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Smith DJ, Wynn-Thompson TM, Stremler MA, Williams MA, Seiler JR, Hession WC. Root reinforcement and extracellular products reduce streambank fluvial erosion. Sci Total Environ 2023; 896:165125. [PMID: 37392881 DOI: 10.1016/j.scitotenv.2023.165125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
A detailed understanding of the factors that impact bank erodibility is necessary to effectively model changes in channel form. This study evaluated the combined contributions of roots and soil microorganisms to soil resistance against fluvial erosion. To do this, three flume walls were constructed to simulate unvegetated and rooted streambanks. Unamended and organic material (OM) amended soil treatments with either no-roots (bare soil), synthetic (inert) roots, or living roots (Panicum virgatum) were created and tested with the corresponding flume wall treatment. OM stimulated the production of extracellular polymeric substances (EPS) and appeared to increase the applied stress required to initiate soil erosion. Synthetic fibers alone provided a base reduction in soil erosion, regardless of the flow rate used. When used in combination, synthetic roots and OM-amendments reduced erosion rates by 86 % or more compared to bare soil; this reduction was identical to the live rooted treatments (95 % to 100 %). In summary, a synergistic relationship between roots and organic carbon inputs can significantly reduce soil erosion rates due to fiber reinforcement and EPS production. These results indicate that root-biochemical interactions, like root physical mechanisms, play an important role in influencing channel migration rates due to reductions in streambank erodibility.
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Affiliation(s)
- D J Smith
- School of Plant and Environmental Sciences, Virginia Tech, 220 Ag Quad Lane, Latham Hall Rm 512, Blacksburg, VA, 24061, USA.
| | | | - M A Stremler
- Department of Biomedical Engineering and Mechanics, Virginia Tech, USA
| | - M A Williams
- School of Plant and Environmental Sciences, Virginia Tech, 220 Ag Quad Lane, Latham Hall Rm 512, Blacksburg, VA, 24061, USA
| | - J R Seiler
- Department of Forest Resources and Environmental Conservation, Virginia Tech, USA
| | - W C Hession
- Department of Biological Systems Engineering, Virginia Tech, USA
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Rahimzadeh V, Fogarty J, Caulfield T, Auñón-Chancellor S, Borry P, Candia J, Cohen IG, Covington M, Lynch HF, Greely HT, Hanlon M, Hatt J, Low L, Menikoff J, Meslin EM, Platts S, Ravitsky V, Ruttley T, Seidler RD, Sugarman J, Urquieta E, Williams MA, Wolpe PR, Donoviel D, McGuire AL. Ethically cleared to launch? Science 2023; 381:1408-1411. [PMID: 37769066 DOI: 10.1126/science.adh9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Rules are needed for human research in commercial spaceflight.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Fogarty
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jessica Candia
- Component Office of Human Research Protections, Air Force Medical Readiness Agency, Department of the Air Force, Falls Church, VA, USA
| | - I Glenn Cohen
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, MA, USA
| | - Marisa Covington
- Office of Research Assurance, Office of the Chief Health and Medical Officer, National Aeronautics and Space Administration, Houston, TX, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry T Greely
- The Center for Law and the Biosciences, Stanford University, Stanford, CA, USA
| | - Michelle Hanlon
- Center for Air and Space Law, University of Mississippi, Oxford, MS, USA
| | - James Hatt
- Space Policy Division, Office of Commercial Space Transportation, Federal Aviation Administration, Washington, DC, USA
| | | | - Jerry Menikoff
- Centre for Biomedical Ethics, National University of Singapore, Republic of Singapore
| | | | - Steven Platts
- Human Research Program, NASA Johnson Space Center, Houston, TX, USA
| | - Vardit Ravitsky
- School of Public Health, University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Emmanuel Urquieta
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Williams
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Dorit Donoviel
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Tzoumas N, Riding G, Williams MA, Steel DH. Complement inhibitors for age-related macular degeneration. Cochrane Database Syst Rev 2023; 6:CD009300. [PMID: 37314061 PMCID: PMC10266126 DOI: 10.1002/14651858.cd009300.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a common eye disease and leading cause of sight loss worldwide. Despite its high prevalence and increasing incidence as populations age, AMD remains incurable and there are no treatments for most patients. Mounting genetic and molecular evidence implicates complement system overactivity as a key driver of AMD development and progression. The last decade has seen the development of several novel therapeutics targeting complement in the eye for the treatment of AMD. This review update encompasses the results of the first randomised controlled trials in this field. OBJECTIVES To assess the effects and safety of complement inhibitors in the prevention or treatment of AMD. SEARCH METHODS We searched CENTRAL on the Cochrane Library, MEDLINE, Embase, LILACS, Web of Science, ISRCTN registry, ClinicalTrials.gov, and the WHO ICTRP to 29 June 2022 with no language restrictions. We also contacted companies running clinical trials for unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) with parallel groups and comparator arms that studied complement inhibition for advanced AMD prevention/treatment. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results and resolved discrepancies through discussion. Outcome measures evaluated at one year included change in best-corrected visual acuity (BCVA), untransformed and square root-transformed geographic atrophy (GA) lesion size progression, development of macular neovascularisation (MNV) or exudative AMD, development of endophthalmitis, loss of ≥ 15 letters of BCVA, change in low luminance visual acuity, and change in quality of life. We assessed risk of bias and evidence certainty using Cochrane risk of bias and GRADE tools. MAIN RESULTS Ten RCTs with 4052 participants and eyes with GA were included. Nine evaluated intravitreal (IVT) administrations against sham, and one investigated an intravenous agent against placebo. Seven studies excluded patients with prior MNV in the non-study eye, whereas the three pegcetacoplan studies did not. The risk of bias in the included studies was low overall. We also synthesised results of two intravitreal agents (lampalizumab, pegcetacoplan) at monthly and every-other-month (EOM) dosing intervals. Efficacy and safety of IVT lampalizumab versus sham for GA For 1932 participants in three studies, lampalizumab did not meaningfully change BCVA given monthly (+1.03 letters, 95% confidence interval (CI) -0.19 to 2.25) or EOM (+0.22 letters, 95% CI -1.00 to 1.44) (high-certainty evidence). For 1920 participants, lampalizumab did not meaningfully change GA lesion growth given monthly (+0.07 mm², 95% CI -0.09 to 0.23; moderate-certainty due to imprecision) or EOM (+0.07 mm², 95% CI -0.05 to 0.19; high-certainty). For 2000 participants, lampalizumab may have also increased MNV risk given monthly (RR 1.77, 95% CI 0.73 to 4.30) and EOM (RR 1.70, 95% CI 0.67 to 4.28), based on low-certainty evidence. The incidence of endophthalmitis in patients treated with monthly and EOM lampalizumab was 4 per 1000 (0 to 87) and 3 per 1000 (0 to 62), respectively, based on moderate-certainty evidence. Efficacy and safety of IVT pegcetacoplan versus sham for GA For 242 participants in one study, pegcetacoplan probably did not meaningfully change BCVA given monthly (+1.05 letters, 95% CI -2.71 to 4.81) or EOM (-1.42 letters, 95% CI -5.25 to 2.41), as supported by moderate-certainty evidence. In contrast, for 1208 participants across three studies, pegcetacoplan meaningfully reduced GA lesion growth when given monthly (-0.38 mm², 95% CI -0.57 to -0.19) and EOM (-0.29 mm², 95% CI -0.44 to -0.13), with high certainty. These reductions correspond to 19.2% and 14.8% versus sham, respectively. A post hoc analysis showed possibly greater benefits in 446 participants with extrafoveal GA given monthly (-0.67 mm², 95% CI -0.98 to -0.36) and EOM (-0.60 mm², 95% CI -0.91 to -0.30), representing 26.1% and 23.3% reductions, respectively. However, we did not have data on subfoveal GA growth to undertake a formal subgroup analysis. In 1502 participants, there is low-certainty evidence that pegcetacoplan may have increased MNV risk when given monthly (RR 4.47, 95% CI 0.41 to 48.98) or EOM (RR 2.29, 95% CI 0.46 to 11.35). The incidence of endophthalmitis in patients treated with monthly and EOM pegcetacoplan was 6 per 1000 (1 to 53) and 8 per 1000 (1 to 70) respectively, based on moderate-certainty evidence. Efficacy and safety of IVT avacincaptad pegol versus sham for GA In a study of 260 participants with extrafoveal or juxtafoveal GA, monthly avacincaptad pegol probably did not result in a clinically meaningful change in BCVA at 2 mg (+1.39 letters, 95% CI -5.89 to 8.67) or 4 mg (-0.28 letters, 95% CI -8.74 to 8.18), based on moderate-certainty evidence. Despite this, the drug was still found to have probably reduced GA lesion growth, with estimates of 30.5% reduction at 2 mg (-0.70 mm², 95% CI -1.99 to 0.59) and 25.6% reduction at 4 mg (-0.71 mm², 95% CI -1.92 to 0.51), based on moderate-certainty evidence. Avacincaptad pegol may have also increased the risk of developing MNV (RR 3.13, 95% CI 0.93 to 10.55), although this evidence is of low certainty. There were no cases of endophthalmitis reported in this study. AUTHORS' CONCLUSIONS Despite confirmation of the negative findings of intravitreal lampalizumab across all endpoints, local complement inhibition with intravitreal pegcetacoplan meaningfully reduces GA lesion growth relative to sham at one year. Inhibition of complement C5 with intravitreal avacincaptad pegol is also an emerging therapy with probable benefits on anatomical endpoints in the extrafoveal or juxtafoveal GA population. However, there is currently no evidence that complement inhibition with any agent improves functional endpoints in advanced AMD; further results from the phase 3 studies of pegcetacoplan and avacincaptad pegol are eagerly awaited. Progression to MNV or exudative AMD is a possible emergent adverse event of complement inhibition, requiring careful consideration should these agents be used clinically. Intravitreal administration of complement inhibitors is probably associated with a small risk of endophthalmitis, which may be higher than that of other intravitreal therapies. Further research is likely to have an important impact on our confidence in the estimates of adverse effects and may change these. The optimal dosing regimens, treatment duration, and cost-effectiveness of such therapies are yet to be established.
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Affiliation(s)
- Nikolaos Tzoumas
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
- Sunderland Eye Infirmary, Sunderland, UK
| | - George Riding
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
- North Middlesex University Hospital NHS Trust, London, UK
| | - Michael A Williams
- School of Medicine, Dentistry and Biomedical Science, Queen's University of Belfast, Belfast, UK
| | - David Hw Steel
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
- Sunderland Eye Infirmary, Sunderland, UK
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Hamilton MG, Israelsson H, Palandri G, Elder BD, Williams MA. Introduction. Adult hydrocephalus: advancements in diagnosis, treatment, and patient outcomes. Neurosurg Focus 2023; 54:E1. [PMID: 37004135 DOI: 10.3171/2023.1.focus22641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Affiliation(s)
- Mark G Hamilton
- 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hanna Israelsson
- 2Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Giorgio Palandri
- 3Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Benjamin D Elder
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael A Williams
- Departments of5Neurology and
- 6Neurological Surgery, University of Washington Medicine, Seattle, Washington
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5
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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Luciano M, Holubkov R, Williams MA, Malm J, Nagel S, Moghekar A, Eklund A, Zwimpfer T, Katzen H, Hanley DF, Hamilton MG. Placebo-Controlled Effectiveness of Idiopathic Normal Pressure Hydrocephalus Shunting: A Randomized Pilot Trial. Neurosurgery 2023; 92:481-489. [PMID: 36700738 PMCID: PMC9904195 DOI: 10.1227/neu.0000000000002225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Multiple prospective nonrandomized studies have shown 60% to 70% of patients with idiopathic normal pressure hydrocephalus (iNPH) improve with shunt surgery, but multicenter placebo-controlled trial data are necessary to determine its effectiveness. OBJECTIVE To evaluate the effectiveness of cerebrospinal fluid shunting in iNPH through comparison of open vs placebo shunting groups at 4 months using a pilot study. METHODS Patients were randomized to a Codman Certas Plus valve (Integra LifeSciences) set at 4 (open shunt group) or 8 ("virtual off"; placebo group). Patients and assessors were blinded to treatment group. The primary outcome measure was 10-m gait velocity. Secondary outcome measures included functional scales for bladder control, activities of daily living, depression, and quality of life. Immediately after 4-month evaluation, all shunts were adjusted in a blinded fashion to an active setting and followed to 12 months after shunting. RESULTS A total of 18 patients were randomized. At the 4-month evaluation, gait velocity increased by 0.28 ± 0.28 m/s in the open shunt group vs 0.04 ± 0.17 m/s in the placebo group. The estimated treatment difference was 0.22 m/s ([ P = .071], 95% CI -0.02 to 0.46). Overactive Bladder Short Form symptom bother questionnaire significantly improved in open shunt vs placebo ( P = .007). The 4-month treatment delay did not reduce the subsequent response to active shunting, nor did it increase the adverse advents rate at 12 months. CONCLUSION This multicenter, randomized pilot study demonstrates the effectiveness, safety, and feasibility of a placebo-controlled trial in iNPH, and found a trend suggesting gait velocity improves more in the open shunt group than in the placebo group.
