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Marks E, Doyle K, Magennis B, O'Connell M, McGreevy C. 131 USE OF FDG-PET BRAIN IMAGING IN THE DIAGNOSIS AND MANAGEMENT OF DEMENTIA IN A UNIVERSITY HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Neuroimaging is an increasingly important tool dementia work-up. Subtype diagnosis helps predict the course of the disease, aiding prognostication and management. Amyloid-beta peptide is intrinsic to the pathogenesis of Alzheimer’s disease (AD), forming characteristic neuritic plaques which can be imaged in vivo on positron emission tomography (PET) scans. NICE recommendations advise use of PET imaging if dementia sub-type diagnosis is unclear and AD is suspected. We sought to establish the referral patterns for FDG-PET brain scans for patients aged 60 and over in a university hospital and to establish whether this imaging modality contributed to a change in diagnosis or treatment.
Methods
Requests for FDG-PET CT brain from 2019 – 2022 were retrospectively reviewed. Information was obtained from clinical notes and patient information software. Patient demographics, indication for scan, source of referral and whether imaging results led to a change in diagnosis or treatment was recorded.
Results
A total of 32 patients were reviewed, with a mean age of 65 years (13 females; 41%). We further analysed the 25 who were aged over 60; this subgroup had a mean age of 70 (9 females; 36%). All 25 patients were appropriately referred to assess for dementia subtype. A revision in diagnosis based on PET imaging was made in 17 (68%) cases. In 9 (30%) cases, results prompted change in dementia-specific pharmacological treatment, including donepezil and memantine. A further 6 (24%) had pharmacological treatment for non-cognitive symptoms of dementia adjusted, such as anti-depressants or anti-psychotics. The majority of referrals had come from neurologists (n = 15; 60%) rather than geriatricians (n = 10; 40%). The final diagnosis was AD in 12 cases (48%) and fronto-temporal dementia in 3 cases (12%).
Conclusion
PET scans are a useful functional imaging modality which can help to differentiate dementia subtypes and influence management.
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Affiliation(s)
- E Marks
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - K Doyle
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - B Magennis
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - M O'Connell
- Mater Misericordiae University Hospital , Dublin, Ireland
| | - C McGreevy
- Mater Misericordiae University Hospital , Dublin, Ireland
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2
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Shah A, Farah N, McNamee E, Lindow SW, O'Connell M. Demographic changes in primiparae of Irish ethnicity between 2000 and 2020. Eur J Obstet Gynecol Reprod Biol 2022; 278:137-140. [PMID: 36174435 DOI: 10.1016/j.ejogrb.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Trends in maternal demographic changes linked to lifestyle and socio-economic conditions reflect greatly on maternal, perinatal and infant mortality rates. Hospital data reflect a heterogenous population where specific demographic changes may not be obvious. OBJECTIVES To report yearly demographic changes in Irish primiparae from 2000 to 2020, specifically looking at age, BMI, smoking and marital status of patients attending the Coombe Women and Infant's University Hospital (CWIUH). METHODS Retrospective report of demographic details contemporaneously documented on the CWIUH data base. FINDINGS In the years 2000 to 2020 inclusive there were 47,659 primiparous women of Irish ethnicity delivered at the CWIUH (70.2% of the total primiparae), of those 99.3% were Caucasian. There was a significant rise in mean age at first delivery in Irish mothers; 26.0 years old in the 2000 to 30.9 years old in 2020 associated with a rise in mean BMI of 9.1%. Smoking rates (ever smoked) showed a significant reduction from 53.9% in 2000 to 39.3% in 2020. There was a significant decrease in rates of marriage, with 61.9% married in 2000 compared to 46.3% in 2020. Birth weight and prematurity rates remained unchanged, with fall in mean gestational age at first delivery from 279.3 days in 2000 to 275.8 days in 2020. CONCLUSION This study highlights that Irish primiparae are older, heavier, less likely to smoke and to be married than they were 20 years ago. These trends are an interesting glimpse into changing economic and cultural climate over just the past 2 decades.
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Affiliation(s)
- A Shah
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland.
| | - N Farah
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - E McNamee
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - S W Lindow
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
| | - M O'Connell
- The Coombe Women and Infants' University Hospital, Cork Street, Dublin, Ireland
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3
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Abstract
The COVID-19 pandemic led to significant changes in people's budgets, the opportunity cost of their time, and where they can purchase and consume food. We use novel data on food and non-alcoholic drink purchases from stores, takeaways, restaurants and other outlets to estimate the impact of the pandemic on the diets of a large, representative panel of British households. We find that a substantial and persistent increase in calories consumed at home more than offset reductions in calories eaten out. Households increased total calories relative to pre-pandemic by 280 per adult per day from March to July 2020, and by 150 from July to the end of 2020. Although quantity increased, there was little change in diet quality over the pandemic. All socioeconomic groups increased their calorie intake, with the largest rises for the highest SES households and the smallest for retired ones. We estimate that the changes could increase the proportion of adults who are overweight by at least five percentage points, two years after the pandemic onset.
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Affiliation(s)
- Martin O'Connell
- University of Wisconsin-Madison, United States; Institute for Fiscal Studies, United Kingdom.
| | - Kate Smith
- Institute for Fiscal Studies, United Kingdom; London School of Economics, United Kingdom.
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4
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Giannotti N, McNulty J, Foley S, McCabe J, Barry M, Crowe M, Dolan E, Harbison J, Horgan G, Kavanagh E, O'Connell M, Marnane M, Murphy S, Donnell CM, O'Donohoe M, Williams D, Kelly PJ. Association Between 18-FDG Positron Emission Tomography and MRI Biomarkers of Plaque Vulnerability in Patients With Symptomatic Carotid Stenosis. Front Neurol 2022; 12:731744. [PMID: 35002912 PMCID: PMC8732361 DOI: 10.3389/fneur.2021.731744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: Pathologic studies suggest that unstable plaque morphology and inflammation are associated with cerebrovascular events. 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) is a validated technique for non-invasive imaging of inflammation-related plaque metabolism, and MRI can identify morphologic features of plaque instability. The aim of this study was to investigate the association of selected imaging characteristics of plaque vulnerability measured with MRI and PET in patients with symptomatic carotid stenosis. Methods: Patients from the BIOVASC study were selected based on the following inclusion criteria: (1) age ≥ 50 years; (2) recent (<30 days) ischaemic stroke (modified Rankin scale ≤3) or motor/speech/vision TIA; (3) ipsilateral internal carotid artery stenosis (≥5 0% lumen-narrowing); (4) carotid PET/CTA and MRI completed. Semi-automated plaque analysis of MRI images was performed to quantify morphologic features of plaque instability. PET images were co-registered with CTA and inflammation-related metabolism expressed as maximum standardised uptake value (SUVmax). Results: Twenty-five patients met inclusion criteria (72% men, mean age 65 years). MRI-measured plaque volume was greater in men (1,708–1,286 mm3, p = 0.03), patients who qualified with stroke (1,856–1,440 mm3, p = 0.05), and non-statin users (1,325–1,797 mm3, p = 0.03). SUVmax was associated with MRI-measured plaque lipid-rich necrotic core (LRNC) in the corresponding axial slice (rs = 0.64, p < 0.001) and was inversely associated with whole-plaque fibrous cap thickness (rs = −0.4, p = 0.02) and calcium volume (rs = −0.4, p = 0.03). Conclusion: This study demonstrated novel correlations of non-invasive imaging biomarkers of inflammation-related plaque metabolism with morphological MRI markers of plaque instability. If replicated, our findings may support the application of combined MRI and PET to detect vulnerable plaque in future clinical practise and randomised trials.
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Affiliation(s)
| | | | - Shane Foley
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John McCabe
- School of Medicine, University College Dublin, Dublin, Ireland.,Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marey Barry
- Vascular Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Morgan Crowe
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Medicine for the Elderly, St. Vincent's University Hospital, Stroke Service, Dublin, Ireland
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland
| | - Joseph Harbison
- Acute Stroke Service, St. James Hospital Dublin, Trinity College Dublin, Dublin, Ireland
| | - Gillian Horgan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Eoin Kavanagh
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin O'Connell
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Marnane
- School of Medicine, University College Dublin, Dublin, Ireland.,Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciaran Mc Donnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin O'Donohoe
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - David Williams
- Geriatric Medicine, Beaumont Hospital and Royal College Surgeons Ireland, Dublin, Ireland
| | - Peter J Kelly
- School of Medicine, University College Dublin, Dublin, Ireland.,Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital, Dublin, Ireland.,Acute Stroke Service, St. James Hospital Dublin, Trinity College Dublin, Dublin, Ireland
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5
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Leydon P, O'Connell M, Greene D, Curran KM. Bone segmentation in contrast enhanced whole-body computed tomography. Biomed Phys Eng Express 2021; 8. [PMID: 34749353 DOI: 10.1088/2057-1976/ac37ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022]
Abstract
Segmentation of bone regions allows for enhanced diagnostics, disease characterisation and treatment monitoring in CT imaging. In contrast enhanced whole-body scans accurate automatic segmentation is particularly difficult as low dose whole body protocols reduce image quality and make contrast enhanced regions more difficult to separate when relying on differences in pixel intensities. This paper outlines a U-net architecture with novel preprocessing techniques, based on the windowing of training data and the modification of sigmoid activation threshold selection to successfully segment bone-bone marrow regions from low dose contrast enhanced whole-body CT scans. The proposed method achieved mean Dice coefficients of 0.979 ±0.02, 0.965 ±0.03, and 0.934 ±0.06 on two internal datasets and one external test dataset respectively. We have demonstrated that appropriate preprocessing is important for differentiating between bone and contrast dye, and that excellent results can be achieved with limited data.
