha P, Lyons O, Ludwinski F, Bell R, Patel S, Donati T, Zayed H, Sallam M, Wilkins C, Tyrrell M, Dialynas M, Sandford B, Abisi S, Gkoutzios P, Black S, Smith A, Modarai B. Radiation-Associated DNA Damage in Operators During Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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EL-Sayed T, Patel A, Saha P, Lyons O, Ludwinski F, Bell R, Patel S, Donati T, Zayed H, Sallam M, Wilkins C, Tyrrell M, Dialynas M, Sandford B, Abisi S, Gkoutzios P, Black S, Smith A, Modarai B. Endovascular Aortic Repair is Associated with Activation of Markers of Radiation Induced DNA Damage in both Operators and Patients. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.05.026] [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: 11/17/2022]
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Guillou M, Bianchini A, Hertault A, D’Elia P, Pottrainl N, Sobocinski J, Maurel B, Azzaoui R, Tyrrell M, Haulon1 S. A New Score to Predict Post Operative Complications after Endovascular Treatment of Thoraco Abdominal Aortic Aneurysms. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2014.11681021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Guillou
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - A. Bianchini
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - A. Hertault
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - P. D’Elia
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - N. Pottrainl
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - J. Sobocinski
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - B. Maurel
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | - R. Azzaoui
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
| | | | - S. Haulon1
- Vascular Surgery, Hopital Cardiologique, CHRU de Lille, France
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Maurel B, Delclaux N, Sobocinski J, Hertault A, Martin-Gonzalez T, Moussa M, Spear R, Le Roux M, Azzaoui R, Tyrrell M, Haulon S. The Impact of Early Pelvic and Lower Limb Reperfusion and Attentive Peri-operative Management on the Incidence of Spinal Cord Ischemia During Thoracoabdominal Aortic Aneurysm Endovascular Repair. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Delloye M, Maurel B, Spear R, Hertault A, Azzaoui R, Tyrrell M, Sobocinski J, Haulon S. Aortic Rupture During a Staged Endovascular Repair of a Thoracoabdominal Aneurysm. EJVES Short Rep 2015. [DOI: 10.1016/j.ejvssr.2015.07.002] [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: 11/24/2022] Open
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10
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Martin Gonzalez T, Maurel B, Sobocinski J, Le Roux M, Azzaoui R, Tyrrell M, Haulon S. Management and fate of renal arteries during endovascular pararenal and thoracoabdominal aneurysm repair. INT ANGIOL 2014; 33:499-510. [PMID: 24945919] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Guillou M, Bianchini A, Hertault A, D'Elia P, Pottrain N, Sobocinski J, Maurel B, Azzaoui R, Tyrrell M, Haulon S. A new score to predict post operative complications after endovascular treatment of thoraco abdominal aortic aneurysms. Acta Chir Belg 2014; 114:250-255. [PMID: 26021420] [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: 06/04/2023]
Abstract
BACKGROUND The endovascular treatment of thoraco abdominal aortic aneurysms (TAAA) is a minimally invasive solution. However, patient selection remains a major problem. We have analysed our experience to identify the risk factors for post-operative morbidity and mortality and to construct a scoring system to identify those patients likely to benefit from this treatment. METHODS We have analysed a consecutive cohort of patients treated electively for TAAA using endovascular techniques between 2006 and October 2012. All data were collected prospectively. The risk factors associated with spinal cord ischemia (SCI), the need for post-operative dialysis and 30 day mortality were determined using multivariate statistical techniques and a logistic regression model including all variables that were significant on univariate analysis (p < 0.05). A predictive score was calculated using a Received Operating Characteristic (ROC) curve, defining best specificity and sensibility. RESULTS We analysed the data from 123 patients (median age 70 years). The 30 day mortality rate was 8% (10 patients). The SCI rate was 6% (7 patients). One patient (1%) required long-term dialysis after the aortic procedure. The cumulative early mortality, SCI and permanent dialysis rate was 14% (17 patients). In multivariate analysis, adverse outcome was associated with advanced age (OR = 1.110 ; p = 0.022), and Crawford type I or II or III (OR = 9.292 ; p = 0.002) as compared with Crawford type IV. Pre-operative beta blocker (BB) treatment was a protective factor (OR = 0.099 ; p = 0.005). A predictive score was then constructed : Score = -10.060 + 0.104x(A) +2.229x(B) -2.315x(C) (A = patient age ; B = 1 if TAAA Crawford type 1, 2 or 3, 0 if TAAA type 4 ; C = 1 if on-going BB treatment (30 days pre-surgery minimum), 0 if none). Its sensitivity and specificity were 88% and 89% respectively. CONCLUSIONS We propose a simple predictive scoring system. This tool is useful in predicting the most feared complications after endovascular TAAA repair and has potential use in the identification and counselling of vulnerable patients being considered for surgery. More data are needed to refine the prediction of individual operative risks.