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Affiliation(s)
- Mark Luciano
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Richard Holubkov
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael A. Williams
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Sean Nagel
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhay Moghekar
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anders Eklund
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Thomas Zwimpfer
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Heather Katzen
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel F. Hanley
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark G. Hamilton
- Adult Hydrocephalus Clinical Research Network, Department of Pediatrics, Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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7
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Cheung CY, Ran AR, Wang S, Chan VTT, Sham K, Hilal S, Venketasubramanian N, Cheng CY, Sabanayagam C, Tham YC, Schmetterer L, McKay GJ, Williams MA, Wong A, Au LWC, Lu Z, Yam JC, Tham CC, Chen JJ, Dumitrascu OM, Heng PA, Kwok TCY, Mok VCT, Milea D, Chen CLH, Wong TY. A deep learning model for detection of Alzheimer's disease based on retinal photographs: a retrospective, multicentre case-control study. Lancet Digit Health 2022; 4:e806-e815. [PMID: 36192349 DOI: 10.1016/s2589-7500(22)00169-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND There is no simple model to screen for Alzheimer's disease, partly because the diagnosis of Alzheimer's disease itself is complex-typically involving expensive and sometimes invasive tests not commonly available outside highly specialised clinical settings. We aimed to develop a deep learning algorithm that could use retinal photographs alone, which is the most common method of non-invasive imaging the retina to detect Alzheimer's disease-dementia. METHODS In this retrospective, multicentre case-control study, we trained, validated, and tested a deep learning algorithm to detect Alzheimer's disease-dementia from retinal photographs using retrospectively collected data from 11 studies that recruited patients with Alzheimer's disease-dementia and people without disease from different countries. Our main aim was to develop a bilateral model to detect Alzheimer's disease-dementia from retinal photographs alone. We designed and internally validated the bilateral deep learning model using retinal photographs from six studies. We used the EfficientNet-b2 network as the backbone of the model to extract features from the images. Integrated features from four retinal photographs (optic nerve head-centred and macula-centred fields from both eyes) for each individual were used to develop supervised deep learning models and equip the network with unsupervised domain adaptation technique, to address dataset discrepancy between the different studies. We tested the trained model using five other studies, three of which used PET as a biomarker of significant amyloid β burden (testing the deep learning model between amyloid β positive vs amyloid β negative). FINDINGS 12 949 retinal photographs from 648 patients with Alzheimer's disease and 3240 people without the disease were used to train, validate, and test the deep learning model. In the internal validation dataset, the deep learning model had 83·6% (SD 2·5) accuracy, 93·2% (SD 2·2) sensitivity, 82·0% (SD 3·1) specificity, and an area under the receiver operating characteristic curve (AUROC) of 0·93 (0·01) for detecting Alzheimer's disease-dementia. In the testing datasets, the bilateral deep learning model had accuracies ranging from 79·6% (SD 15·5) to 92·1% (11·4) and AUROCs ranging from 0·73 (SD 0·24) to 0·91 (0·10). In the datasets with data on PET, the model was able to differentiate between participants who were amyloid β positive and those who were amyloid β negative: accuracies ranged from 80·6 (SD 13·4%) to 89·3 (13·7%) and AUROC ranged from 0·68 (SD 0·24) to 0·86 (0·16). In subgroup analyses, the discriminative performance of the model was improved in patients with eye disease (accuracy 89·6% [SD 12·5%]) versus those without eye disease (71·7% [11·6%]) and patients with diabetes (81·9% [SD 20·3%]) versus those without the disease (72·4% [11·7%]). INTERPRETATION A retinal photograph-based deep learning algorithm can detect Alzheimer's disease with good accuracy, showing its potential for screening Alzheimer's disease in a community setting. FUNDING BrightFocus Foundation.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shujun Wang
- Department of Computer Science and Engineering, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Victor T T Chan
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Kaiser Sham
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Saima Hilal
- Memory Aging &Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Yih Chung Tham
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Advanced Ocular Engineering and School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
| | - Gareth J McKay
- Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
| | | | - Adrian Wong
- Gerald Choa Neuroscience Institute, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lisa W C Au
- Gerald Choa Neuroscience Institute, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhihui Lu
- Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Medicine and Therapeutics, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - John J Chen
- Department of Ophthalmology and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Oana M Dumitrascu
- Department of Neurology and Department of Ophthalmology, Division of Cerebrovascular Diseases, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Medicine and Therapeutics, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent C T Mok
- Gerald Choa Neuroscience Institute, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Christopher Li-Hsian Chen
- Memory Aging &Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
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Williams MA, Nielsen DR, Dayao Z, Brown-Glaberman U, Tawfik B. Patient-Reported Measures of a Breast Cancer Nurse Navigator Program in an Underserved, Rural, and Economically Disadvantaged Patient Population. Oncol Nurs Forum 2022; 49:532-539. [PMID: 36413732 DOI: 10.1188/22.onf.532-539] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the efficacy of the University of New Mexico Comprehensive Cancer Center's (UNMCCC's) breast cancer nurse navigator (BCNN) program in addressing gaps in cancer care for an underserved, rural, and economically disadvantaged population. SAMPLE & SETTING 54 navigated patients under the care of the BCNN and 32 non-navigated patients whose care began prior to the start of the program. METHODS & VARIABLES Surveys were administered anonymously to patients during regularly scheduled appointments at UNMCCC. RESULTS Navigated patients more strongly agreed that they were prepared for the beginning of treatment and that calls were returned promptly, and showed a decreased desire for an after-treatment summary compared to non-navigated patients. IMPLICATIONS FOR NURSING Navigated patients report better understanding of and engagement with the healthcare system when assisted by a BCNN during breast cancer treatment with curative intent, as well as desire fewer services than non-navigated peers, indicating greater satisfaction.
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Affiliation(s)
| | | | - Zoneddy Dayao
- University of New Mexico Comprehensive Cancer Center
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Williams MA, Nagel SJ, Golomb J, Jensen H, Dasher NA, Holubkov R, Edwards RJ, Luciano MG, Zwimpfer TJ, Katzen H, Moghekar A, Wisoff JH, McKhann GM, Hamilton MG. Safety and effectiveness of the assessment and treatment of idiopathic normal pressure hydrocephalus in the Adult Hydrocephalus Clinical Research Network. J Neurosurg 2022; 137:1-13. [PMID: 35276651 DOI: 10.3171/2022.1.jns212782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to describe the processes and outcomes associated with patients at five sites in the Adult Hydrocephalus Clinical Research Network (AHCRN) who had undergone evaluation and treatment for suspected idiopathic normal pressure hydrocephalus (iNPH) and had 1-year postoperative follow-up. METHODS Subjects with possible iNPH who had been prospectively enrolled in the AHCRN registry between November 19, 2014, and December 31, 2018, were evaluated by CSF drainage via either lumbar puncture or external lumbar drainage, consistent with recommendations of the international iNPH guidelines. Standardized clinical evaluations of gait, cognition, urinary symptoms, depression, and functional outcomes were conducted at baseline, before and after CSF drainage, and at 4-month intervals after shunt surgery. Complications of CSF drainage and shunt surgery were recorded. RESULTS Seventy-four percent (424/570) of patients with possible iNPH had CSF drainage, and 46% of them (193/424) underwent shunt surgery. The mean change in gait velocity with CSF drainage was 0.18 m/sec in patients who underwent shunt surgery versus 0.08 m/sec in patients who did not. For shunt surgery patients, gait velocity increased by 54% from 0.67 m/sec before CSF drainage to 0.96 m/sec 8-12 months after surgery, and 80% of patients had an increase of at least 0.1 m/sec by the first postoperative visit. Evaluation of cognition, urinary symptoms, depression, and functional outcomes also revealed improvement after shunt surgery. Of 193 patients who had undergone shunt surgery, 176 (91%) had no complications and 17 (9%) had 28 complications. Eleven patients (6%) had 14 serious complications that resulted in the need for surgery or an extended hospital stay. The 30-day reoperation rate was 3%. CONCLUSIONS Using criteria recommended by the international iNPH guidelines, the authors found that evaluation and treatment of iNPH are safe and effective. Testing with CSF drainage and treatment with shunt surgery are associated with a high rate of sustained improvement and a low rate of complications for iNPH in the 1st year after shunt surgery. Patients who had undergone shunt surgery for iNPH experienced improvement in gait, cognitive function, bladder symptoms, depression, and functional outcome measures. Gait velocity, which is an easily measured, objective, continuous variable, should be used as a standard outcome measure to test a patient's response to CSF drainage and shunt surgery in iNPH.
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Affiliation(s)
- Michael A Williams
- 1Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Sean J Nagel
- 2Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - James Golomb
- 3Department of Neurology, New York University School of Medicine, New York, New York
| | - Hailey Jensen
- 4Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Nickolas A Dasher
- 5Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Richard Holubkov
- 4Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Richard J Edwards
- 6Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom
| | - Mark G Luciano
- 7Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Thomas J Zwimpfer
- 8Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Katzen
- 9Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Abhay Moghekar
- 10Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeffrey H Wisoff
- 11Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York
| | - Guy M McKhann
- 12Department of Neurological Surgery, Columbia University School of Medicine, New York, New York; and
| | - Mark G Hamilton
- 13Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary School of Medicine, Calgary, Alberta, Canada
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10
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Wahler EA, Ressler JD, Johnson SC, Rortvedt C, Saecker T, Helling J, Williams MA, Hoover D. Public Library-Based Social Work Field Placements: Guidance for Public Libraries Planning to Become a Social Work Practicum Site. Public Library Quarterly 2022. [DOI: 10.1080/01616846.2022.2044264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth A. Wahler
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jacob D. Ressler
- Indiana University School of Social Work, Indianapolis, Indiana, USA
| | - Sarah C. Johnson
- Hunter College Libraries, Hunter College, New York, New York, USA
| | | | | | - John Helling
- Indianapolis Public Library, Indianapolis, Indiana, USA
| | | | - Danielle Hoover
- Indiana University School of Social Work, Indianapolis, Indiana, USA
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11
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Oates TW, Guy V, Ni K, Ji C, Saito H, Shiau H, Shah R, Williams MA, Blasi G, Goloubeva O. Meta-regression Analysis of Study Heterogeneity for Systemic Outcomes after Periodontal Therapy. JDR Clin Trans Res 2022; 8:23800844211070467. [PMID: 35037489 DOI: 10.1177/23800844211070467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The contribution of periodontal disease to adverse systemic consequences remains controversial. This analysis examined 2 well-investigated conditions independently and combined-adverse pregnancy outcomes and glycemic control for patients with diabetes-based on shared pathogenic mechanisms of periodontal infection and inflammation. It was proposed that inconsistencies in study design significantly contribute to outcome discrepancies found between periodontal intervention studies undergoing meta-analysis. METHODS Meta-analyses evaluating periodontal interventions on the rate of preterm birth and changes in glycated hemoglobin A1c in type 2 diabetes populations were conducted based on a systematic review of randomized controlled trials. Meta-regression covariates for exploring heterogeneity included sample size, level of medical management, and bias risk as moderator variables in a random-effects meta-regression. RESULTS Systematic review identified 17 studies of diabetes and 13 of pregnancy outcomes. Analyses of these studies identified 0.50% reduction in HbA1c and 0.78 odds ratio for preterm births. The heterogeneity associated with the models was high (I2 = 92.4 and I2 = 62.7%, respectively). The adjusted models evaluating each systemic condition separately accounted for 52.2% of the effect for diabetes and 81.4% for pregnancy outcome effects independently, and 63.5% collectively, across interventional studies. CONCLUSION This systematic review with meta-regression analysis of heterogeneity demonstrates that disparate results seen in randomized controlled trials of periodontal therapy affecting systemic outcomes may be explained in large part by study design, specifically stringency in consideration of medical management and sample size. The potential for confounding factors to influence outcomes remains a concern in understanding the implications of oral health on systemic conditions. KNOWLEDGE TRANSFER STATEMENT The findings of this study demonstrate that much of the benefits seen from periodontal therapy on adverse systemic outcomes for diabetes and pregnancy are due to limitations in study design.