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Affiliation(s)
- Patrick Leydon
- Applied Science, Limerick Institute of Technology, Moylish, Limerick, IRELAND
| | - Martin O'Connell
- School of Medicine, University College Dublin, University College Dublin, Dublin, Dublin 4, IRELAND
| | - Derek Greene
- School of Computer Science, University College Dublin, University College Dublin, Dublin, Dublin 4, IRELAND
| | - Kathleen M Curran
- School of Medicine, University College Dublin, University College Dublin, Dublin, 4, IRELAND
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6
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Donlon E, Lynch R, Murphy OC, Farrell M, Noel J, Keogan M, O'Connell M, Lynch T. Braak's Unfinished Hypothesis: A Clinicopathological Case Report of α-Synuclein Peripheral Neuropathy Preceding Parkinsonism by 20 Years. Mov Disord Clin Pract 2021; 8:1129-1133. [PMID: 34631951 DOI: 10.1002/mdc3.13321] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/22/2021] [Accepted: 07/04/2021] [Indexed: 01/03/2023] Open
Abstract
Background α-synuclein aggregates in the form of Lewy bodies and Lewy neurites are the pathological hallmark of Parkinson disease (PD) and dementia with Lewy bodies (DLB). Autopsy studies suggest that α-synuclein aggregates appear in localized areas of the central nervous system before spreading in a sequential pattern from the brainstem to the cerebral cortex, known as the Braak hypothesis. Increased prevalence of peripheral neuropathy in PD is recognized, with multiple hypothesized mechanisms including α-synuclein deposition. Method We describe a patient who developed a peripheral sensory neuropathy at age 60, which progressed insidiously over the following decade. Results During the patient's eighth decade, the patient developed a fluctuant cognitive disturbance with hallucinations before becoming overtly parkinsonian at age 78 years leading to a diagnosis of DLB. At this point, histology slides from a sural nerve biopsy taken at age 72 were re-evaluated and immunohistochemistry demonstrated α-synuclein deposition. Conclusion This case provides important in vivo clinical correlation for the Braak hypothesis, extending its scope beyond idiopathic PD. A growing body of evidence supports the α-synuclein spreading hypothesis that posits the pathologic process begins in the peripheral nerves and spreads trans-synaptically to the CNS in an ascending pattern.
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Affiliation(s)
- Eoghan Donlon
- Department of Neurology Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Rionagh Lynch
- Department of Neurology Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Olwen C Murphy
- Department of Neurology Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland.,Department of Neurology Johns Hopkins Hospital Baltimore Maryland USA
| | - Michael Farrell
- Department of Neuropathology Beaumont Hospital Dublin Ireland
| | - Jaques Noel
- Department of Medicine for the Elderly Mater Misericordiae University Hospital Dublin Ireland
| | - Mary Keogan
- Department of Neuropathology Beaumont Hospital Dublin Ireland
| | - Martin O'Connell
- Department of Radiology Mater Misericordiae University Hospital Dublin Ireland
| | - Timothy Lynch
- Department of Neurology Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland.,Health Affairs University College Dublin Dublin Ireland
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7
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McCabe JJ, Camps-Renom P, Giannotti N, McNulty JP, Coveney S, Murphy S, Barry M, Harbison J, Cronin S, Williams D, Horgan G, Dolan E, Cassidy T, McDonnell C, Kavanagh E, Foley S, Collins S, O'Connell M, Fernández-León A, Delgado-Mederos R, Marnane M, Martí-Fàbregas J, Kelly PJ. Carotid Plaque Inflammation Imaged by PET and Prediction of Recurrent Stroke at 5 Years. Neurology 2021; 97:e2282-e2291. [PMID: 34610991 DOI: 10.1212/wnl.0000000000012909] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether carotid plaque inflammation identified by 18F-fluorodeoxyglucose (18FDG)-PET is associated with late (5-year) recurrent stroke. METHODS We did an individual-participant data pooled analysis of three prospective studies with near-identical study methods. Eligible patients had recent non-severe (modified Rankin Score ≤3) ischaemic stroke/TIA and ipsilateral carotid stenosis (50-99%). Participants underwent carotid 18FDG-PET/CT angiography ≤14 days after recruitment. 18FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice of symptomatic plaque. We calculated the previously-validated Symptomatic Carotid Atheroma Inflammation Lumen-stenosis (SCAIL) score, which incorporates a measure of stenosis severity and 18FDG uptake. The primary outcome was 5-year recurrent ipsilateral ischaemic stroke after PET imaging. RESULTS Of 183 eligible patients, 181 patients completed follow-up (98.9%). The median duration of follow-up was 4.9 years (interquartile range 3.3-6.4, cumulative follow-up period 901.8 patient-years). After PET imaging, 17 patients had a recurrent ipsilateral ischemic strokes at 5 years (recurrence rate 9.4%, 95% CI 5.6-14.6%). Baseline plaque SUVmax independently predicted 5-year ipsilateral recurrent stroke after adjustment for age, gender, carotid revascularization, stenosis severity, NIH Stroke Scale, and diabetes mellitus (adjusted HR 1.98; 95 % CI, 1.10-3.56, p=0.02, per 1g/mL increase SUVmax). On multivariable Cox regression, SCAIL score predicted 5-year ipsilateral stroke (adjusted HR 2.73 per 1-point increase; 95% CI 1.52-4.90, p=0.001). CONCLUSION Plaque inflammation-related 18FDG uptake improved identification of 5-year recurrent ipsilateral ischaemic stroke. Addition of plaque inflammation to current selection strategies may target patients most likely to have late as well as early benefit from carotid revascularization. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in individuals with recent ischemic stroke/TIA and ipsilateral carotid stenosis, carotid plaque inflammation-related 18FDG uptake on PET/CT angiography was associated with 5-year recurrent ipsilateral stroke.
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Affiliation(s)
- John Joseph McCabe
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland .,School of Medicine, University College Dublin (UCD), Ireland
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | | | | | - Sarah Coveney
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - Seán Murphy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,School of Medicine, University College Dublin (UCD), Ireland
| | - Mary Barry
- Department of Vascular Surgery, St Vincent's University Hospital, Ireland
| | - Joseph Harbison
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Stroke Service, Department of Geriatric Medicine, St James' Hospital, Ireland
| | - Simon Cronin
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Neurology, Cork University Hospital, Ireland and Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Ireland
| | - David Williams
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Gillian Horgan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - Eamon Dolan
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, James Connolly Memorial Hospital, Ireland
| | - Tim Cassidy
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,Department of Geriatric Medicine, St Vincent's University Hospital, Ireland
| | - Ciaran McDonnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital
| | - Eoin Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Ireland
| | - Shane Foley
- School of Medicine, University College Dublin (UCD), Ireland
| | - Seán Collins
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland
| | - Martin O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Ireland
| | | | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Michael Marnane
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,School of Medicine, University College Dublin (UCD), Ireland
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain
| | - Peter J Kelly
- Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI), Dublin, Ireland.,School of Medicine, University College Dublin (UCD), Ireland
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8
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Moreira AP, Jamar F, Ozcan Z, Piciu D, Als C, Franceschi M, Trägårdh E, Zagar I, Sowa-Staszczak A, Cachin F, Bennink R, Forrer F, Adamsen TC, Fotopolous A, Kalnina M, Jensen LT, Mussalo H, Simanek M, Garcia-Cañamaque L, Nazarenko S, Mihailovic J, Bar-Sever Z, O'Connell M, Miladinova D, Graham R, Giubbini R, Kaliská L, Rozić D, Krause BJ, Gallowitsch HJ, Györke T, Sediene S, Rumyantsev P, Wadsak W, Kunikowska J. Impact of the COVID-19 pandemic on nuclear medicine departments in Europe. Eur J Nucl Med Mol Imaging 2021; 48:3361-3364. [PMID: 34328532 PMCID: PMC8322112 DOI: 10.1007/s00259-021-05484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Paula Moreira
- Nuclear Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. .,Institute for Nuclear Sciences Applied To Health, University of Coimbra, Coimbra, Portugal.