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Affiliation(s)
- M Guillou
- Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France
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Sobocinski J, Hertault A, Tyrrell M, Maurel B, Azzaoui R, Haulon S. Chronic type B dissections: are fenestrated and branched endografts an option? J Cardiovasc Surg (Torino) 2013; 54:97-107. [PMID: 23443594] [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
While there are centers reporting encouraging outcomes after endovascular repair of thoracoabdominal aortic aneurysms, chronic dissections (a specific etiological subgroup of thoracoabdominal aneurysms) present an even greater technical and clinical challenge. There are particular technical issues associated with the management of the proximal sealing zone, the need to work in a narrow aortic lumen and also to maintain perfusion of all target (visceral and supra-aortic) vessels including those perfused by the false lumen. We present here the various endovascular options available for the treatment of these complex aortic lesions.
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Affiliation(s)
- J Sobocinski
- Department of Vascular Surgery, CHRU de Lille, Lille Nord de France University, Lille, France
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Lioupis C, Mistry H, Chandak P, Tyrrell M, Valenti D. Autogenous Brachial—Brachial Fistula for Vein Access. Haemodynamic Factors Predicting Outcome and 1 Year Clinical Data. Eur J Vasc Endovasc Surg 2009; 38:770-6. [DOI: 10.1016/j.ejvs.2009.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
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Mistry H, Currie A, Lioupis C, Tyrrell M, Valenti D. An Unusual Case of Post-stent Carotid Artery Stenosis with Successful Operative Repair: A Case Report. Eur J Vasc Endovasc Surg 2009. [DOI: 10.1016/j.ejvs.2009.07.018] [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: 11/16/2022]
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D'Elia P, Tyrrell M, Sobocinski J, Azzaoui R, Koussa M, Haulon S. Endovascular thoracoabdominal aortic aneurysm repair: a literature review of early and mid-term results. J Cardiovasc Surg (Torino) 2009; 50:439-445. [PMID: 19734829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Successful endovascular repair of abdominal aortic aneurysms (AAA) requires undilated proximal (infrarenal neck) and distal landing zones (common or external iliac arteries). A range of approved endografts are available to exclude such aneurysms. Recent multicentric prospective randomized trials have demonstrated a short and midterm decrease in aneurysm-related deaths of the endovascular technique compared to open surgery. These results have induced an overall increase in the rate of endovascular repair of AAA. Patients with more complex aortic aneurysms, involving the visceral vessels (juxta, para and thoraco-abdominal aneurysms (TAAA), have increased perioperative morbidity and mortality after open repair compared to AAA. These patients could potentially benefit from an endovascular approach. Branched and fenestrated endografts have been developed to address this endovascular challenge. This review was carried out on the current literature evaluating these new endovascular complex procedures. Spinal cord ischemia, 30-day mortality and branch patency rates after endovascular exclusion of TAAA ranged from 2.7% to 20%, 0% to 9.1% and 96% to 100% respectively. Mid-term results of endovascular complex aortic repairs are favourable compared to open surgery in high risk patients. Long-term results will be necessary to evaluate specific complications such as migration, material fatigue and component separation that can result in loss of visceral branches.
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Affiliation(s)
- P D'Elia
- Department of Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France and King's College Hospital London, UK
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D'Elia P, Tyrrell M, Azzaoui R, Sobocinski J, Koussa M, Valenti D, Haulon S. Zenith abdominal aortic aneurysm endovascular graft: a literature review. J Cardiovasc Surg (Torino) 2009; 50:165-170. [PMID: 19329913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The early experience of endovascular aneurysm repair (EVAR) using ''first generation'' devices was disappointing. There was an appreciable incidence of delayed, post-EVAR, aneurysm rupture. This was primarily a consequence of structural device failure. These failures provided important lessons for re-design and the modern ''second generation'' devices, including the Zenith (Cook Inc, Bloomington, IN, USA) endograft, are thought to be more reliable, particularly providing better fixation and sealing and also a more durable stent/fabric structure. This article comprises a review of the English literature detailing the endovascular treatment of abdominal aortic aneurysms using the Zenith endograft. It focuses on clinical studies or trials with intermediate to long-term follow-up, and related the literature to our own experience. In the series examined (N.=2 017 patients) the early mortality rate ranged from 0% to 4.1% and the technical success rate from 97.7% to 100%. The re-intervention rate was related to the length of follow-up (6.8% to 14%). Conversion rates were consistently <1%. There was a low incidence of device migration, limb thrombosis, component separation and stent fracture. These data support the ongoing use of the Zenith endovascular graft in patients with abdominal aortic aneurysms suitable for EVAR.