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Affiliation(s)
- T W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - V Guy
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Summerville, SC, USA
| | - K Ni
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Lancaster, PA, USA
| | - C Ji
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - H Saito
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - H Shiau
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - R Shah
- University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: UCSF School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - M A Williams
- Health Sciences & Human Services Library, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Barcelona, Spain
| | - O Goloubeva
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Mialon HM, Klumpp T, Williams MA. International trade and the survival of mammalian and reptilian species. Sci Adv 2022; 8:eabh3442. [PMID: 34995106 PMCID: PMC8741183 DOI: 10.1126/sciadv.abh3442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/15/2021] [Indexed: 05/27/2023]
Abstract
The Convention on International Trade in Endangered Species (CITES) bans international trade in species threatened with extinction. We investigate the effects of these bans on species’ endangerment, as assessed by the International Union for Conservation of Nature (IUCN). Our analysis exploits changes in CITES bans between 1979 and 2017. We find that CITES bans lead to subsequent improvements in mammalian species’ IUCN status, relative to species in which trade was not banned. These effects are primarily due to improvements in the status of commercially targeted species. On the other hand, CITES bans lead to deteriorations in reptilian species’ IUCN status. We find that major spikes in trade volume occurred in anticipation of the bans on reptilian species but not in anticipation of those on mammalian species.
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Affiliation(s)
- Hugo M. Mialon
- Department of Economics, Emory University, Atlanta, GA, USA
| | - Tilman Klumpp
- Department of Economics, University of Alberta, Edmonton, AB, Canada
| | - Michael A. Williams
- Berkeley Research Group, Emeryville, CA, USA
- Competition Economics LLC, Emeryville, CA, USA
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Zwimpfer TJ, Salterio N, Williams MA, Holubkov R, Katzen H, Luciano MG, Moghekar A, Nagel SJ, Wisoff JH, Golomb J, McKhann GM, Edwards RJ, Hamilton MG. Cognitive and gait outcomes after primary endoscopic third ventriculostomy in adults with chronic obstructive hydrocephalus. J Neurosurg 2021; 136:887-894. [PMID: 34534954 DOI: 10.3171/2021.3.jns203424] [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: 09/10/2020] [Accepted: 03/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to determine the short- and long-term efficacy of primary endoscopic third ventriculostomy (ETV) on cognition and gait in adults with chronic obstructive hydrocephalus. METHODS Patients were prospectively accrued through the Adult Hydrocephalus Clinical Research Network patient registry. Patients with previously untreated congenital or acquired obstructive hydrocephalus were included in this study. Gait velocity was assessed using a 10-m walk test. Global cognition was assessed with the Montreal Cognitive Assessment (MoCA). Only patients with documented pre- and post-ETV gait analysis and/or pre- and post-ETV MoCA were included. RESULTS A total of 74 patients had undergone primary ETV, 42 of whom were analyzed. The remaining 32 patients were excluded, as they could not complete both pre- and post-ETV assessments. The mean age of the 42 patients, 19 (45.2%) of whom were female, was 51.9 ± 17.1 years (range 19-79 years). Most patients were White (37 [88.1%]), and the remainder were Asian. Surgical complications were minor. Congenital etiologies occurred in 31 patients (73.8%), with aqueductal stenosis in 23 of those patients (54.8%). The remaining 11 patients (26.2%) had acquired cases. The gait short-term follow-up cohort (mean 4.7 ± 4.1 months, 35 patients) had a baseline median gait velocity of 0.9 m/sec (IQR 0.7-1.3 m/sec) and a post-ETV median velocity of 1.3 m/sec (IQR 1.1-1.4 m/sec). Gait velocity significantly improved post-ETV with a median within-patient change of 0.3 m/sec (IQR 0.0-0.6 m/sec, p < 0.001). Gait velocity improvements were sustained in the long term (mean 14 ± 2.8 months, 12 patients) with a baseline median velocity of 0.7 m/sec (IQR 0.6-1.3 m/sec), post-ETV median of 1.3 m/sec (IQR 1.1-1.7 m/sec), and median within-patient change of 0.4 m/sec (IQR 0.2-0.6 m/sec, p < 0.001). The cognitive short-term follow-up cohort (mean 4.6 ± 4.0 months, 38 patients) had a baseline median MoCA total score (MoCA TS) of 24/30 (IQR 23-27) that improved to 26/30 (IQR 24-28) post-ETV. The median within-patient change was +1 point (IQR 0-2 points, p < 0.001). However, this change is not clinically significant. The cognitive long-term follow-up cohort (mean 14 ± 3.1 months, 15 patients) had a baseline median MoCA TS of 23/30 (IQR 22-27), which improved to 26/30 (IQR 25-28) post-ETV. The median within-patient change was +2 points (IQR 1-3 points, p = 0.007), which is both statistically and clinically significant. CONCLUSIONS Primary ETV can safely improve symptoms of gait and cognitive dysfunction in adults with chronic obstructive hydrocephalus. Gait velocity and global cognition were significantly improved, and the worsening of either was rare following ETV.
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Affiliation(s)
- Thomas J Zwimpfer
- 1Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Salterio
- 1Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Williams
- 2Departments of Neurology and Neurological Surgery, University of Washington, Seattle, Washington
| | - Richard Holubkov
- 3Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Heather Katzen
- 4Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Abhay Moghekar
- 6Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Sean J Nagel
- 7Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | | | - James Golomb
- 9Neurology, New York University School of Medicine, New York, New York
| | - Guy M McKhann
- 10Department of Neurological Surgery, Columbia University Irving Medical Center, New York, New York
| | - Richard J Edwards
- 11Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom; and
| | - Mark G Hamilton
- 12Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Yuen V, Ran A, Shi J, Sham K, Yang D, Chan VTT, Chan R, Yam JC, Tham CC, McKay GJ, Williams MA, Schmetterer L, Cheng CY, Mok V, Chen CL, Wong TY, Cheung CY. Deep-Learning-Based Pre-Diagnosis Assessment Module for Retinal Photographs: A Multicenter Study. Transl Vis Sci Technol 2021; 10:16. [PMID: 34524409 PMCID: PMC8444486 DOI: 10.1167/tvst.10.11.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/12/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose Artificial intelligence (AI) deep learning (DL) has been shown to have significant potential for eye disease detection and screening on retinal photographs in different clinical settings, particular in primary care. However, an automated pre-diagnosis image assessment is essential to streamline the application of the developed AI-DL algorithms. In this study, we developed and validated a DL-based pre-diagnosis assessment module for retinal photographs, targeting image quality (gradable vs. ungradable), field of view (macula-centered vs. optic-disc-centered), and laterality of the eye (right vs. left). Methods A total of 21,348 retinal photographs from 1914 subjects from various clinical settings in Hong Kong, Singapore, and the United Kingdom were used for training, internal validation, and external testing for the DL module, developed by two DL-based algorithms (EfficientNet-B0 and MobileNet-V2). Results For image-quality assessment, the pre-diagnosis module achieved area under the receiver operating characteristic curve (AUROC) values of 0.975, 0.999, and 0.987 in the internal validation dataset and the two external testing datasets, respectively. For field-of-view assessment, the module had an AUROC value of 1.000 in all of the datasets. For laterality-of-the-eye assessment, the module had AUROC values of 1.000, 0.999, and 0.985 in the internal validation dataset and the two external testing datasets, respectively. Conclusions Our study showed that this three-in-one DL module for assessing image quality, field of view, and laterality of the eye of retinal photographs achieved excellent performance and generalizability across different centers and ethnicities. Translational Relevance The proposed DL-based pre-diagnosis module realized accurate and automated assessments of image quality, field of view, and laterality of the eye of retinal photographs, which could be further integrated into AI-based models to improve operational flow for enhancing disease screening and diagnosis.
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Affiliation(s)
- Vincent Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Anran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jian Shi
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kaiser Sham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Victor T. T. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Raymond Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Eye Hospital, Hong Kong
| | - Gareth J. McKay
- Center for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
| | - Michael A. Williams
- Center for Medical Education, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Vincent Mok
- Gerald Choa Neuroscience Center, Therese Pei Fong Chow Research Center for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Christopher L. Chen
- Memory, Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Y. Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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15
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Kotecha S, Williams MA, White HB, Graystone J, Gibbons M, Cosker T. Head and neck sarcoma: three-year data from a tertiary referral centre. Ann R Coll Surg Engl 2021; 103:762-767. [PMID: 34448646 DOI: 10.1308/rcsann.2021.0119] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sarcomas of the head and neck are neoplasms arising from the embryonic mesenchyme. They are rare and heterogeneous in nature and are associated with significant morbidity and mortality. This study evaluates patients referred to the Oxford Sarcoma Service, a tertiary referral centre. METHODS Patients discussed over a three-year period were included. Medical records were analysed using the electronic patient record database. Data were acquired on a range of domains, including: demographics, histopathology, treatment modality, recurrence, mortality, survival, etc. RESULTS Thirty-two eligible patients, 21 male and 11 female, were identified with a mean age of 58 years; 26 out of 32 patients had high-grade sarcomas. The commonest histological subtype was chondrosarcoma (8/32). Twenty-two underwent planned multidisciplinary team surgical resection after biopsy and staging: negative margins were noted in 9, with close and involved margins in 5 and 8, respectively. Local recurrence was noted in 13 and 6 had metastatic disease out of the 32 eligible patients. Mortality was noted in 10 out of 32 patients. Mean survival was 69.5 months. Five-year overall survival was 64%. Surgery demonstrated statistically significant improvement in survival (p=0.0095). There were no significant differences in survival, recurrence or marginal status between methods of adjuvant or neoadjuvant therapy. CONCLUSION Outcomes of head and neck sarcomas are inferior compared with other types of sarcoma. The nature of the complex surrounding anatomy presents unique challenges in surgical management. This in turn affects rates of local recurrence and prognosis. Therefore, it is critical that they are managed in tertiary, specialist centres with a multidisciplinary approach.
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Affiliation(s)
- S Kotecha
- Oxford University Hospitals NHS Foundation Trust, UK
| | - M A Williams
- Oxford University Hospitals NHS Foundation Trust, UK
| | | | - J Graystone
- Oxford University Hospitals NHS Foundation Trust, UK
| | - M Gibbons
- Oxford University Hospitals NHS Foundation Trust, UK
| | - T Cosker
- Oxford University Hospitals NHS Foundation Trust, UK
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16
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Alsop K, Norman D, Remy G, Wilson P, Williams MA. Quantitative characterisation of ballistic cartridge cases from micro-CT. Forensic Sci Int 2021; 326:110913. [PMID: 34311286 DOI: 10.1016/j.forsciint.2021.110913] [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: 04/13/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022]
Abstract
Evaluation of cartridge cases is essential within forensic ballistic analysis and is used in an attempt to establish a connection to the weapon used to fire it. This study consists of two experiments. The aims of Experiment 1 were to establish whether micro-CT is appropriate and repeatable for ballistic cartridge case analysis and if measurements can be extracted repeatably and reliably. Experiment 2 aimed to compare cartridge cases from two weapons to establish the magnitude of variation within and between weapons. A total of 48 cartridge cases fired by two distinct weapons were collected and micro-CT scanned to a high resolution. One randomly selected cartridge was scanned ten times under the same conditions to ensure repeatability of the scanning conditions in Experiment 1. Three novel measurements to quantitatively assess the firing pin impressions were proposed in Experiment 1 and comparatively analysed from two weapons in Experiment 2. Experiment 1 showed that micro-CT is an effective and highly repeatable and reliable method for 3-dimensional imaging and measurement of ballistic cartridge cases. Furthermore, high agreement for inter-rater reliability was found between five raters. Quantitative micro-CT analysis of the firing pin impression measurements in Experiment 2 showed a significant difference between the two studied weapons using Welch's t-test (p < 0.01). This study shows the advantage and reliability of utilising micro-CT for firing pin impression analysis. Quantitation of the firing pin impression allows distinction between the weapons studied. With expansion to further weapons, application of this methodology could complement current analysis techniques through classification models.