| | - François Jamar
- Nuclear Medicine Department, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Zehra Ozcan
- Department of Nuclear Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Doina Piciu
- University of Medicine and Pharmacy Iuliu Hațieganu Cluj-Napoca, Cluj-Napoca, Romania.,Nuclear Medicine Department, Institute of Oncology I. Chiricuta Cluj-Napoca, Cluj-Napoca, Romania
| | - Claudine Als
- Department of Nuclear Medicine, Hôpitaux Robert Schuman Zithaklinik, Luxembourg, Luxembourg
| | - Maja Franceschi
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice UHC, Zagreb, Croatia
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Ivana Zagar
- Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Anna Sowa-Staszczak
- Medical College, Endocrinology Department, Nuclear Medicine Unit, Jagiellonian University, Kraków, Poland
| | - Florent Cachin
- Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France.,Medical Biophysics Department, Clermont Auvergne University, Clermont-Ferrand, France
| | - Roel Bennink
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Flavio Forrer
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tom Christian Adamsen
- Centre for Nuclear Medicine, Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Chemistry, University of Bergen, Bergen, Norway
| | - Andreas Fotopolous
- Nuclear Medicine Department, University Hospital of Ioannina, Ioannina, Greece
| | - Marika Kalnina
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Hanna Mussalo
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Milan Simanek
- Department of Nuclear Medicine, Hospital Pelhřimov, Pelhřimov, Czech Republic
| | | | - Sergei Nazarenko
- Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Jasna Mihailovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Centre of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska, Kamenica, Serbia
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Martin O'Connell
- Mater University Hospital, University College Dublin, Dublin, Ireland
| | - Daniela Miladinova
- Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
| | - Richard Graham
- School of Radiology, Royal United Hospitals, Bath NHS Foundation Trust, Bath, UK
| | - Raffaele Giubbini
- Chair of Nuclear Medicine, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Lucia Kaliská
- Institute of Nuclear and Molecular Medicine, Banská Bystrica, Slovak Republic
| | - Damir Rozić
- Department of Nuclear Medicine, University Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Bernd J Krause
- Department of Nuclear Medicine, Rostock University Medical Centre, Rostock, Germany
| | - Hans-Jürgen Gallowitsch
- Department of Nuclear Medicine and Endocrinology, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Tamás Györke
- Department of Nuclear Medicine/Semmelweis University, Medical Imaging Centre, Budapest, Hungary
| | | | - Pavel Rumyantsev
- SOGAZ International Medical Center, Saint-Petersburg, Russian Federation
| | - Wolfgang Wadsak
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jolanta Kunikowska
- Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
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9
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O'Connor C, Gallagher C, Hollywood A, Paul L, O'Connell M. Anakinra for recalcitrant pyoderma gangrenosum. Clin Exp Dermatol 2021; 46:1558-1560. [PMID: 34137070 DOI: 10.1111/ced.14809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. Anakinra is a recombinant interleukin (IL)-1 receptor antagonist that blocks the activity of IL-1α and IL-1β by competitively inhibiting IL-1 binding to the IL-1 type 1 receptor. We present a series of two patients with recalcitrant PG, who had limited therapeutic options and multiple comorbidities and multiple previous treatment failures, who obtained 100% healing with anakinra. Compared with conventional first-line therapies for PG, the safety profile of anakinra may be preferable for patients with multiple comorbidities. Further research is needed to assess the safety and efficacy of anakinra for PG.
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Affiliation(s)
- C O'Connor
- Department of Dermatology, University Hospital Waterford, Waterford, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - C Gallagher
- Department of Dermatology, University Hospital Waterford, Waterford, Ireland
| | - A Hollywood
- Department of Dermatology, University Hospital Waterford, Waterford, Ireland
| | - L Paul
- Department of Dermatology, University Hospital Waterford, Waterford, Ireland
| | - M O'Connell
- Department of Dermatology, University Hospital Waterford, Waterford, Ireland
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10
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Abstract
In times of heightened uncertainty, consumers face incentives to build up precautionary stocks of essential supplies. We study consumer spending dynamics during one such time, the first infection wave of the COVID-19 pandemic, using household scanner data covering fast-moving consumer goods in the United Kingdom. We document large increases in demand for storable products, such as food staples and household supplies, in the days before lockdown. Households in all socio-economic groups exhibit unusually high demand pre-lockdown, but there is a clear gradient, with the largest demand spikes for wealthier households. Although stories of people purchasing extreme amounts received a lot of attention, higher aggregate demand was mainly driven by more households than usual choosing to buy storable products, with only small increases in average quantities bought on a given trip. Temporary limits on the number of units per transaction, introduced following the demand spike, are therefore unlikely to lead to the avoidance of stock-outs.
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Affiliation(s)
| | | | - Kate Smith
- Institute for Fiscal Studies; University College London
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11
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Delaney FT, Dempsey P, Welaratne I, Buckley B, O'Sullivan D, O'Connell M. Incidental cardiac uptake in bone scintigraphy: increased importance and association with cardiac amyloidosis. BJR Case Rep 2021; 7:20200161. [PMID: 34131495 PMCID: PMC8171131 DOI: 10.1259/bjrcr.20200161] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/01/2021] [Accepted: 01/08/2021] [Indexed: 11/05/2022] Open
Abstract
Extraosseous radiotracer uptake during bone scintigraphy must be carefully assessed and it offers the potential to detect previously undiagnosed disease processes. A range of neoplastic, metabolic, traumatic, ischaemic and inflammatory disorders can cause soft tissue accumulation of bone avid radiopharmaceuticals. Accordingly, cardiac uptake in bone scintigraphy has a broad differential diagnosis and is commonly attributed to ischaemia/infarction related to coronary artery disease. However, there has been renewed focus on incidental cardiac uptake in recent years in light of significant developments in the diagnosis and management of cardiac amyloidosis.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Philip Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ivan Welaratne
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Bryan Buckley
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donagh O'Sullivan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
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12
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O'Connor C, Gallagher C, O'Connell M, Bourke J, Murphy M, Bennett M. Bare necessities? The utility of full skin examination in the COVID-19 era. Clin Exp Dermatol 2021; 46:720-722. [PMID: 33639003 PMCID: PMC8013915 DOI: 10.1111/ced.14620] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
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Affiliation(s)
- C O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - C Gallagher
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - M O'Connell
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - J Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - M Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - M Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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13
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Jomeen J, Martin CR, Jones C, Marshall C, Ayers S, Burt K, Frodsham L, Horsch A, Midwinter D, O'Connell M, Shakespeare J, Sheen K, Thomson G. Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research. J Reprod Infant Psychol 2020; 39:2-15. [PMID: 33206580 DOI: 10.1080/02646838.2020.1843908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/14/2022]
Abstract
Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.
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Affiliation(s)
- J Jomeen
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C R Martin
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK.,School of Nursing and Allied Health, Buckinghamshire New University , High Wycombe, UK
| | - C Jones
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C Marshall
- Perinatal Mental Health Team, Humber Teaching NHS Foundation Trust , Hull, UK
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London , London, UK
| | - K Burt
- Expert by Experience , UK
| | - L Frodsham
- Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - A Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne , Lausanne, Switzerland.,Department Woman-Mother-Child, University Hospital , Lausanne, Switzerland
| | - D Midwinter
- Maternity and Midwifery Services, North Lincolnshire and Goole NHS Foundation Trust , Scunthorpe, UK
| | - M O'Connell
- School of Nursing and Midwifery, Royal College of Surgeons Ireland in Bahrain , Adliya, Bahrain
| | | | - K Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University , Liverpool, UK
| | - G Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire , Lancashire, UK.,School of Education, Health and Social Studies, Dalarna University , Falun, Sweden
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14
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Jaravel X, O'Connell M. Real-time price indices: Inflation spike and falling product variety during the Great Lockdown. J Public Econ 2020; 191:104270. [PMID: 32952225 PMCID: PMC7487746 DOI: 10.1016/j.jpubeco.2020.104270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 05/24/2023]
Abstract
We characterize inflation dynamics during the Great Lockdown using scanner data covering millions of transactions for fast-moving consumer goods in the United Kingdom. We show that there was a significant and widespread spike in inflation. First, aggregate month-to-month inflation was 2.4% in the first month of lockdown, a rate over 10 times higher than in preceding months. Over half of this increase stems from reduced frequency of promotions. Consumers' purchasing power was further eroded by a reduction in product variety. Second, 96% of households have experienced inflation in 2020, while in prior years around half of households experienced deflation. Third, there was inflation in most product categories, including those that experienced output falls. Only 13% of product categories experienced deflation, compared with over half in previous years. While market-based measures of inflation expectations point to disinflation or deflation, these findings indicate a risk of stagflation should not be ruled out. We hope our approach can serve as a template to facilitate rapid diagnosis of inflation risks during economic crises, leveraging scanner data and appropriate price indices in real-time.