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Affiliation(s)
- P D'Elia
- Vascular Surgery, Cardiology Hospital, CHRU de Lille, Lille, France
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Affiliation(s)
- J H N Wolfe
- St. Mary's Hospital, Praed Street, London W2 1NY, UK
| | - M Tyrrell
- St. Mary's Hospital, Praed Street, London W2 1NY, UK
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Abstract
Syntaxins and other SNARE (soluble NSF-attachment protein receptor) complex proteins play a key role in the cellular processes of vesicle trafficking, vesicle fusion and secretion. Intriguingly, the SNARE NtSyr1 (=NtSyp121) from Nicotiana tabacum also appears to have a role in signalling evoked by the plant stress hormone abscisic acid. However, partner proteins contributing to its function(s) remain unknown. We used an affinity chromatography approach to identify proteins from tobacco leaf microsomes that directly interact with the hydrophilic (cytosolic) domains of NtSyr1 and report several interacting proteins with sensitivities to the endopeptidase activity of Clostridium botulinum neurotoxins, including one protein that was recognised by alphaAtSNAP33 antiserum, raised against the Arabidopsis SNAP25 homologue. Treatment of microsomal membrane fractions indicated a protein near 55 kDa was sensitive to proteolysis by BotN/A and BotN/E, yielding degradation products of approximately 34 and 23 kDa. Expressed and purified AtSNAP33 also bound directly to the cytosolic domain of NtSyr1 and was sensitive to proteolysis by these toxins, suggesting that NtSyr1, a tobacco homologue of AtSNAP33, and coordinate SNAREs are likely to associate as partners for function in vivo.
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Affiliation(s)
- J Kargul
- Laboratory of Plant Physiology and Biophysics, Imperial College of Science, Technology and Medicine at Wye, Kent, UK
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Abstract
OBJECTIVE To determine if women would have higher breast and cervical cancer screening rates if lay health advisers recommended screening and offered a convenient screening opportunity. DESIGN Controlled trial. SETTING Urban county teaching hospital. PARTICIPANTS Women aged 40 years and over attending appointments in several non-primary-care outpatient clinics. INTERVENTIONS Lay health advisers assessed the participants' breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner. MEASUREMENTS AND MAIN RESULTS Screening rates at baseline and at follow-up 1 year after the intervention were determined. At follow-up, the mammography rate was 69% in the intervention group versus 63% in the usual care group (p = .009), and the Pap smear rate was 70% in the intervention group versus 63% in the usual care group (p = .02). In women who were due for screening at baseline, the mammography rate was 60% in the intervention group versus 50% in the usual care group (p = .006), and the Pap smear rate was 63% in the intervention group versus 50% in the usual care group (p = .002). The intervention was effective across age and insurance payer strata, and was particularly effective in Native American women. CONCLUSIONS Breast and cervical cancer screening rates were improved in women attending non-primary-care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening. The effect was strongest in women in greatest need of screening.
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Affiliation(s)
- K L Margolis
- Hennepin County Medical Center, University of Minnesota, Minneapolis 55404, USA
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Tyrrell M, Margolis K, Sandberg L, Slater J, Lurie N. Older women helping older women: Employing senior workers in community research. Am J Public Health 1996; 86:588-9. [PMID: 8604799] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Tyrrell
- Hennepin County Medical Center Program in Clinical Epidemiology, Effectiveness and Policy, St. Paul, MN 55116, USA
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Shenassa H, Sankaran K, Duncan W, Tyrrell M, Bharadwaj B. Surgical ligation of patent ductus arteriosus in a neonatal intensive care setting is safe and cost effective. Can J Cardiol 1986; 2:353-5. [PMID: 3100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The physiological and biochemical status of two groups of neonates with patent ductus arteriosus (PDA) requiring surgical ligation were compared. One group (n = 14) had ductus ligation in the operating room (OR) and the other group (n = 14) had the same operation in an isolation room in the Neonatal Intensive Care Unit (NICU). The groups were closely matched in terms of gestational age and weight. Nursing time and disposable equipment savings were significantly different. We have confirmed that PDA ligation can be done safely in the NICU and is more cost efficient than ligation in the OR.
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Abstract
An asymptomatic boy was found to have coarctation of the thoracic aorta. Despite no history of endocarditis or trauma, a large saccular aneurysm involving the coarctation site was identified angiographically, confirmed, resected surgically, and examined histologically.
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Sankaran K, Conly J, Boyle CA, Tyrrell M. Intestinal colic and diarrhea as side effects of intravenous alprostadil administration. Am J Dis Child 1981; 135:664-5. [PMID: 7246498 DOI: 10.1001/archpedi.1981.02130310068023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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