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Affiliation(s)
- K Alsop
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry CV4 7AL, UK.
| | - D Norman
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - G Remy
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - P Wilson
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - M A Williams
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry CV4 7AL, UK
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17
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Angerame MR, Holst DC, Phocas A, Williams MA, Dennis DA, Jennings JM. Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients? Arthroplast Today 2021; 7:136-142. [PMID: 33553540 PMCID: PMC7850936 DOI: 10.1016/j.artd.2020.12.001] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Laboratory studies are routinely obtained preoperatively and postoperatively for total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study evaluates the necessity of routine, perioperative laboratory tests and identifies risk factors for laboratory-associated interventions. Methods This retrospective review evaluated 967 consecutive patients scheduled for primary, unilateral TKAs (n = 593) or THAs (n = 374) over an 18-month period at a single institution. Preoperative prothrombin time (PT) and International Normalized Ratio (INR), complete blood count (CBC), complete metabolic panel (CMP), and postoperative CBC and basic metabolic panel (BMP) were recorded along with any laboratory-associated intervention. Patient demographics and comorbidities identified risk factors for abnormal or actionable laboratory studies. Results Preoperatively, the actionable rates for PT/INR, CMP, and CBC were 0.3%, 1.4%, and 0.5%, respectively. Vascular, renal, and immunologic diseases were risk factors for an actionable CBC. Risk factors for an actionable CMP include cardiac arrhythmia and diabetes. There were no risk factors for an actionable PT/INR. Postoperatively, only 1.5% of BMPs and 1.5% of CBCs were actionable. Congestive heart failure, renal disease vascular disease, or history of cancer (P = .030) were risk factors for an actionable CBC. There were no risk factors for an actionable BMP. Patients with an abnormal preoperative lab were 2.4 times more likely to have an actionable postoperative lab. Patients with an actionable preoperative lab were 11.3 times more likely to have an actionable postoperative lab. Conclusion Routine preoperative and postoperative labs may not be necessary on all patients undergoing a TKA or THA. Comorbid risk factors and abnormal or actionable preoperative CMPs and CBCs can help determine the usefulness of postoperative laboratory assessments.
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Affiliation(s)
| | - David C Holst
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Alexandria Phocas
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA
| | | | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA.,Department of Mechanical and Materials Engineering, Denver University, Denver, CO, USA.,Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA.,Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO, USA.,Department of Mechanical and Materials Engineering, Denver University, Denver, CO, USA
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18
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Williams MA, Lallo CHO, Sundaram V. The Effect of Early Post Hatch Feeding Times on the Growth and Development of the Gastrointestinal Tract of Mule Ducklings to Five Days of Age. Braz J Poult Sci 2021. [DOI: 10.1590/1806-9061-2019-1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Hansen AB, Lawley JS, Rickards CA, Howden EJ, Sarma S, Cornwell WK, Amin SB, Mugele H, Marume K, Possnig C, Whitworth LA, Williams MA, Levine BD. Reducing intracranial pressure by reducing central venous pressure: assessment of potential countermeasures to spaceflight-associated neuro-ocular syndrome. J Appl Physiol (1985) 2020; 130:283-289. [PMID: 33270516 DOI: 10.1152/japplphysiol.00786.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spaceflight-associated neuro-ocular syndrome (SANS) involves unilateral or bilateral optic disc edema, widening of the optic nerve sheath, and posterior globe flattening. Owing to posterior globe flattening, it is hypothesized that microgravity causes a disproportionate change in intracranial pressure (ICP) relative to intraocular pressure. Countermeasures capable of reducing ICP include thigh cuffs and breathing against inspiratory resistance. Owing to the coupling of central venous pressure (CVP) and intracranial pressure, we hypothesized that both ICP and CVP will be reduced during both countermeasures. In four male participants (32 ± 13 yr) who were previously implanted with Ommaya reservoirs for treatment of unrelated clinical conditions, ICP was measured invasively through these ports. Subjects were healthy at the time of testing. CVP was measured invasively by a peripherally inserted central catheter. Participants breathed through an impedance threshold device (ITD, -7 cmH2O) to generate negative intrathoracic pressure for 5 min, and subsequently, wore bilateral thigh cuffs inflated to 30 mmHg for 2 min. Breathing through an ITD reduced both CVP (6 ± 2 vs. 3 ± 1 mmHg; P = 0.02) and ICP (16 ± 3 vs. 12 ± 1 mmHg; P = 0.04) compared to baseline, a result that was not observed during the free breathing condition (CVP, 6 ± 2 vs. 6 ± 2 mmHg, P = 0.87; ICP, 15 ± 3 vs. 15 ± 4 mmHg, P = 0.68). Inflation of the thigh cuffs to 30 mmHg caused no meaningful reduction in CVP in all four individuals (5 ± 4 vs. 5 ± 4 mmHg; P = 0.1), coincident with minimal reduction in ICP (15 ± 3 vs. 14 ± 4 mmHg; P = 0.13). The application of inspiratory resistance breathing resulted in reductions in both ICP and CVP, likely due to intrathoracic unloading.NEW & NOTEWORTHY Spaceflight causes pathological changes in the eye that may be due to the absence of gravitational unloading of intracranial pressure (ICP) under microgravity conditions commonly referred to as spaceflight-associated neuro-ocular syndrome (SANS), whereby countermeasures aimed at lowering ICP are necessary. These data show that impedance threshold breathing acutely reduces ICP via a reduction in central venous pressure (CVP). Whereas, acute thigh cuff inflation, a popular known spaceflight-associated countermeasure, had little effect on ICP and CVP.
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Affiliation(s)
- Alexander B Hansen
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Justin S Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Caroline A Rickards
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Erin J Howden
- The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - William K Cornwell
- Division of Cardiology, Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sachin B Amin
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Hendrik Mugele
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Kyohei Marume
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Carmen Possnig
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | | | - Michael A Williams
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
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Alsop K, Baier W, Norman D, Burnett B, Williams MA. Accurate prediction of saw blade thicknesses from false start measurements. Forensic Sci Int 2020; 318:110602. [PMID: 33279765 DOI: 10.1016/j.forsciint.2020.110602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/18/2020] [Revised: 10/03/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND False start analysis is the examination of incomplete saw marks created on bone in an effort to establish information on the saw that created them. The present study aims to use quantitative data from micro-CT cross-sections to predict the thickness of the saw blade used to create the mark. Random forest statistical models are utilised for prediction to present a methodology that is useful to both forensic researchers and practitioners. METHOD 340 false starts were created on 32 fleshed cadaveric leg bones by 38 saws of various classes. False starts were micro-CT scanned and seven measurements taken digitally. A regression random forest model was produced from the measurement data of all saws to predict the saw blade thickness from false starts with an unknown class. A further model was created, consisting of three random forests, to predict the saw blade thickness when the class of the saw is known. The predictive capability of the models was tested using a second sample of data, consisting of measurements taken from a further 17 false starts created randomly selected saws from the 38 in the experiment. RESULTS Random forest models were able to accurately predict up to 100% of saw blade thicknesses for both samples of false starts. CONCLUSION This study demonstrates the applicability of random forest statistical regression models for reliable prediction of saw blade thicknesses from false start data. The methodology proposed enables prediction of saw blade thickness from empirical data and offers a significant step towards reduced subjectivity and database formation in false start analysis. Application of this methodology to false start analysis, with a more complete database, will allow complementary results to current analysis techniques to provide more information on the saw used in dismemberment casework.
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Affiliation(s)
- K Alsop
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, CV4 7AL, UK.
| | - W Baier
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, CV4 7AL, UK
| | - D Norman
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, CV4 7AL, UK
| | - B Burnett
- Anatomy & Surgical Training Centre Manager, UHCW NHS Trust, Coventry, CV2 2DX, UK
| | - M A Williams
- Forensic Centre for Digital Scanning and 3D Printing, WMG, University of Warwick, Coventry, CV4 7AL, UK
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21
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Smillie RW, Williams MA, Richard M, Cosker T. Producing three-dimensional printed models of the hepatobiliary system from computed tomography imaging data. Ann R Coll Surg Engl 2020; 103:41-46. [PMID: 32964727 DOI: 10.1308/rcsann.2020.0191] [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] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Macroscopic anatomy has traditionally been taught using cadaveric material, lectures and a variety of additional resources including online modules and anatomical models. Traditional plastic models are effective educational tools yet they have significant drawbacks such as a lack of anatomical detail, a lack of texturisation and cost. Three-dimensional printed models stand to solve these problems and widen access to high-quality anatomical teaching. This paper outlines the use of three-dimensional multiplanar imaging (computed tomography) in the development of an accurate model of the hepatobiliary system. MATERIALS AND METHODS Computed tomography scans were used to construct a virtual three-dimensional model of the hepatobiliary system. This was printed locally as a full-size colour model. We give a complete account of the process and software used. DISCUSSION This study is among the first of a series in which we will document the newly formed Oxford Library of Anatomy. This series will provide the methodology for the production of three-dimensional models from computed tomography and magnetic resonance imaging scans, and the library will provide a complete collection of the most complex anatomical areas. We hope that these models will form an important adjunct in teaching anatomy to medical students and surgical trainees.
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Affiliation(s)
- R W Smillie
- Department of Physiology, Anatomy and Genetics, Oxford, UK
| | - M A Williams
- Department of Physiology, Anatomy and Genetics, Oxford, UK
| | - M Richard
- 3D LifePrints, Nuffield Orthopaedic Centre, Oxford, UK
| | - T Cosker
- Department of Physiology, Anatomy and Genetics, Oxford, UK
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22
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Lawley JS, Babu G, Janssen SLJE, Petersen LG, Hearon CM, Dias KA, Sarma S, Williams MA, Whitworth LA, Levine BD. Daily generation of a footward fluid shift attenuates ocular changes associated with head-down tilt bed rest. J Appl Physiol (1985) 2020; 129:1220-1231. [PMID: 32940563 DOI: 10.1152/japplphysiol.00250.2020] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Astronauts have presented with a constellation of visual changes referred to as spaceflight-associated neuro-ocular syndrome (SANS). However, neither have early markers of microgravity-induced optic remodeling been fully identified nor have countermeasures been developed. To identify early markers of SANS, we studied 10 subjects with optical coherence tomography and ultrasonography when upright and supine and again after 24 h of 6° head-down tilt (HDT) bed rest. Upon acute transition from the upright to the supine position, choroid area (2.24 ± 0.53 to 2.28 ± 0.52 mm2, P = 0.001) and volume (9.51 ± 2.08 to 9.73 ± 2.08 mm3, P = 0.002) increased. After 24 h of HDT bed rest, subfoveal choroidal thickness (372 ± 93 to 381 ± 95 µm, P = 0.02), choroid area (2.25 ± 0.52 to 2.33 ± 0.54 mm2, P = 0.08), and volume (9.64 ± 2.03 to 9.82 ± 2.08 mm3, P = 0.08) increased relative to the supine position. Subsequently, seven subjects spent 3 days in -6°HDT bed rest to assess whether low-level lower body negative pressure (LBNP) could prevent the observed choroidal engorgement during bed rest. Maintaining the -6° HDT position for 3 days caused choroid area (Δ0.11 mm2, P = 0.05) and volume (Δ0.45 mm3, P = 0.003) to increase. When participants also spent 8 h daily under -20 mmHg LBNP, choroid volume still increased, but substantially (40%) less than in the control trial (Δ0.27 mm3, P = 0.05). Moreover, the increase in choroid area was diminished (Δ0.03 mm2, P = 0.13), indicating that low-level LBNP attenuates the choroid expansion associated with 3 days of -6° HDT bed rest. These data suggest that low-level LBNP may be an effective countermeasure for SANS.NEW & NOTEWORTHY Choroid measurements appear to be sensitive to changes in gravitational gradients, as well as periods of head-down tilt (HDT) bed rest, suggesting that they are potential indicators of early ocular remodeling and could serve to evaluate the efficacy of countermeasures for SANS. Eight hours of lower body negative pressure (LBNP) daily attenuates the choroid expansion associated with 3 days of strict -6° HDT bed rest, indicating that LBNP may be an effective countermeasure for SANS.