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15
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Spergel J, Blaiss M, Lio P, Kessel A, Takiya L, Werth J, O'Connell M, Zang C, Cork M. P500 EFFICACY OF CRISABOROLE IN PATIENTS WITH MILD-TO-MODERATE ATOPIC DERMATITIS WITH AND WITHOUT COMORBID ALLERGIC RHINITIS. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.158] [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: 11/30/2022]
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16
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Jaravel X, O'Connell M. High-Frequency Changes in Shopping Behaviours, Promotions and the Measurement of Inflation: Evidence from the Great Lockdown. Fisc Stud 2020; 41:733-755. [PMID: 33362316 PMCID: PMC7753338 DOI: 10.1111/1475-5890.12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We use real-time scanner data in Great Britain during the COVID-19 pandemic to investigate the drivers of the inflationary spike at the beginning of lockdown and to quantify the impact of high-frequency changes in shopping behaviours and promotions on inflation measurement. Although changes in product-level expenditure shares were unusually high during lockdown, we find that the induced bias in price indices that do not account for expenditure switching is not larger than in prior years. We also document substantial consumer switching towards online shopping and across retailers, but show this was not a key driver of the inflationary spike. In contrast, a reduction in price and quantity promotions was key to driving higher inflation, and lower use of promotions by low-income consumers explains why they experienced moderately lower inflation. Overall, changes in shopping behaviours played only a minor role in driving higher inflation during lockdown; higher prices were the main cause, in particular through a reduced frequency of promotions.
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17
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McCabe JJ, Giannotti N, McNulty J, Collins S, Coveney S, Murphy S, Barry M, Harbison J, Cronin S, Williams D, Horgan G, Dolan E, Cassidy T, McDonnell C, Kavanagh E, Foley S, O'Connell M, Marnane M, Kelly P. Cohort profile: BIOVASC-late, a prospective multicentred study of imaging and blood biomarkers of carotid plaque inflammation and risk of late vascular recurrence after non-severe stroke in Ireland. BMJ Open 2020; 10:e038607. [PMID: 32690537 PMCID: PMC7371237 DOI: 10.1136/bmjopen-2020-038607] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Inflammation is important in stroke. Anti-inflammatory therapy reduces vascular events in coronary patients. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) identifies plaque inflammation-related metabolism. However, long-term prospective cohort studies investigating the association between carotid plaque inflammation, identified on 18F-FDG PET and the risk of recurrent vascular events, have not yet been undertaken in patients with stroke. PARTICIPANTS The Biomarkers Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease (BIOVASC) study and Dublin Carotid Atherosclerosis Study (DUCASS) are two prospective multicentred observational cohort studies, employing near-identical methodologies, which recruited 285 patients between 2008 and 2016 with non-severe stroke/transient ischaemic attack and ipsilateral carotid stenosis (50%-99%). Patients underwent coregistered carotid 18F-FDG PET/CT angiography and phlebotomy for measurement of inflammatory cytokines. Plaque 18F-FDG-uptake is expressed as maximum standardised uptake value (SUVmax) and tissue-to-background ratio. The BIOVASC-Late study is a follow-up study (median 7 years) of patients recruited to the DUCASS/BIOVASC cohorts. FINDINGS TO DATE We have reported that 18F-FDG-uptake in atherosclerotic plaques of patients with symptomatic carotid stenosis predicts early recurrent stroke, independent of luminal narrowing. The incorporation of 18F-FDG plaque uptake into a clinical prediction model also improves discrimination of early recurrent stroke, when compared with risk stratification by luminal stenosis alone. However, the relationship between 18F-FDG-uptake and late vascular events has not been investigated to date. FUTURE PLANS The primary aim of BIOVASC-Late is to investigate the association between SUVmax in symptomatic 'culprit' carotid plaque (as a marker of systemic inflammatory atherosclerosis) and the composite outcome of any late major vascular event (recurrent ischaemic stroke, coronary event or vascular death). Secondary aims are to investigate associations between: (1) SUVmax in symptomatic plaque, and individual vascular endpoints (2) SUVmax in asymptomatic contralateral carotid plaque and SUVmax in ipsilateral symptomatic plaque (3) SUVmax in asymptomatic carotid plaque and major vascular events (4) inflammatory cytokines and vascular events.
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Affiliation(s)
- John Joseph McCabe
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nicola Giannotti
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jonathan McNulty
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sean Collins
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
| | - Sarah Coveney
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mary Barry
- Vascular Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Joseph Harbison
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Stroke Service, St James Hospital, Dublin, Ireland
| | - Simon Cronin
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Neurology, Cork University Hospital Group, Cork, Ireland
| | - David Williams
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Stroke, Beaumont Hospital, Dublin, Ireland
| | - Gillian Horgan
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Department of Geriatric Medicine, James Connolly Memorial Hospital, Dublin, Ireland
| | - Tim Cassidy
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Geriatric Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Ciaran McDonnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Martin O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Marnane
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Kelly
- Health Research Board Stroke Clinical Trials Network Ireland (HRB SCTNI), Dublin, Ireland
- Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
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18
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Paramanandam V, Olszewska DA, Shakya B, Chalissery AJ, O'Connell M, Farrell M, Lynch T. Reply to Comment on: A 57-Year-Old Woman With Progressive Left Hand Clumsiness and Falls. Mov Disord Clin Pract 2020; 7:581-582. [PMID: 32626813 PMCID: PMC7328408 DOI: 10.1002/mdc3.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Vijayashankar Paramanandam
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | - Diana Angelika Olszewska
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | | | - Albi Jose Chalissery
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
| | - Martin O'Connell
- Department of RadiologyMater Misericordiae University HospitalDublinIreland
| | | | - Tim Lynch
- Centre for Brain Health, Dublin Neurological Institute at the Mater MisericordiaeUniversity HospitalDublinIreland
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19
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Abstract
The spread of COVID-19 has led to sweeping changes in the way households work, spend their time and shop, resulting in different shopping patterns and rapid price changes in some goods. How will changes such as these be reflected in headline inflation measures such as the Consumer Prices Index (CPI)? This paper discusses problems in interpreting the CPI as a measure of how the cost of living is changing during the lockdown.
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20
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Abstract
Young people in the UK consume far above the maximum recommended levels of added sugar. It is likely that neither they nor their parents fully take account of the future health, social and economic costs of this high sugar consumption. This provides a rationale for policy intervention. The majority of young people's added sugar consumption occurs in the home, where purchases are typically made by parents. This means that understanding the purchase decisions of adults is important for policy design, even if the policies aim to reduce the consumption of young people. We discuss the merits of popular policies, including taxes, advertising restrictions and restrictions on the availability of specific foods, and we identify promising avenues for future research.
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Affiliation(s)
| | | | - Kate Smith
- Institute for Fiscal StudiesUniversity College London
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Paramanandam V, Olszewska DA, Shakya B, Chalissery AJ, O'Connell M, Farrell M, Lynch T. A 57-Year-Old Woman With Progressive Left Hand Clumsiness and Falls. Mov Disord Clin Pract 2019; 6:656-660. [PMID: 31745473 DOI: 10.1002/mdc3.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/11/2022] Open
Abstract
Clinical History A 57-year old woman presented with left hand pain, periodic leg movement during sleep, gradual onset of stiffness, clumsiness, and falls. Neurological examination showed: generalized rigidity and bradykinesia. There was left hand dystonic posturing and ideomotor apraxia, as well as mirror movements of upper limbs and stimulus-sensitive myoclonus. The patient had a high-pitched voice and hypophonia (Video S1). Discussion Experts discuss localization and the syndromic diagnosis and predict the underlying pathology. The pathological diagnosis is then provided and clinical learning points are considered.