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Affiliation(s)
- Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas.,Division of Physiology, Department of Sports Science, University of Innsbruck, Innsbruck, Austria
| | - Gautam Babu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Lonnie G Petersen
- Department of Orthopedic Surgery, University of California San Diego, California
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A Williams
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington.,Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Nunn AC, Jones HE, Morosanu CO, Singleton WGB, Williams MA, Nagel SJ, Luciano MG, Zwimpfer TJ, Holubkov R, Wisoff JH, McKhann GM, Hamilton MG, Edwards RJ. Extended lumbar drainage in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis of diagnostic test accuracy. Br J Neurosurg 2020; 35:285-291. [PMID: 32643967 DOI: 10.1080/02688697.2020.1787948] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND When appropriately selected, a high proportion of patients with suspected idiopathic normal pressure hydrocephalus (iNPH) will respond to cerebrospinal fluid diversion with a shunt. Extended lumbar drainage (ELD) is regarded as the most accurate test for this condition, however, varying estimates of its accuracy are found in the current literature. Here, we review the literature in order to provide summary estimates of sensitivity, specificity, positive- and negative predictive value for this test through meta-analysis of suitably rigorous studies. METHODS Studies involving a population of NPH patients with predominantly idiopathic aetiology (>80%) in which the intention of the study was to shunt patients regardless of the outcome of ELD were included in the review. Various literature databases were searched to identify diagnostic test accuracy studies addressing ELD in the diagnosis of iNPH. Those studies passing screening and eligibility were assessed using the QUADAS-2 tool and data extracted for bivariate random effects meta-analysis. RESULTS Four small studies were identified. They showed disparate results concerning diagnostic test accuracy. The summary estimates for sensitivity and specificity were 94% (CI 41-100%) and 85% (CI 33-100%), respectively. The summary estimates of positive and negative predictive value were both 90% (CIs 65-100% and 48-100%, respectively). CONCLUSION Large, rigorous studies addressing the diagnostic accuracy of ELD are lacking, and little robust evidence exists to support the use of ELD in diagnostic algorithms for iNPH. Therefore, a large cohort study, or ideally an RCT, is needed to determine best practice in selecting patients for shunt surgery.
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Affiliation(s)
- Adam C Nunn
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Michael A Williams
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.,Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA
| | - Sean J Nagel
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Mark G Luciano
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas J Zwimpfer
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Richard Holubkov
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey H Wisoff
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Division of Pediatric Neurosurgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA
| | - Guy M McKhann
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Department of Neurological Surgery, Columbia University School of Medicine, New York, NY, USA
| | - Mark G Hamilton
- Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA.,Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary School of Medicine, Calgary, Canada
| | - Richard J Edwards
- Department of Neurosurgery, Southmead Hospital, Bristol, UK.,Adult Hydrocephalus Clinical Research Network, Hydrocephalus Association, Bethesda, MD, USA
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24
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Jennings JM, Mejia M, Williams MA, Johnson RM, Yang CC, Dennis DA. The James A. Rand Young Investigator's Award: Traditional Intravenous Fluid vs. Oral Fluid Administration in Primary Total Knee Arthroplasty: A Randomized Trial. J Arthroplasty 2020; 35:S3-S9. [PMID: 32037213 DOI: 10.1016/j.arth.2020.01.029] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Optimal perioperative fluid management has not been established in patients undergoing orthopedic surgical procedures. Our purpose was to investigate the effects of perioperative fluid management (ie, preoperative, intraoperative, and postoperative) on patients undergoing total knee arthroplasty (TKA). METHODS One hundred thirty patients who met inclusion criteria undergoing primary unilateral TKA were prospectively randomized into traditional (TFG) vs oral (OFG) perioperative fluid management groups. The primary outcome was change in body weight (BW). Secondary outcome measures included knee motion, leg girth, bioelectrical impendence, quadriceps activation, functional outcomes testing, Knee injury and Osteoarthritis Outcome Score JR, VR-12, laboratory values, vital signs, patient satisfaction, pain scores, and adverse events. RESULTS The TFG had increased BW the evening of surgery (7.0 ± 4.3 vs 3.0 ± 3.9, P < .0001), postoperative day (POD) #1 (9.1 ± 4.3 vs 4.7 ± 3.9, P < .0001), and POD #2 (6.2 ± 5.0 vs 4.4 ± 4.0, P = .032). Bioelectrical impedance showed less limb edema in the OFG (4.2 ± 29.7 vs 17.8 ± 30.3, P < .0001) on POD #1. Urine specific gravity differences were seen preoperatively between groups (OFG, more hydrated, P = .002). Systolic blood pressure decrease from the baseline was greater in the OFG on arrival to the floor (19.4 ± 13.5 vs 10.6 ± 12.8, P < .0001) and 8 (23.4 ± 13.3 vs 17.0 ± 12.9, P = .006) and 16 (25.8 ± 13.8 vs 25.8 ± 13.8, P = .046) hours after floor arrival. The TFG had more urine output on POD #1 (3369 mL ± 1343 mL vs 2435 mL ± 1151 mL, P < .0001). The OFG were more likely to go home on POD #1 than the TFG (63 vs 56, P = .02). CONCLUSION Oral fluid intake with IVF restriction in the perioperative period after TKA may offer short-term benefits with swelling and BW fluctuations. The authors continue to limit perioperative IVFs and encourage patient initiated fluid intake.
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Affiliation(s)
- Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO
| | | | | | | | - Charlie C Yang
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
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25
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Williams MA, Nagel SJ, Luciano MG, Relkin N, Zwimpfer TJ, Katzen H, Holubkov R, Moghekar A, Wisoff JH, McKhann GM, Golomb J, Edwards RJ, Hamilton MG. The clinical spectrum of hydrocephalus in adults: report of the first 517 patients of the Adult Hydrocephalus Clinical Research Network registry. J Neurosurg 2020; 132:1773-1784. [DOI: 10.3171/2019.2.jns183538] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors describe the demographics and clinical characteristics of the first 517 patients enrolled in the Adult Hydrocephalus Clinical Research Network (AHCRN) during its first 2 years.METHODSAdults ≥ 18 years were nonconsecutively enrolled in a registry at 6 centers. Four categories of adult hydrocephalus were defined: transition (treated before age 18 years), unrecognized congenital (congenital pattern, not treated before age 18 years), acquired (secondary to known risk factors, treated or untreated), and suspected idiopathic normal pressure hydrocephalus (iNPH) (≥ age 65 years, not previously treated). Data include etiology, symptoms, examination findings, neuropsychology screening, comorbidities, treatment, complications, and outcomes. Standard evaluations were administered to all patients by trained examiners, including the Montreal Cognitive Assessment, the Symbol Digit Modalities Test, the Beck Depression Inventory–II, the Overactive Bladder Questionnaire Short Form symptom bother, the 10-Meter Walk Test, the Boon iNPH gait scale, the Lawton Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) questionnaire, the iNPH grading scale, and the modified Rankin Scale.RESULTSOverall, 517 individuals were enrolled. Age ranged from 18.1 to 90.7 years, with patients in the transition group (32.7 ± 10.0 years) being the youngest and those in the suspected iNPH group (76.5 ± 5.2 years) being the oldest. The proportion of patients in each group was as follows: 16.6% transition, 26.5% unrecognized congenital, 18.2% acquired, and 38.7% suspected iNPH. Excluding the 86 patients in the transition group, who all had received treatment, 79.4% of adults in the remaining 3 groups had not been treated at the time of enrollment. Patients in the suspected iNPH group had the poorest performance in cognitive evaluations, and those in the unrecognized congenital group had the best performance. The same pattern was seen in the Lawton ADL/IADL scores. Gait velocity was lowest in patients in the suspected iNPH group. Categories that had the most comorbidities (suspected iNPH) or etiologies of hydrocephalus that directly cause neurological injury (transition, acquired) had greater degrees of impairment compared to unrecognized congenital, which had the fewest comorbidities or etiologies associated with neurological injury.CONCLUSIONSThe clinical spectrum of hydrocephalus in adults comprises more than iNPH or acquired hydrocephalus. Only 39% of patients had suspected iNPH, whereas 43% had childhood onset (i.e., those in the transition and unrecognized congenital groups). The severity of symptoms and impairment was worsened when the etiology of the hydrocephalus or complications of treatment caused additional neurological injury or when multiple comorbidities were present. However, more than half of patients in the transition, unrecognized congenital, and acquired hydrocephalus groups had minimal or no impairment. Excluding the transition group, nearly 80% of patients in the AHCRN registry were untreated at the time of enrollment. A future goal for the AHCRN is to determine whether patients with unrecognized congenital and acquired hydrocephalus need treatment and which patients in the suspected iNPH cohort actually have possible hydrocephalus and should undergo further diagnostic testing. Future prospective research is needed in the diagnosis, treatment, outcomes, quality of life, and macroeconomics of all categories of adult hydrocephalus.
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Affiliation(s)
- Michael A. Williams
- 1Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Sean J. Nagel
- 2Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Mark G. Luciano
- 3Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Norman Relkin
- 4Department of Neurology, Weill Cornell School of Medicine, New York, New York
| | - Thomas J. Zwimpfer
- 5Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Katzen
- 6Department of Neurology, University of Miami Miller School of Medicine, Florida
| | - Richard Holubkov
- 7Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Abhay Moghekar
- 8Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeffrey H. Wisoff
- 9Division of Pediatric Neurosurgery, Hassenfeld Children’s Hospital at NYU Langone Health
| | - Guy M. McKhann
- 10Department of Neurological Surgery, Columbia University School of Medicine
| | - James Golomb
- 11Department of Neurology, New York University School of Medicine, New York, New York,
| | - Richard J. Edwards
- 12Department of Neurosurgery, Southmead Hospital, Bristol, United Kingdom; and
| | - Mark G. Hamilton
- 13Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary School of Medicine, Calgary, Alberta, Canada
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26
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Russell JA, Epstein LG, Bonnie RJ, Conwit R, Graf WD, Kirschen M, Kurek JA, Larriviere DG, Pascuzzi RM, Rizzo M, Sattin JA, Simmons Z, Taylor L, Williams MA. In defense of the AAN position on lawful physician-hastened death. Neurology 2020; 94:641-643. [PMID: 32179699 DOI: 10.1212/wnl.0000000000009237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- James A Russell
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle.