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Affiliation(s)
- Vijayashankar Paramanandam
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Diana Angelika Olszewska
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | | | - Albi Jose Chalissery
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
| | - Martin O'Connell
- Department of Radiology Mater Misericordiae University Hospital Dublin Ireland
| | - Michael Farrell
- Department of Neuropathology Beaumont Hospital Dublin Ireland
| | - Tim Lynch
- Centre for Brain Health Dublin Neurological Institute at the Mater Misericordiae University Hospital Dublin Ireland
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Bhattacharjee S, Chalissery AJ, Barry T, O'Sullivan D, O'Connell M, Lynch T. Referral practice, reporting standards, and the impact of dopamine transporter scans done in a tertiary hospital. Neurol India 2019; 65:1264-1270. [PMID: 29133699 DOI: 10.4103/0028-3886.217946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS We studied the referral practice, reporting standards, and the impact of 123 ioflupane single photon emission computed tomogram dopamine transporters (DAT-SPECT) scans conducted for the diagnosis and clinical management of patients. SETTINGS AND DESIGNS The present study was a retrospective, non-interventional study. MATERIALS AND METHODS We assessed the DAT scan referral and the official reports available from the Nuclear Medicine Department of the Mater Misericordiae University Hospital over 1 year (2013). We also assessed the impact of the DAT scan result on the management of patients by analyzing patient records. The European Association of Nuclear Medicine Neuroimaging (EANM) 2010 and the Federal Drug Administration (FDA) 2012 guidelines were taken as the standard against which the quality of our DAT scans reporting was assessed. STATISTICAL METHODS Microsoft Excel 2010 and graphpad software were used for statistical analysis. RESULTS Twenty five (56.2%) out of a total of 48 DAT scans were performed to confirm early Parkinson's disease, 5 (8.9%) were done to exclude drug-induced parkinsonism, and 8 (14.3%) to distinguish essential tremor from parkinsonism; 2 scans were performed to distinguish Lewy body diseases from Alzheimer's dementia, and 4 indications were outside the recommended guidelines. Twelve out of the 26 (46%) abnormal scans had bilateral abnormalities. Twenty one out of the 25 DAT scans proved the clinical diagnosis of degenerative parkinsonism to be correct. CONCLUSION The overall compliance of the DAT imaging with the existing standard guidelines was good. DAT scan can be very useful in clinical practice because it influences the clinical diagnosis and management in 23% of the patients.
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Affiliation(s)
| | - Albi J Chalissery
- Department of Neurology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Tim Barry
- Department of Neurology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Donagh O'Sullivan
- Department of Nuclear Medicine, Mater University Hospital, Dublin, Ireland
| | - Martin O'Connell
- Department of Neurology, Mater Misercordiae University Hospital, Dublin, Ireland
| | - Timothy Lynch
- Department of Neurology, Mater Misercordiae University Hospital, Dublin, Ireland
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23
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Kelly PJ, Camps-Renom P, Giannotti N, Martí-Fàbregas J, Murphy S, McNulty J, Barry M, Barry P, Calvet D, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Fernández-León A, Foley S, Harbison J, Horgan G, Kavanagh E, Marnane M, McDonnell C, O'Donohoe M, Sharma V, Walsh C, Williams D, O'Connell M. Carotid Plaque Inflammation Imaged by 18F-Fluorodeoxyglucose Positron Emission Tomography and Risk of Early Recurrent Stroke. Stroke 2019; 50:1766-1773. [PMID: 31167623 DOI: 10.1161/strokeaha.119.025422] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 12/30/2022]
Abstract
Background and Purpose- Plaque inflammation contributes to stroke and coronary events. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) identifies plaque inflammation-related metabolism. Almost no prospective data exist on the relationship of carotid 18F-FDG uptake and early recurrent stroke. Methods- We did a multicenter prospective cohort study BIOVASC (Biomarkers/Imaging Vulnerable Atherosclerosis in Symptomatic Carotid disease) of patients with carotid stenosis and recent stroke/transient ischemic attack with 90-day follow-up. On coregistered carotid 18F-FDG PET/computed tomography angiography, 18F-FDG uptake was expressed as maximum standardized uptake value (SUVmax) in the axial single hottest slice. We then conducted a systematic review of similar studies and pooled unpublished individual-patient data with 2 highly similar independent studies (Dublin and Barcelona). We analyzed the association of SUVmax with all recurrent nonprocedural stroke (before and after PET) and with recurrent stroke after PET only. Results- In BIOVASC (n=109, 14 recurrent strokes), after adjustment (for age, sex, stenosis severity, antiplatelets, statins, diabetes mellitus, hypertension, and smoking), the hazard ratio for recurrent stroke per 1 g/mL SUVmax was 2.2 (CI, 1.1-4.5; P=0.025). Findings were consistent in the independent Dublin (n=52, hazard ratio, 2.2; CI, 1.1-4.3) and Barcelona studies (n=35, hazard ratio, 2.8; CI, 0.98-5.5). In the pooled cohort (n=196), 37 recurrent strokes occurred (29 before and 8 after PET). Plaque SUVmax was higher in patients with all recurrence ( P<0.0001) and post-PET recurrence ( P=0.009). The fully adjusted hazard ratio of any recurrent stroke was 2.19 (CI, 1.41-3.39; P<0.001) and for post-PET recurrent stroke was 4.57 (CI, 1.5-13.96; P=0.008). Recurrent stroke risk increased across SUVmax quartiles (log-rank P=0.003). The area under receiver operating curve for all recurrence was 0.70 (CI, 0.59-0.78) and for post-PET recurrence was 0.80 (CI, 0.64-0.96). Conclusions- Plaque inflammation-related 18F-FDG uptake independently predicted future recurrent stroke post-PET. Although further studies are needed, 18F-FDG PET may improve patient selection for carotid revascularization and suggest that anti-inflammatory agents may have benefit for poststroke vascular prevention.
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Affiliation(s)
- Peter J Kelly
- From the Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology (P.J.K., N.G., S.M., G.H., M.M.), University College Dublin, Ireland.,HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Nicola Giannotti
- From the Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology (P.J.K., N.G., S.M., G.H., M.M.), University College Dublin, Ireland.,Mater University Hospital, Radiography and Diagnostic Imaging, School of Medicine (N.G., J.M., S.F.), University College Dublin, Ireland
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Sean Murphy
- From the Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology (P.J.K., N.G., S.M., G.H., M.M.), University College Dublin, Ireland.,HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.)
| | - Jonathan McNulty
- Mater University Hospital, Radiography and Diagnostic Imaging, School of Medicine (N.G., J.M., S.F.), University College Dublin, Ireland
| | - Mary Barry
- Department of Vascular Surgery, St Vincent's University Hospital (M.B.), University College Dublin, Ireland
| | - Patrick Barry
- Stroke Service, Departments of Geriatric Medicine, Cork University Hospital, Ireland (P.B.)
| | - David Calvet
- Université Paris Descartes, INSERM UMR S 894, Service de Neurologie et Unité Neurovasculaire, Hôpital Sainte-Anne, Paris, France (D.C.)
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (S.B.C.)
| | - Simon Cronin
- HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.).,Department of Neurology, Cork University Hospital, and Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Ireland (S.C.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Barcelona, Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Eamon Dolan
- HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.).,Connolly Hospital Dublin and Royal College of Surgeons Ireland (E.D.)
| | - Alejandro Fernández-León
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.F.-L.)
| | - Shane Foley
- Mater University Hospital, Radiography and Diagnostic Imaging, School of Medicine (N.G., J.M., S.F.), University College Dublin, Ireland
| | - Joseph Harbison
- HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.).,Stroke Service, Department of Geriatric Medicine, St James' Hospital and Trinity College Dublin, Ireland (J.H.)
| | - Gillian Horgan
- From the Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology (P.J.K., N.G., S.M., G.H., M.M.), University College Dublin, Ireland.,HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.)
| | - Eoin Kavanagh
- Department of Radiology (E.K., M. O'Connell), University College Dublin, Ireland
| | - Michael Marnane
- From the Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology (P.J.K., N.G., S.M., G.H., M.M.), University College Dublin, Ireland.,HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.)
| | - Ciaran McDonnell
- Department of Vascular Surgery (C.M., M. O'Donohoe), University College Dublin, Ireland
| | - Martin O'Donohoe
- Department of Vascular Surgery (C.M., M. O'Donohoe), University College Dublin, Ireland
| | - Vijay Sharma
- Division of Neurology, National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore (V.S.)
| | - Cathal Walsh
- Health Research Institute and Department of Biostatistics, University of Limerick, Ireland (C.W.)
| | - David Williams
- HRB Stroke Clinical Trials Network Ireland (P.J.K., S.M., S.C., E.D., J.H., G.H., M.M., D.W.).,Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland/Beaumont Hospital Dublin Ireland (D.W.)
| | - Martin O'Connell
- Department of Radiology (E.K., M. O'Connell), University College Dublin, Ireland
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McKiernan K, Jimenez H, McEachern M, Hubbard J, O'Connell M. Abstract P5-07-16: Role of collagen X in enhancing the metastatic potential of breast cancer cells using a MDA-MB-231 cell line model. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-07-16] [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: 11/16/2022]
Abstract
Abstract
Breast cancer is the second highest cause of cancer related deaths for women in developed countries. Breast cancer patients with distant metastasis at the time of diagnosis have an estimated 5-year relative survival rate of 26% as compared to a 99% survival rate of patients who have localized tumors. Evidence suggests that collagens play a role in enhancing the metastatic capability of breast cancer cells. Short chain collagen, collagen X, is encoded by the collagen type x alpha 1 chain (COL10A1) gene and is normally expressed exclusively by hypertrophic chondrocytes during endochondral ossification. Recently, COL10A1 gene expression has been found to be overexpressed in various tumor types, including breast tumors. It is hypothesized that an increase in COL10A1 expression may play a role in breast cancer metastasis. The goal of our project was to evaluate the role of collagen X in breast cancer metastasis using the MDA-MB-231 breast cancer cell line. Stable cell lines were generated to express either GFP only (MDA-VEC) or GFP tagged COL10A1 (MDA-COL). GFP and COL10A1 transcript and protein levels were examined to confirm overexpression of collagen X and transwell assays were used to determine changes in the invasive capability of the cells. Cells overexpressing collagen X demonstrated a higher rate of invasion suggesting that collagen X may play a role in enhancing the metastatic potential of breast cancer cells. Understanding the role collagen X plays in breast cancer metastasis may provide a mechanism for developing diagnostic and prognostic strategies for identifying patients whose breast cancer is more prone to metastasize.