| | - Leon G Epstein
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Richard J Bonnie
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Robin Conwit
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - William D Graf
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Matthew Kirschen
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Julie A Kurek
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Daniel G Larriviere
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Robert M Pascuzzi
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Matthew Rizzo
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Justin A Sattin
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Zachary Simmons
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Lynne Taylor
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
| | - Michael A Williams
- From the Division of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H. Lurie Children's Hospital of Chicago, IL; University of Virginia School of Law (R.J.B.), Charlottesville; Neurosciences Center (R.C.), NIH, Bethesda, MD; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Inova Neuroscience and Spine Institute (D.G.L.), Falls Church, VA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center, PA; Departments of Neurology and Neurologic Surgery and Seattle Cancer Care Alliance (L.T.), UW Medicine; and Departments of Neurology and Neurological Surgery (M.A.W.), University of Washington Medical Center, Seattle
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Provence MA, Wahler EA, Helling J, Williams MA. Self-Reported Psychosocial Needs of Public Library Patrons: Comparisons Based on Housing Status. Public Library Quarterly 2020. [DOI: 10.1080/01616846.2020.1730738] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mary A. Provence
- Indiana University School of Social Work, Indianapolis, Indiana, USA
| | | | - John Helling
- Indianapolis Public Library, Library Services Center, Indianapolis, Indiana, USA
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Rocque BG, Weprin BE, Blount JP, Hopson BD, Drake JM, Hamilton MG, Williams MA, White PH, Orrico KO, Martin JE. Health care transition in pediatric neurosurgery: a consensus statement from the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr 2020; 25:1-9. [PMID: 32059192 DOI: 10.3171/2019.12.peds19524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The number of children with complex medical conditions surviving to adulthood is increasing. A planned transition to adult care systems is essential to the health maintenance of these patients. Guidance has been established for the general health care transition (HCT) from adolescence to adulthood. No formal assessment of the performance of pediatric neurosurgeons in HCT has been previously performed. No "best practice" for this process in pediatric neurosurgery currently exists. The authors pursued two goals in this paper: 1) define the current state of HCT in pediatric neurosurgery through a survey of the membership of the American Society of Pediatric Neurosurgeons (ASPN) on current methods of HCT, and 2) develop leadership-endorsed best-practice guidelines for HCT from pediatric to adult neurosurgical health care. METHODS Completion of the Current Assessment of Health Care Transition Activities survey was requested of 178 North American pediatric neurosurgeons by using a web-based questionnaire to capture HCT practices of the ASPN membership. The authors concurrently conducted a PubMed/MEDLINE-based literature review of HCT for young adults with special health care needs, surgical conditions, and/or neurological conditions for the period from 1990 to 2018. Selected articles were assembled and reviewed by subject matter experts and members of the ASPN Quality, Safety, and Advocacy Committee. Best-practice recommendations were developed and subjected to peer review by external expert groups. RESULTS Seventy-six responses to the survey (43%) were received, and 62 respondents (82%) answered all 12 questions. Scores of 1 (lowest possible score) were recorded by nearly 60% of respondents on transition policy, by almost 70% on transition tracking, by 85% on transition readiness, by at least 40% on transition planning as well as transfer of care, and by 53% on transition completion. Average responses on all core elements were < 2 on the established 4-point scale. Seven best-practice recommendations were developed and endorsed by the ASPN leadership. CONCLUSIONS The majority of pediatric neurosurgeons have transition practices that are poor, do not meet the needs of patients and families, and should be improved. A structured approach to transition, local engagement with adult neurosurgical providers, and national partnerships between pediatric and adult neurosurgery organizations are suggested to address current gaps in HCT for patients served by pediatric neurosurgeons.
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Affiliation(s)
- Brandon G Rocque
- 1Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Bradley E Weprin
- 2Department of Pediatric Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey P Blount
- 1Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Betsy D Hopson
- 1Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - James M Drake
- 3Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark G Hamilton
- 4Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Michael A Williams
- Departments of5Neurology and
- 6Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Patience H White
- 7The National Alliance to Advance Adolescent Health and Got Transition, Washington, DC
| | - Katie O Orrico
- 8American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Office, Washington, DC; and
| | - Jonathan E Martin
- 9Department of Surgery, Division of Neurosurgery, Connecticut Children's Medical Center, Hartford, Connecticut
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Palit A, King R, Gu Y, Pierrepont J, Hart Z, Elliott MT, Williams MA. Prediction and Visualisation of Bony Impingement for Subject Specific Total Hip Arthroplasty .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2127-2131. [PMID: 31946321 DOI: 10.1109/embc.2019.8857861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Bony impingement (BI) may contribute to restricted hip joint motion, and recurrent dislocation after total hip arthroplasty (THA), and therefore, should be avoided where possible. However, BI risk assessment is generally performed intra-operatively by surgeons, which is partially subjective and qualitative. Therefore, the aim of the study was to develop a method for identifying subject-specific BI, and subsequently, visualising BI area on native bone anatomy to highlight the amount of bone should be resected. Activity definitions and subject-specific bone geometries, constructed from CT scans, with planned implants were used as inputs for the method. For each activity, a conical clearance angle (CCA) was checked between femur and pelvis through simulation. Simultaneously, BI boundary and area were automatically calculated using ray intersection and region growing algorithm respectively. The potential use of the developed method was explained through a case study using an anonymised pre-THA patient data. Two pure (flexion, and extension) and two combined hip joint motions (internal and external rotation at flexion and extension respectively) were considered as activities. BI area were represented in two ways: (a) CCA specific where BI area for each activity with different CCAs was highlighted, (b) activity specific where BI area for all activities with a particular CCA was presented. Result showed that BI area between the femoral and pelvic parts was clearly identified so that the pre-operative surgical plan could be adjusted to minimise impingement. Therefore, this method could potentially be used to examine the effect of different preoperative plans and hip motion on BI, and to guide bony resection during THA surgery.
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Gelaye B, Kirschbaum C, Zhong QY, Sanchez SE, Rondon MB, Koenen KC, Williams MA. Chronic HPA activity in mothers with preterm delivery: A pilot nested case-control study. J Neonatal Perinatal Med 2020; 13:313-321. [PMID: 31744018 DOI: 10.3233/npm-180139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic hypothalamic-pituitary-adrenal (HPA) axis activity role in the pathogenesis of preterm birth (PTB) remains unclear due to inconsistent measures with limited ability to monitor long-term cortisol concentrations. We explored this relationship using the novel method of assessing cortisol in hair, which is a valid and reliable measure of chronic HPA axis activity. METHODS 137 participants (40 PTB cases and 97 controls from a birth cohort of pregnant women in Peru) were interviewed and invited to provide a 9-cm hair sample from the posterior vertex position of the scalp (mean = 13 weeks gestation). Hair cortisol concentration (HCC) was determined using luminescence immunoassay and values were natural-log transformed. PTB cases were defined as women who delivered before 37 gestational weeks. Case-control differences were assessed using multivariable linear and logistic regressions. RESULTS Overall, combined pre-conception and first-trimester HCC was 13% lower among cases as compared with controls (p-value = 0.01). Compared with controls, maternal HCC among PTB cases were 14% (p = 0.11), 10% (p = 0.22) and 14% (p = 0.08) lower for 3-6 months pre-conception, 0-3 months pre-conception, and first trimester, respectively. After adjusting for putative confounders, a 1-unit increase in HCC was associated with 55% reduced odds of PTB (aOR = 0.45; 95% CI: 0.17-1.17). For a 1-unit increase in HCC in the scalp-intermediate and scalp-distal segments (representing HCC concentrations in 0-3 months pre-conception and first trimester), the corresponding odds for PTB were 0.53 (95% CI: 0.19-1.48) and 0.39 (95% CI: 0.13-1.13), respectively. CONCLUSIONS Women who deliver preterm, as compared with those who deliver at term, have lower preconception and first trimester HCC. Our findings suggest that HPA axis activation, integral to the adaptive stress-response system, may be chronically dysregulated in women at increased risk of PTB.
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Affiliation(s)
- B Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - C Kirschbaum
- Technische Universität Dresden, Dresden, Germany
| | - Q Y Zhong
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - S E Sanchez
- Universidad San Martin de Porres, Lima, Peru
- Asociación Civil PROESA, Lima, Peru
| | - M B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru Instituto Nacional Materno Perinatal, Lima, Peru
| | - K C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - M A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Abstract
PURPOSE OF REVIEW Idiopathic normal pressure hydrocephalus (iNPH) is a surgically treatable neurological disorder of the elderly population that is characterized by abnormal ventricular enlargement due to cerebrospinal fluid (CSF) accumulation and gait disturbance, cognitive impairment, or urinary incontinence. The objective of this review is to present the current diagnostic and treatment approaches for iNPH and to discuss some of the postoperative modalities that complement positive surgical outcomes. RECENT FINDINGS Although historically reported patient outcomes following iNPH surgery were dismal and highly variable, recent advances in terms of better understanding of the iNPH disease process, better standardization of iNPH diagnostic and treatment processes arising from the adoption of clinical guidelines for diagnosis, treatment and in research methodologies, and availability of long-term follow-up data, have helped reduce the variations to a much improved 73 to 96% reported good outcomes. With careful evaluation, good patient selection, and advanced surgical techniques, iNPH can be surgically treated to return patients close to their pre-iNPH functional status. Institution of an interdisciplinary effort to rehabilitate patients following surgery may help augment their recovery.
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Affiliation(s)
- Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA.,Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Williams
- Adult and Transitional Hydrocephalus and CSF Disorders, Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark G Hamilton
- Division of Neurosurgery, Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada. .,Adult Hydrocephalus Program, Department of Clinical Neuroscience, University of Calgary, Foothills Medical Centre - 12th Floor, Neurosurgery, 1403 - 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
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Browne D, Williams MA, Maxwell AP, McGuinness B, Passmore P, Silvestri G, Woodside JV, McKay GJ. Serum xanthophyll carotenoids are associated with estimated glomerular filtration rate in an aged cohort. Sci Rep 2019; 9:17068. [PMID: 31745176 PMCID: PMC6864050 DOI: 10.1038/s41598-019-53674-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
Progressive renal decline is associated with increasing oxidative stress. However, the majority of studies have investigated endogenous antioxidants in predominantly advanced stages of kidney disease. Many traditional risk factors associated with renal dysfunction have been linked with cognitive decline as the kidneys and brain share comparable anatomic and haemodynamic characteristics that leave them susceptible to common pathogenic mechanisms. The objective of this study was to examine serum dietary antioxidants and their association with renal function characterised by estimated glomerular filtration rate (eGFR) in a cross-sectional analysis of 570 participants. High performance liquid chromatography quantified serum levels of retinol, α-tocopherol, γ-tocopherol and six carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene and zeaxanthin) in participants. Multiple regression analyses were used to evaluate associations while adjusting for potential confounders. A sensitivity analysis was performed in cognitively-intact participants only. Serum levels of the xanthophyll carotenoid lutein were positively associated with eGFR in analyses adjusted for age (years), gender, smoking, APOE4 status and Alzheimer’s disease. Retinol was inversely associated with eGFR, although was no longer significant in the smaller sensitivity analysis. Our findings identify significant associations between the xanthophyll carotenoids and eGFR. Further investigations are required to confirm these findings.
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Affiliation(s)
- Declan Browne
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael A Williams
- Centre for Medical Education, Queen's University of Belfast, Belfast, UK
| | | | | | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giuliana Silvestri
- Centre for Experimental Medicine, Queen's University of Belfast, Belfast, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
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Affiliation(s)
- Michael A. Williams
- Adult & Transitional Hydrocephalus, Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle
| | - Jan Malm
- Umeå Hydrocephalus Research Group, Department of Clinical Neuroscience, University of Umeå, Umeå, Sweden
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Gray CF, Quill S, Compton M, McAvoy CE, Williams MA. Epidemiology of Adult Uveitis in a Northern Ireland Tertiary Referral Centre. Ulster Med J 2019; 88:170-173. [PMID: 31619852 PMCID: PMC6790633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/03/2022]
Abstract
Uveitis is inflammation of the middle layer of the eye, called the uveal tract. It can be classified by anatomic location of the focus of inflammation inside the eye: intermediate, posterior or pan-uveitis. These types are less common than anterior uveitis (iritis), but more often have underlying aetiologies that require identification. Some aetiologies are infective, while others require systemic immunosuppression. Underlying aetiologies vary in different regions in the world, and so local data is important to guide clinicians. This study describes the aetiology of 255 cases of intermediate, posterior and pan-uveitis in adults. The most common non-infectious causes, after idiopathic, were sarcoid, Birdshot chorioretinopathy, demyelination-related and Behçet's, whereas toxoplasmosis and herpes simplex and zoster related retinitis were the common infectious causes. Neither age nor sex of the patient were related to aetiology.