Citation Format: McKiernan K, Jimenez H, McEachern M, Hubbard J, O'Connell M. Role of collagen X in enhancing the metastatic potential of breast cancer cells using a MDA-MB-231 cell line model [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-07-16.
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Paramanandam V, Hadjivassiliou M, Olszewska DA, Munteanu T, Williams L, Magennis B, Fearon C, O'Connell M, Sarrigiannis P, Lynch T. Reversible Corticobasal Syndrome due to Coeliac Disease. Mov Disord Clin Pract 2019; 5:551-554. [PMID: 30637273 DOI: 10.1002/mdc3.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/18/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences Royal Hallamshire Hospital Sheffield South Yorkshire S1 3JD United Kingdom
| | | | - Tudor Munteanu
- Dublin Neurological Institute at the Mater Misericordiae University Hospital Ireland
| | - Laura Williams
- Dublin Neurological Institute at the Mater Misericordiae University Hospital Ireland
| | - Brian Magennis
- Dublin Neurological Institute at the Mater Misericordiae University Hospital Ireland
| | - Conor Fearon
- Dublin Neurological Institute at the Mater Misericordiae University Hospital Ireland
| | - Martin O'Connell
- Department of Radiology Mater Misericordiae University Hospital Ireland
| | - Ptolemaios Sarrigiannis
- Academic Department of Neurosciences Royal Hallamshire Hospital Sheffield South Yorkshire S1 3JD United Kingdom
| | - Tim Lynch
- Dublin Neurological Institute at the Mater Misericordiae University Hospital Ireland
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O'Leary C, Greally M, McCaffrey J, Hughes P, Lawler LLP, O'Connell M, Geoghegan T, Farrelly C. Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases. Ir J Med Sci 2018; 188:43-53. [PMID: 29511912 DOI: 10.1007/s11845-018-1773-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer. AIMS To measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution. METHODS Retrospective case series was performed. Patient charts and medical records were reviewed. RESULTS All 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1 day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10 months (range 6-26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11 months post-SIRT. CONCLUSIONS SIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.
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Affiliation(s)
- Cathal O'Leary
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Peter Hughes
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Leo L P Lawler
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Martin O'Connell
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Tony Geoghegan
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Cormac Farrelly
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
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McCarthy S, Paul L, O'Connell M. Skin Cancer Awareness Amongst Irish Golfers. Ir Med J 2017; 110:620. [PMID: 29169002] [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: 06/07/2023]
Abstract
Aim The aim of this study was to assess skin cancer awareness and identify the UV protective measures used by golfers within the Munster region of Ireland. Methods Subjects were recruited from throughout the Munster region at a regional competition, and at three other local golf clubs and "pro" shops. Participants filled out a short anonymous validated questionnaire when collecting their score cards7. Results One hundred and sixty-three golfers completed the questionnaire with a mean age of 65.6 years. 137 (84%) were male and 26 (16%) were female. We noted a high incidence of both non-melanoma and melanoma skin cancer in our subjects. Sixteen (9.8%) had a previous history of skin cancer, with 8 melanomas and 8 non-melanoma skin cancers. A high percentage, 85%, of the golfers surveyed were compliant with SPF use. However many were using too low a SPF, 63 (44%) were using a SPF less than 30. Knowledge of risk of skin cancer is better amongst the golfers surveyed when compared to the general population. Most respondents (N = 96 (59%)) were aware that melanoma can lead to death if left untreated and 114 (70%) recognized that melanoma can be cured if treated early. Conclusion Golfers may benefit from targeted education emphasizing the importance of higher SPF use. Other interventions that may benefit this population would include availability of sunscreens and educational literature in 'pro' shops at golf courses.
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Affiliation(s)
- S McCarthy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - L Paul
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - M O'Connell
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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Lonergan PE, Nic An Riogh A, O'Kelly F, Lundon DJ, O'Sullivan D, O'Connell M, Hegarty PK. Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital. Ir J Med Sci 2017; 186:841-845. [PMID: 28102480 DOI: 10.1007/s11845-017-1558-3] [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: 11/04/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease. AIM Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients. METHODS DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe. RESULTS In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences. CONCLUSION Further cases and longer follow-up will define the accuracy of this technique in the Irish population.
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Affiliation(s)
- P E Lonergan
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - A Nic An Riogh
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - F O'Kelly
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D J Lundon
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D O'Sullivan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P K Hegarty
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Dublin, Ireland.,Mater Private Hospital, Cork, Ireland
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Affiliation(s)
- Peter Levell
- Institute for Fiscal Studies, London WC1E 7AE, UK
| | | | - Kate Smith
- Institute for Fiscal Studies, London WC1E 7AE, UK
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Dupan S, O'Connell M, Kenny RA, Finucane C. 41BAROREFLEX SENSITIVITY AND ARTERIAL STIFFNESS INFLUENCE ORTHOSTATIC BLOOD PRESSURE RESPONSES IN OLDER ADULTS: INSIGHTS FROM THE IRISH LONGITUDINAL STUDY ON AGEING. Age Ageing 2016. [DOI: 10.1093/ageing/afw026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCarthy A, Lonergan R, Olszewska DA, O'Dowd S, Cummins G, Magennis B, Fallon EM, Pender N, Huey ED, Cosentino S, O'Rourke K, Kelly BD, O'Connell M, Delon I, Farrell M, Spillantini MG, Rowland LP, Fahn S, Craig P, Hutton M, Lynch T. Closing the tau loop: the missing tau mutation. Brain 2015; 138:3100-9. [PMID: 26297556 DOI: 10.1093/brain/awv234] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/27/2015] [Indexed: 12/30/2022] Open
Abstract
Frontotemporal lobar degeneration comprises a group of disorders characterized by behavioural, executive, language impairment and sometimes features of parkinsonism and motor neuron disease. In 1994 we described an Irish-American family with frontotemporal dementia linked to chromosome 17 associated with extensive tau pathology. We named this disinhibition-dementia-parkinsonism-amyotrophy complex. We subsequently identified mutations in the MAPT gene. Eleven MAPT gene splice site stem loop mutations were identified over time except for 5' splice site of exon 10. We recently identified another Irish family with autosomal dominant early amnesia and behavioural change or parkinsonism associated with the 'missing' +15 mutation at the intronic boundary of exon 10. We performed a clinical, neuropsychological and neuroimaging study on the proband and four siblings, including two affected siblings. We sequenced MAPT and performed segregation analysis. We looked for a biological effect of the tau variant by performing real-time polymerase chain reaction analysis of RNA extracted from human embryonic kidney cells transfected with exon trapping constructs. We found a c.915+15A>C exon 10/intron 10 stem loop mutation in all affected subjects but not in the unaffected. The c.915+15A>C variant caused a shift in tau splicing pattern to a predominantly exon 10+ pattern presumably resulting in predominant 4 repeat tau and little 3 repeat tau. This strongly suggests that the c.915+15A>C variant is a mutation and that it causes frontotemporal dementia linked to chromosome 17 in this pedigree by shifting tau transcription and translation to +4 repeat tau. Tau (MAPT) screening should be considered in families where amnesia or atypical parkinsonism coexists with behavioural disturbance early in the disease process. We describe the final missing stem loop tau mutation predicted 15 years ago. Mutations have now been identified at all predicted sites within the 'stem' when the stem-loop model was first proposed and no mutations have been found within the 'loop' region as expected. Therefore we 'close the tau loop' having 'opened the loop' 21 years ago.