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Affiliation(s)
- CF Gray
- Northern Ireland Medical and Dental Training Agency
| | - S Quill
- School of Medicine, National University of Ireland, Galway
| | - M Compton
- Department of Ophthalmology, Belfast Health and Social Care Trust
| | - CE McAvoy
- Department of Ophthalmology, Belfast Health and Social Care Trust
| | - MA Williams
- Department of Ophthalmology, Belfast Health and Social Care Trust,Centre for Medical Education, Queen’s University of Belfast,Corresponding author: Dr Michael Williams E-mail:
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Monaghan MT, Steenson C, Williams MA. Re: Understanding quality of life impact in people with retinal vein occlusion: a qualitative inquiry. Clin Exp Optom 2019; 102:536. [PMID: 31018248 PMCID: PMC6767443 DOI: 10.1111/cxo.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Claire Steenson
- Northern Ireland Medical and Dental Training Agency, Belfast, UK
| | - Michael A Williams
- School of Medicine, Dentistry and Biomedical Science, Queen's University of Belfast, Belfast, UK
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Petersen LG, Lawley JS, Lilja-Cyron A, Petersen JCG, Howden EJ, Sarma S, Cornwell WK, Zhang R, Whitworth LA, Williams MA, Juhler M, Levine BD. Lower body negative pressure to safely reduce intracranial pressure. J Physiol 2018; 597:237-248. [PMID: 30286250 DOI: 10.1113/jp276557] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 05/25/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022] Open
Abstract
KEY POINTS During long-term missions, some astronauts experience structural and functional changes of the eyes and brain which resemble signs/symptoms experienced by patients with intracranial hypertension. Weightlessness prevents the normal cerebral volume and pressure 'unloading' associated with upright postures on Earth, which may be part of the cerebral and ocular pathophysiology. By placing the lower body in a negative pressure device (LBNP) that pulls fluid away from cranial compartments, we simulated effects of gravity and significantly lowered pressure within the brain parenchyma and ventricle compartments. Application of incremental LBNP demonstrated a non-linear dose-response curve, suggesting 20 mmHg LBNP as the optimal level for reducing pressure in the brain without impairing cerebral perfusion pressure. This non-invasive method of reducing pressure in the brain holds potential as a countermeasure in space as well as having treatment potential for patients on Earth with traumatic brain injury or other pathology leading to intracranial hypertension. ABSTRACT Patients with elevated intracranial pressure (ICP) exhibit neuro-ocular symptoms including headache, papilloedema and loss of vision. Some of these symptoms are also present in astronauts during and after prolonged space-flight where lack of gravitational stress prevents daily lowering of ICP associated with upright posture. Lower body negative pressure (LBNP) simulates the effects of gravity by displacing fluid caudally and we hypothesized that LBNP would lower ICP without compromising cerebral perfusion. Ten cerebrally intact volunteers were included: six ambulatory neurosurgical patients with parenchymal ICP-sensors and four former cancer patients with Ommaya-reservoirs to the frontal horn of a lateral ventricle. We applied LBNP while recording ICP and blood pressure while supine, and during simulated intracranial hypertension by 15° head-down tilt. LBNP from 0 to 50 mmHg at increments of 10 mmHg lowered ICP in a non-linear dose-dependent fashion; when supine (n = 10), ICP was decreased from 15 ± 2 mmHg to 14 ± 4, 12 ± 5, 11 ± 4, 10 ± 3 and 9 ± 4 mmHg, respectively (P < 0.0001). Cerebral perfusion pressure (CPP), calculated as mean arterial blood pressure at midbrain level minus ICP, was unchanged (from 70 ± 12 mmHg to 67 ± 9, 69 ± 10, 70 ± 12, 72 ± 13 and 74 ± 15 mmHg; P = 0.02). A 15° head-down tilt (n = 6) increased ICP to 26 ± 4 mmHg, while application of LBNP lowered ICP (to 21 ± 4, 20 ± 4, 18 ± 4, 17 ± 4 and 17 ± 4 mmHg; P < 0.0001) and increased CPP (P < 0.01). An LBNP of 20 mmHg may be the optimal level to lower ICP without impairing CPP to counteract spaceflight-associated neuro-ocular syndrome in astronauts. Furthermore, LBNP holds clinical potential as a safe, non-invasive method for lowering ICP and improving CPP for patients with pathologically elevated ICP on Earth.
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Affiliation(s)
- Lonnie G Petersen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA.,Institut für Sportwissenschaft, Universität Innsbruck, Innsbruck, Austria
| | | | - Johan C G Petersen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Erin J Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William K Cornwell
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,Department of Internal Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michael A Williams
- University of Washington School of Medicine, Departments of Neurology and Neurological Surgery, Seattle, WA, USA
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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Williams MA, van der Willigen T, White PH, Cartwright CC, Wood DL, Hamilton MG. Improving health care transition and longitudinal care for adolescents and young adults with hydrocephalus: report from the Hydrocephalus Association Transition Summit. J Neurosurg 2018; 131:1-9. [PMID: 30497160 DOI: 10.3171/2018.6.jns188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/27/2018] [Indexed: 11/06/2022]
Abstract
The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000-6000 adolescents and young adults (collectively, youth) with hydrocephalus must move to the adult health care system, a process known as health care transition (HCT), for which many are not prepared. Many discover that they cannot find neurosurgeons to care for them. A significant gap in health care services exists for young adults with hydrocephalus. To address these issues, the Hydrocephalus Association convened a Transition Summit in Seattle, Washington, February 17-18, 2017.The Hydrocephalus Association surveyed youth and families in focus groups to identify common concerns with HCT that were used to identify topics for the summit. Seven plenary sessions consisted of formal presentations. Four breakout groups identified key priorities and recommended actions regarding HCT models and practices, to prepare and engage patients, educate health care professionals, and address payment issues. The breakout group results were discussed by all participants to generate consensus recommendations.Barriers to effective HCT included difficulty finding adult neurosurgeons to accept young adults with hydrocephalus into their practices; unfamiliarity of neurologists, primary care providers, and other health care professionals with the principles of care for patients with hydrocephalus; insufficient infrastructure and processes to provide effective HCT for youth, and longitudinal care for adults with hydrocephalus; and inadequate compensation for health care services.Best practices were identified, including the National Center for Health Care Transition Improvement's "Six Core Elements of Health Care Transition 2.0"; development of hydrocephalus-specific transition programs or incorporation of hydrocephalus into existing general HCT programs; and development of specialty centers for longitudinal care of adults with hydrocephalus.The lack of formal HCT and longitudinal care for young adults with hydrocephalus is a significant health care services problem in the US and Canada that professional societies in neurosurgery and neurology must address. Consensus recommendations of the Hydrocephalus Association Transition Summit address 1) actions by hospitals, health systems, and practices to meet local community needs to improve processes and infrastructure for HCT services and longitudinal care; and 2) actions by professional societies in adult and pediatric neurosurgery and neurology to meet national needs to improve processes and infrastructure for HCT services; to improve training in medical and surgical management of hydrocephalus and in HCT and longitudinal care; and to demonstrate the outcomes and effectiveness of HCT and longitudinal care by promoting research funding.
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Affiliation(s)
- Michael A Williams
- 1Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Patience H White
- 3The National Alliance to Advance Adolescent Health, Washington, DC
| | - Cathy C Cartwright
- 4Department of Neurosurgery, Children's Mercy Hospital, Kansas City, Missouri
| | - David L Wood
- 5Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee; and
| | - Mark G Hamilton
- 6Department of Neurosurgery, University of Calgary School of Medicine, Calgary, Alberta, Canada
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Williams MA, Luciano MG, Nagel SJ, Relkin N, Zwimpfer TJ, Katzen H, Holubkov R, Hamilton MG. 357 Demographics and Characteristics of Hydrocephalus in Adults. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paterson EN, Williams MA, Passmore P, Silvestri G, MacGillivray TJ, Maxwell AP, McKay GJ. Estimated Glomerular Filtration Rate is not Associated with Alzheimer's Disease in a Northern Ireland Cohort. J Alzheimers Dis 2018; 60:1379-1385. [PMID: 29036821 DOI: 10.3233/jad-170480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) prevalence is increasing globally and typically progresses for several years prior to clinical presentation of dementia. Renal dysfunction and vascular disease have been reported in association with dementia in several cross-sectional and longitudinal studies, and may contribute to AD risk. Experimental and observational studies suggest amyloid-β (Aβ) clearance may be impaired in chronic kidney disease (CKD) indicating a mechanism for increased AD risk. OBJECTIVE The objective of this study was to compare estimated glomerular filtration rate (eGFR) between individuals with AD and cognitively intact controls, controlling for potential confounding factors. METHODS A cross-sectional, case-control study was carried out in 317 cognitively normal participants and 253 cases with a clinical diagnosis of AD in a UK tertiary care dementia clinic. Associations were considered using logistic regression adjusting for confounding variables (age, APOEɛ4 genotype, systolic blood pressure, education (left school at 14), and smoking status). RESULTS AD cases were older than cognitively intact controls, had lower MMSE scores, were more likely to have at least one APOEɛ4 allele, had higher rates of smoking, were more likely to be taking aspirin and/or clopidogrel, and had lower blood pressure. We found no significant association between eGFR and AD both before and following adjustment for appropriate confounders. CONCLUSION This study failed to find an association between eGFR and AD in a cross-sectional sample study of elderly white individuals.
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Affiliation(s)
- Euan N Paterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Michael A Williams
- Centre for Medical Education, Queen's University of Belfast, Belfast, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giuliana Silvestri
- Centre for Experimental Medicine, Queen's University of Belfast, and Belfast Health and Social Care Trust, Belfast, UK
| | - Tom J MacGillivray
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Russell JA, Epstein LG, Bonnie RJ, Conwit R, Graf WD, Kirschen M, Kurek JA, Larriviere DG, Pascuzzi RM, Rizzo M, Sattin JA, Simmons Z, Taylor L, Tsou A, Williams MA. Lawful physician-hastened death: AAN position statement. Neurology 2018; 90:420-422. [PMID: 29483313 PMCID: PMC5837869 DOI: 10.1212/wnl.0000000000005012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/08/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- James A Russell
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA.
| | - Leon G Epstein
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Richard J Bonnie
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Robin Conwit
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - William D Graf
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Matthew Kirschen
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Julie A Kurek
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Daniel G Larriviere
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Robert M Pascuzzi
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Matthew Rizzo
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Justin A Sattin
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Zachary Simmons
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Lynne Taylor
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Amy Tsou
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
| | - Michael A Williams
- From the Department of Neurology (J.A.R.), Lahey Hospital and Medical Center, Burlington, MA; Neurology Division (L.G.E.), Ann & Robert H Lurie Children's Hospital of Chicago, IL; Harrison Foundation Prof. of Law and Medicine (R.J.B.), University of Virginia School of Law, Charlottesville; Neurosciences Center (R.C.), National Institutes of Health, Bethesda, MA; Department of Neurology (W.D.G.), Connecticut Children's Medical Center, Hartford; Department of Neurology (M.K.), The Children's Hospital of Philadelphia, PA; Department of Neurology (J.A.K.), Augusta University at the Medical College of Georgia; Department of Neurology, (D.G.L.), Ochsner Medical Center, Jefferson, LA; Department of Neurology (R.M.P.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.R.), University of Nebraska Medical Center, Omaha; Department of Neurology (J.A.S.), University of Wisconsin School of Medicine and Public Health, Madison; Department of Neurology (Z.S.), Penn State Hershey Medical Center; Alvord Brain Tumor Center (L.T.) and Department of Neurology (M.A.W.), University of Washington Medical Center, Seattle; and Emergency Care Research Institute (A.T.), Philadelphia, PA
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Williams MA, Shute C, Wright S. Comments on ‘Treatment patterns of ranibizumab intravitreal injection and dexamethasone intravitreal implant for retinal vein occlusion in the USA’. Eye (Lond) 2018; 32:468-469. [DOI: 10.1038/eye.2017.178] [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: 11/09/2022] Open
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Lawley JS, Petersen LG, Howden EJ, Sarma S, Cornwell WK, Zhang R, Whitworth LA, Williams MA, Levine BD. Effect of gravity and microgravity on intracranial pressure. J Physiol 2017; 595:2115-2127. [PMID: 28092926 DOI: 10.1113/jp273557] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [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: 10/01/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Astronauts have recently been discovered to have impaired vision, with a presentation that resembles syndromes of elevated intracranial pressure on Earth. Gravity has a profound effect on fluid distribution and pressure within the human circulation. In contrast to prevailing theory, we observed that microgravity reduces central venous and intracranial pressure. This being said, intracranial pressure is not reduced to the levels observed in the 90 deg seated upright posture on Earth. Thus, over 24 h in zero gravity, pressure in the brain is slightly above that observed on Earth, which may explain remodelling of the eye in astronauts. ABSTRACT Astronauts have recently been discovered to have impaired vision, with a presentation that resembles syndromes of elevated intracranial pressure (ICP). This syndrome is considered the most mission-critical medical problem identified in the past decade of manned spaceflight. We recruited five men and three women who had an Ommaya reservoir inserted for the delivery of prophylactic CNS chemotherapy, but were free of their malignant disease for at least 1 year. ICP was assessed by placing a fluid-filled 25 gauge butterfly needle into the Ommaya reservoir. Subjects were studied in the upright and supine position, during acute zero gravity (parabolic flight) and prolonged simulated microgravity (6 deg head-down tilt bedrest). ICP was lower when seated in the 90 deg upright posture compared to lying supine (seated, 4 ± 1 vs. supine, 15 ± 2 mmHg). Whilst lying in the supine posture, central venous pressure (supine, 7 ± 3 vs. microgravity, 4 ± 2 mmHg) and ICP (supine, 17 ± 2 vs. microgravity, 13 ± 2 mmHg) were reduced in acute zero gravity, although not to the levels observed in the 90 deg seated upright posture on Earth. Prolonged periods of simulated microgravity did not cause progressive elevations in ICP (supine, 15 ± 2 vs. 24 h head-down tilt, 15 ± 4 mmHg). Complete removal of gravity does not pathologically elevate ICP but does prevent the normal lowering of ICP when upright. These findings suggest the human brain is protected by the daily circadian cycles in regional ICPs, without which pathology may occur.