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Affiliation(s)
- Allan McCarthy
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Roisin Lonergan
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Diana A Olszewska
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Sean O'Dowd
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Gemma Cummins
- 2 Department of Clinical Neuroscience, Centre for Brain Repair, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK
| | - Brian Magennis
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Emer M Fallon
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Niall Pender
- 3 Department of Psychology, Beaumont Hospital, Beaumont Rd, Dublin 9, Ireland, Department of Psychology, Royal College of Surgeons in Ireland
| | - Edward D Huey
- 4 Departments of Psychiatry and Neurology, College of Physicians and Surgeons, University Medical Centre, 630 West 168th Street, New York, NY 10032, USA
| | - Stephanie Cosentino
- 5 Cognitive Neuroscience Section, Department of Neurology, Columbia University Medical Centre, 630 West 168th Street, New York, NY 10032, USA
| | - Killian O'Rourke
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | - Brendan D Kelly
- 6 Department of Psychiatry, Mater Misericordiae University Hospital, 63 Eccles Street, Dublin 7, Ireland
| | - Martin O'Connell
- 7 Department of Radiology, Mater Misericordiae University Hospital, North Circular Road, Dublin 7, Ireland
| | - Isabelle Delon
- 8 Medical Genetics Service, Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Treatment Centre, Hills Road, Cambridge, CB2 0QQ, UK
| | - Michael Farrell
- 9 Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Maria Grazia Spillantini
- 10 Department of Clinical Neurosciences, Clifford Allbutt Building, University of Cambridge, Cambridge, CB2 0AH, UK
| | - Lewis P Rowland
- 11 The Neurological Institute, Columbia University, 710 West 168th Street, New York, NY 10032-3784, USA
| | - Stanley Fahn
- 11 The Neurological Institute, Columbia University, 710 West 168th Street, New York, NY 10032-3784, USA
| | - Peter Craig
- 12 Eli Lilly, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - Michael Hutton
- 12 Eli Lilly, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - Tim Lynch
- 1 The Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
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Wiborg O, O'Connell M, Thiele R, Wichert M, Kolb G. Automated and Continuous Production of Microstructured Metallic Plates via Cold Embossing. Chem Eng Technol 2015. [DOI: 10.1002/ceat.201400708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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O'Connell M, Wonodi C. Routine immunization consultants (RICON) review in Nigeria: A country
driven management approach for health systems strengthening in routine
immunization. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.920] [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] Open
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Anglim B, Maher N, Cunningham O, Mulcahy D, Harbison J, O'Connell M. A rare case of cryptogenic stroke with an incidental finding of patent foramen ovale. Ir Med J 2015; 108:92. [PMID: 25876305] [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: 06/04/2023]
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McKinley J, O'Connell M, Farrell M, Lynch T. Normal dopamine transporter imaging does not exclude multiple system atrophy. Parkinsonism Relat Disord 2014; 20:933-4. [PMID: 24861660 DOI: 10.1016/j.parkreldis.2014.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/16/2022]
Affiliation(s)
- John McKinley
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles St, Dublin 7, Ireland.
| | - Martin O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, 57 Eccles St, Dublin 7, Ireland
| | - Michael Farrell
- Department of Neuropathology and Dublin Brain Bank, Beaumont Hospital, Dublin 9, Ireland
| | - Timothy Lynch
- Department of Neurology, Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles St, Dublin 7, Ireland
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Chróinín DN, Marnane M, Akijian L, Merwick A, Fallon E, Horgan G, Dolan E, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Serum lipids associated with inflammation-related PET-FDG uptake in symptomatic carotid plaque. Neurology 2014; 82:1693-9. [PMID: 24727313 DOI: 10.1212/wnl.0000000000000408] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We hypothesized that serum lipids, which experimental data suggest may be key initiators of carotid plaque inflammation, would be associated with plaque inflammation on (18)fluorodeoxyglucose (FDG)-PET in patients with acutely symptomatic carotid stenosis. METHODS In this cohort study, consecutive patients with acute symptomatic internal carotid artery (ICA) stenosis (≥50%) underwent carotid PET-CT. We quantified plaque FDG uptake as follows: (1) average maximum standardized uptake values (SUVmax) across 10 regions of interest (ROI); (2) highest single ROI SUV measure (SUVROImax); (3) averaged mean SUV across 10 ROIs (SUVmean). RESULTS Sixty-one patients were included. Plaque inflammatory FDG SUVmax was associated with increasing tertiles of low-density lipoprotein (LDL) (trend p = 0.004), total cholesterol (p = 0.009), and triglycerides (p = 0.01), and with lower high-density lipoprotein (HDL) (p = 0.005). When analyzed as a continuous variable, LDL was associated with symptomatic ICA SUVmean (Spearman rho 0.44, p = 0.009), SUVROImax (rho 0.33, p = 0.01), and SUVmax (rho 0.35, p = 0.06). Total cholesterol was associated with SUVmean (rho 0.33, p = 0.009), with trends for SUVmax (rho 0.24, p = 0.059) and SUVROImax (rho 0.23, p = 0.08). Triglycerides were associated with SUVmax (rho 0.32, p = 0.01) and SUVROImax (rho 0.35, p = 0.005). HDL was associated with lower SUVmax (rho -0.37, p = 0.004) and SUVROImax (rho -0.44, p = 0.0004). On multivariable linear regression analysis adjusting for age, sex, degree of carotid stenosis, statins, and smoking, LDL (p = 0.008) and total cholesterol (p = 0.04) were independently associated with SUVmax. CONCLUSION Serum LDL and total cholesterol were associated with acutely symptomatic carotid plaque FDG uptake, supporting experimental data suggesting lipids may promote plaque inflammation, mediating rupture and clinical events.
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Affiliation(s)
- Danielle Ní Chróinín
- From the Neurovascular Unit for Translational and Therapeutics Research (D. Ní C., M.M., L.A., Á.M., E.F., G.H., S.M., K. O'Rourke, P.J.K.) and the Departments of Vascular Surgery (K. O'Malley, M. O'Donohoe, C.M.) and Radiology (E.K., M. O'Connell), Mater University Hospital/University College Dublin; Connolly Hospital (E.D.); and St Vincent's University Hospital (I.N., M.B., M.C.), Dublin, Ireland
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Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J, Pourcher E, Hsu A, O'Connell M, Kell S, Gupta S. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord 2014; 20:142-8. [DOI: 10.1016/j.parkreldis.2013.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Essex MN, O'Connell M, Bhadra Brown P. Response to nonsteroidal anti-inflammatory drugs in African Americans with osteoarthritis of the knee. J Int Med Res 2013; 40:2251-66. [PMID: 23321182 DOI: 10.1177/030006051204000623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This 6-week, randomized, double-blind, parallel-group study compared the analgesic efficacy, tolerability and safety of celecoxib, naproxen and placebo in African Americans with osteoarthritis (OA) of the knee. METHODS A total of 322 patients aged ≥ 45 years with OA of the knee in a flare state received 200 mg celecoxib orally once daily, 500 mg naproxen orally twice daily or placebo for 6 weeks. The primary endpoint was change from baseline in the Patient's Assessment of Arthritis Pain. RESULTS Celecoxib was as effective as naproxen in reducing OA pain. Similar efficacy was observed in many of the secondary outcome measures. Celecoxib was well tolerated and demonstrated favorable upper gastro-intestinal tolerability. Improvements in outcome measures were numerically greater in the active treatment groups compared with the placebo group, but did not reach statistical significance. CONCLUSIONS Celecoxib was as effective as naproxen in relieving OA pain in African Americans and was well tolerated. Few significant differences were observed between active treatments and placebo, possibly because of a strong placebo effect.
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Affiliation(s)
- M N Essex
- US Medical Affairs, Pfizer Inc., New York, NY 10017, USA.
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39
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Greiner H, Schaller-Ammann R, Huber A, O'Connell M, Krejci J, Porro G, Korsatko S, Gurban J, Deller S, Brunner M, Berghofer A, Priedl J, Zijlstra E, Heise T, Pieber TR, Schaupp L. Continuous Blood Glucose Monitoring (Cgm) System Based on Intravenous Microdialysis and Glucose Sensing. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-I/bmt-2013-4224/bmt-2013-4224.xml. [PMID: 24042873 DOI: 10.1515/bmt-2013-4224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Pazderska A, O'Connell M, Pender N, Gavin C, Murray B, O'Dowd S. Insights into thermoregulation: A clinico-radiological description of Shapiro syndrome. J Neurol Sci 2013; 329:66-8. [DOI: 10.1016/j.jns.2013.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
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41
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Hauser RA, Hsu A, Kell S, Espay AJ, Sethi K, Stacy M, Ondo W, O'Connell M, Gupta S. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkinson's disease and motor fluctuations: a phase 3 randomised, double-blind trial. Lancet Neurol 2013; 12:346-56. [DOI: 10.1016/s1474-4422(13)70025-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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42
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O'Dowd S, Curtin D, Waite AJ, Roberts K, Pender N, Reid V, O'Connell M, Williams NM, Morris HR, Traynor BJ, Lynch T. C9ORF72 expansion in amyotrophic lateral sclerosis/frontotemporal dementia also causes parkinsonism. Mov Disord 2012; 27:1072-4. [PMID: 22807188 DOI: 10.1002/mds.25022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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43
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Eastin T, O'Connell M, Gorgas D, Schwaab J. 33 A Novel Approach to the Asynchronous Learning Curriculum. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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44
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Marnane M, Merwick A, Sheehan OC, Hannon N, Foran P, Grant T, Dolan E, Moroney J, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence. Ann Neurol 2012; 71:709-18. [DOI: 10.1002/ana.23553] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/04/2011] [Accepted: 12/14/2011] [Indexed: 11/06/2022]
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Marnane M, Merwick A, Sheehan OC, Hannon N, Foran P, Grant T, Dolan E, Moroney J, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Abstract 2756: Carotid Plaque Inflammation On
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F-Fluorodeoxyglucose Positron Emission Tomography Predicts Early Stroke Recurrence- The Dublin Carotid Atherosclerosis Stroke Study. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a2756] [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: 11/16/2022]
Abstract
Background
Symptomatic carotid stenosis is associated with a 3-fold risk of early stroke recurrence compared to other stroke subtypes. Current carotid imaging techniques rely on estimating plaque-related lumen narrowing but do not evaluate intra-plaque inflammation, a key mediator of plaque rupture and thromboembolism. Using combined
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F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) we investigated the relationship between inflammation-related FDG uptake and stroke recurrence.
Methods
Consecutive patients with a recent (median 6.5 days [IQR 4-8]) stroke, TIA, or retinal embolism and ipsilateral carotid stenosis ( ≥50%) were included. FDG uptake was quantified as mean standardised uptake values (SUV, g/ml). Patients were followed prospectively for stroke recurrence.
Results
60 patients were included (25 stroke, 29 TIA, 6 retinal embolism). 22% (13/60) had stroke recurrence within 90 days. FDG uptake in ipsilateral carotid plaque was greater in patients with early recurrent stroke (mean SUV 1.85 [SD 0.44] vs. 1.58 [SD 0.32] g/ml, p=0.02). On life-table analysis, 90-day recurrence rates with mean SUV greater than a 2.14g/ml threshold were 80% (CI 41.8-99.2%) versus 22.9% (CI 12.3-40.3%) with SUV ≤2.14g/ml (log-rank p<0.0001). In a Cox regression model including age and degree of stenosis (50-69% or ≥70%), mean plaque FDG uptake was the only independent predictor of stroke recurrence (adjusted hazard ratio 6.1, CI 1.3-28.8, p=0.02).
Conclusion
In recently-symptomatic carotid stenosis, inflammation-related FDG uptake was associated with early stroke recurrence, independent of the degree of stenosis. Plaque FDG-PET may identify patients at highest risk for stroke recurrence, who may be selected for immediate revascularisation or intensive medical treatment.
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Affiliation(s)
- Michael Marnane
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Aine Merwick
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Orla C Sheehan
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Niamh Hannon
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Paul Foran
- Dept of Radiology, Mater Univ Hosp, Dublin, Ireland
| | - Tim Grant
- Cntr for Support and Training in Analysis and Rsch [CSTAR], Sch of Public Health, Physiotherapy and Population Science, Univ College Dublin, Dublin, Ireland
| | | | | | - Sean Murphy
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Killian O'Rourke
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
| | - Kevin O'Malley
- Dept of Vascular Surgery, Mater Univ Hosp, Dublin, Ireland
| | | | | | | | | | | | | | | | - Peter J Kelly
- Neurovascular Clinical Science Unit, Mater Univ Hosp/Univ College Dublin at Dublin Academic Med Cntr, Dublin, Ireland
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Cheung WY, Shi Q, O'Connell M, Cassidy J, Blanke CD, Kerr DJ, Van Cutsem E, Alberts SR, Yothers GA, Sargent DJ. Predictive and prognostic value of gender in early-stage colon cancer: A pooled analysis of 33,345 patients from the ACCENT database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3619] [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: 11/20/2022] Open
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Martyn F, Phelan O, O'Connell M. Hepatitis C: is there a case for universal screening in pregnancy? Ir Med J 2011; 104:144-146. [PMID: 21736090] [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: 05/31/2023]
Abstract
Hepatitis C (HCV) is not routinely screened for antenatally in all maternity hospitals. Most hospitals adopt a policy of targeted screening. The policy in the Coombe Women and Infants University Hospital in Dublin changed from targeted screening in 2006 to universal screening in 2007. We audited the two consecutive years. The prevalence of HCV in our antenatal population was 1.4% for 2006 (67/4666) when targeted screening applied and in 2007--0.71% (66/9222) when universal screening came into affect. One woman in 2007 would not have been detected by targeted screening--1.49% (1/67). Fifty five percent (37/67) of women were HCV-RNA positive in 2006 and 57.5% (38/66) were positive in 2007. We conclude that there were similar detection rates for HCV in 2006 and 2007 and that universal screening is not required if inclusive criteria for selective screening are employed but is of use in research context.
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Affiliation(s)
- F Martyn
- Department of Obstetrics & Gynaecology, Coombe Women & Infant's University Hospital, Dolphin's Barn, Dublin 8.
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Clifford A, O'Connell M, Gabriel S, Miller LE, Block JE. The KineSpring load absorber implant: rationale, design and biomechanical characterization. J Med Eng Technol 2011; 35:65-71. [PMID: 21142591 DOI: 10.3109/03091902.2010.535592] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Osteoarthritis (OA) of the knee is the leading cause of disability in the adult population. Although a number of treatments for knee OA are available, none effectively prevent OA progression. Currently, a wide therapeutic gap exists for patients who have unsuccessfully exhausted conservative OA treatments but who are hesitant or ineligible to undergo invasive surgery. The KineSpring device is a novel, joint preserving, minimally invasive implant that reduces medial compartment loading without significantly impacting the loading of the lateral compartment. This article describes the rationale for and the design of the KineSpring device and summarizes results of initial biomechanical testing in an OA cadaver model.
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Affiliation(s)
- A Clifford
- Moximed, Inc., 26460 Corporate Avenue, Hayward, CA 94545, USA
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Burton F, Alkaade S, Collins D, Muddana V, Slivka A, Brand RE, Gelrud A, Banks PA, Sherman S, Anderson MA, Romagnuolo J, Lawrence C, Baillie J, Gardner TB, Lewis MD, Amann ST, Lieb JG, O'Connell M, Kennard ED, Yadav D, Whitcomb DC, Forsmark CE. Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States. Aliment Pharmacol Ther 2011; 33:149-59. [PMID: 21083584 PMCID: PMC3142582 DOI: 10.1111/j.1365-2036.2010.04491.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. AIM To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. METHODS Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. RESULTS Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87-9.18), constant (OR 3.42, 95% CI 1.93-6.04) or intermittent pain (OR 1.98, 95% CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36-3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB - 5%, octreotide - 7%) with efficacy generally <50%. CONCLUSIONS Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.
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Affiliation(s)
- F. Burton
- Division of Gastroenterology, Hepatology and Nutrition, St. Louis University, St. Louis, MO
| | - S. Alkaade
- Division of Gastroenterology, Hepatology and Nutrition, St. Louis University, St. Louis, MO
| | - D. Collins
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, FL
| | - V. Muddana
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - A. Slivka
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - R. E. Brand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - A. Gelrud
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - P. A. Banks
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA
| | - S. Sherman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
| | - M. A. Anderson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine University of Michigan, Ann Arbor, MI
| | - J. Romagnuolo
- Digestive Disease Center, Medical University of South Carolina, Charleston, SC
| | - C. Lawrence
- Digestive Disease Center, Medical University of South Carolina, Charleston, SC
| | - J. Baillie
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | | - M. D. Lewis
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - S. T. Amann
- North Mississippi Medical Center, Tupelo, MS
| | - J. G. Lieb
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - M. O'Connell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - E. D. Kennard
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - D. Yadav
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - D. C. Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - C. E. Forsmark
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, FL
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Khan R, Burgoyne L, O'Connell M, Dempsey EM. Antenatal management of the expectant mother and extreme preterm infant at the limits of viability. Ir Med J 2010; 103:266-269. [PMID: 21186749] [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: 05/30/2023]
Abstract
We explored the opinions of healthcare providers on the antenatal management and outcome of preterm delivery at less than 28 weeks gestation. An anonymous postal questionnaire was sent to health care providers. The response rate was 55% (74% Obstetrician, 70% neonatologist). Twenty four weeks is the limit at which most would advocate intervention. At 23 weeks 67% of neonatologists advocate antenatal steroids. 50% of all health care providers advocate cardiotocographic monitoring at 24 weeks gestation. Written information on survival and long-term outcome is provided by 8% of the respondents. Neonatologists (50%) were more likely than obstetrician (40%) to advocate caesarean section at 25 weeks. We conclude that 24 weeks is the limit at which most would advocate intervention. Significant variation exists both between and within each health care group at less than 25 weeks. Establishment and provision of national outcome data may aid decision making at the limits of viability.
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Affiliation(s)
- R Khan
- Neonatal Intensive Care Unit, Cork University Maternity Hospital, Wilton, Cork
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