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Affiliation(s)
- Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lonnie G Petersen
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Erin J Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William K Cornwell
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Louis A Whitworth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA
| | - Michael A Williams
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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Abstract
PURPOSE OF REVIEW This article provides neurologists with a pragmatic approach to the diagnosis and treatment of idiopathic normal pressure hydrocephalus (iNPH), including an overview of: (1) key symptoms and examination and radiologic findings; (2) use of appropriate tests to determine the patient's likelihood of shunt responsiveness; (3) appropriate referral to tertiary centers with expertise in complex iNPH; and (4) the contribution of neurologists to the care of patients with iNPH following shunt surgery. RECENT FINDINGS The prevalence of iNPH is higher than previously estimated; however, only a fraction of persons with the disorder receive shunt surgery. iNPH should be considered as a diagnosis for patients with unexplained symmetric gait disturbance, a frontal-subcortical pattern of cognitive impairment, and urinary urge incontinence, whose MRI scans show enlarged ventricles and whose comorbidities are not sufficient to explain their symptoms. Physiologically based tests, such as the tap test (large-volume lumbar puncture) or temporary spinal catheter insertion for external lumbar drainage with gait testing before and after CSF removal, or CSF infusion testing for measurement of CSF outflow resistance, can reliably identify patients who are likely to respond to shunt surgery. Properly selected patients have an 80% to 90% chance of responding to shunt surgery, and all symptoms can improve following shunt surgery. Longitudinal care involves investigating the differential diagnosis of any symptoms that either fail to respond to shunt surgery or that worsen after initial improvement from shunt surgery. SUMMARY Neurologists play an important role in the identification of patients who should be evaluated for possible iNPH. With contemporary diagnostic tests and treatment with programmable shunts, the benefit-to-risk ratio of shunt surgery is highly favorable. For more complex patients, tertiary centers with expertise in complex iNPH are available throughout the world.
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Osorio-Yañez C, Gelaye B, Miller RS, Enquobahrie DA, Baccarelli AA, Qiu C, Williams MA. Associations of Maternal Urinary Cadmium with Trimester-Specific Blood Pressure in Pregnancy: Role of Dietary Intake of Micronutrients. Biol Trace Elem Res 2016; 174:71-81. [PMID: 27129315 PMCID: PMC6601343 DOI: 10.1007/s12011-016-0705-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
Previous studies revealed associations of urinary Cd (U-Cd), a chronic Cd exposure biomarker, with blood pressure (BP) in non-pregnant adults. However, the evidence regarding trimester-specific blood pressure in pregnancy and U-Cd and effect modification by dietary intake of micronutrients is scarce. We randomly selected 653 women from the Omega Study cohort. U-Cd was quantified by inductively coupled plasma mass spectrometry. Trimester-specific, systolic (SBP) and diastolic blood pressure (DBP) were determined employing standard protocols and mean arterial pressure (MAP) was also calculated. Associations of SBP, DBP, and MAP with U-Cd tertiles (≤0.21; 0.22-0.41; ≥0.42 μg/g Cr) were assessed using multivariable linear regression models. We also explored effect modification by pre-pregnancy BMI (≤25 or >25 kg/m2) or low/high micronutrients intake. After adjusting confounders in women with elevated (upper tertile) as compared with those with low (lowest tertile) U-Cd (≥0.42 vs. ≤0.21 μg/g Cr, respectively) had reduced third trimester MAP (-1.8; 95 % confidence interval (CI) = -3.1, -0.5 mmHg) and second trimester MAP (-1.1; 95 % CI = -2.3, -0.03 mmHg). A significant decrease in third-trimester MAP associated with increased U-Cd was observed only among normal/underweight women (BMI ≤ 25 kg/m2) and women with high dietary intake of micronutrients (calcium, magnesium, zinc, and selenium). Notably, U-Cd concentrations increased with the increased consumption of zinc and non-heme iron food sources. No significant differences in U-Cd concentrations were found in preeclamptic women compared with non-preeclamptic women. Our study provides evidence that dietary intake of micronutrients should be taken into account when assessing the health effects of Cd in pregnant women.
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Affiliation(s)
- C Osorio-Yañez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Kresge 500, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - B Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Kresge 500, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - R S Miller
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - D A Enquobahrie
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A A Baccarelli
- Environmental Health Department, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - C Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - M A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Kresge 500, 677 Huntington Avenue, Boston, MA, 02115, USA
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Williams MA, Malm J, Eklund A, Horton NJ, Voss SE. Distortion Product Otoacoustic Emissions and Intracranial Pressure During CSF Infusion Testing. Aerosp Med Hum Perform 2016; 87:844-851. [PMID: 27662346 DOI: 10.3357/amhp.4572.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND A noninvasive method to monitor changes in intracranial pressure (ICP) is required for astronauts on long-duration spaceflight who are at risk of developing the Visual Impairment/Intracranial Pressure syndrome that has some, but not all of the features of idiopathic intracranial hypertension. We assessed the validity of distortion product otoacoustic emissions (DPOAEs) to detect changes in ICP. METHODS Subjects were eight patients undergoing medically necessary diagnostic cerebrospinal fluid (CSF) infusion testing for hydrocephalus. DPOAE measurements were obtained with an FDA-approved system at baseline and six controlled ICP levels in ∼3 mmHg increments in random order, with a range from 10.8 ± 2.9 mmHg (SD) at baseline to 32.3 ± 4.1 mmHg (SD) at level 6. RESULTS For f2 frequencies between 800 and 1700 Hz, when ICP was ≥ 12 mmHg above baseline ICP, DPOAE angles increased significantly and DPOAE magnitudes decreased significantly, but less robustly. DISCUSSION Significant changes in DPOAE angle and magnitude are seen when ICP is ≥ 12 mmHg above a subject's supine baseline ICP during CSF infusion testing. These results suggest that the changes in DPOAE angle and magnitude seen with change in ICP are physiologically based, and suggest that it should be possible to detect pathological ICP elevation using DPOAE measurements. To use DPOAE for noninvasive estimation of ICP during spaceflight will require baseline measurements in the head-up, supine, and head-down positions to obtain baseline DPOAE values at different ICP ranges. Williams MA, Malm J, Eklund A, Horton NJ, Voss SE. Distortion product otoacoustic emissions and intracranial pressure during CSF infusion testing. Aerosp Med Hum Perform. 2016; 87(10):844-851.
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Affiliation(s)
- Michael A Williams
- Departments of Neurology and Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Hwang SS, Smith RA, Barfield WD, Smith VC, McCormick MC, Williams MA. Supine sleep positioning in preterm and term infants after hospital discharge from 2000 to 2011. J Perinatol 2016; 36:787-93. [PMID: 27171759 DOI: 10.1038/jp.2016.80] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Supine sleep positioning (SSP) has been shown to reduce the risk of sudden infant death syndrome (SIDS) and preterm infants are at higher risk for SIDS. Population-based estimates of SSP are lacking for the preterm population. The objectives of this study are: (1) compare the prevalence of SSP after hospital discharge for preterm and term infants in the United States; and (2) assess racial/ethnic disparities in SSP for preterm and term infants. STUDY DESIGN We analyzed the 2000 to 2011 data from the Pregnancy Risk Assessment Monitoring System of Centers for Disease Control and Prevention from 35 states. We measured prevalence of SSP by preterm and term gestational age (GA) categories. We calculated adjusted prevalence ratios (APR) to evaluate the likelihood of SSP for each GA category compared with term infants and the likelihood of SSP for non-Hispanic black (NHB) and Hispanic infants compared with non-Hispanic white (NHW) infants. RESULTS Prevalence of SSP varied by GA: ⩽27, 59.7%; 28 0/7 to 33 6/7, 63.7%; 34 0/7 to 36 6/7 (late preterm), 63.6%; and 37 0/7 to 42 6/7 (term) weeks, 66.8% (P<0.001). In the adjusted analyses, late preterm infants were slightly less likely to be placed in SSP compared with term infants (APR: 0.96, confidence interval: 0.95 to 0.98). There were racial/ethnic disparities in SSP for all GA categories when NHB and Hispanic infants were compared with NHW infants. CONCLUSIONS All infants had suboptimal adherence to SSP indicating a continued need to better engage families about SSP. Parents of late preterm infants and families of NHB and Hispanic infants will also require greater attention given their decreased likelihood of SSP.
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Affiliation(s)
- S S Hwang
- Section of Neonatology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - R A Smith
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W D Barfield
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - V C Smith
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M C McCormick
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - M A Williams
- Harvard School of Public Health, Boston, MA, USA
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Savitsky B, Manor O, Friedlander Y, Burger A, Lawrence G, Calderon-Margalit R, Siscovick DS, Enquobahrie DA, Williams MA, Hochner H. Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study. J Epidemiol Community Health 2016; 71:43-51. [PMID: 27417428 DOI: 10.1136/jech-2014-204323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/02/2014] [Revised: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several stages in the life course have been identified as important to the development of cardiovascular disease. This study aimed to assess the associations of childhood and adulthood socioeconomic position (SEP) and social mobility with cardiometabolic risk factors (CMRs) later in life. METHODS We conducted follow-up examinations of 1132 offspring, aged 32, within a population-based cohort of all births in Jerusalem from 1974 to 1976. SEP was indicated by parents' occupation and education, and adulthood SEP was based on offspring's occupation and education recorded at age 32. Linear regression models were used to investigate the associations of SEP and social mobility with CMRs. RESULTS Childhood-occupational SEP was negatively associated with body mass index (BMI; β=-0.29, p=0.031), fat percentage (fat%; β=-0.58, p=0.005), insulin (β=-0.01, p=0.031), triglycerides (β=-0.02, p=0.024) and low-density lipoprotein cholesterol (LDL-C; β=-1.91, p=0.015), independent of adulthood SEP. Adulthood-occupational SEP was negatively associated with waist-to-hip ratio (WHR; β=-0.01, p=0.002), and positively with high-density lipoprotein cholesterol (HDL-C; β=0.87, p=0.030). Results remained similar after adjustment for smoking and inactivity. Childhood-educational SEP was associated with decreased WHR and LDL-C level (p=0.0002), and adulthood-educational SEP was inversely associated with BMI (p=0.001), waist circumference (p=0.008), WHR (p=0.001) and fat% (p=0.0002) and positively associated with HDL-C (p=0.030). Additionally, social mobility (mainly upward) was shown to have adverse cardiometabolic outcomes. CONCLUSIONS Both childhood and adulthood SEP contribute independently to CMR. The match-mismatch hypothesis may explain the elevated CMRs among participants experiencing social mobility. Identification of life-course SEP-related aspects that translate into social inequality in cardiovascular risk may facilitate efforts for improving health and for reducing disparities in cardiovascular disease.
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Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Burger
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - D S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - D A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Taussig D, Williams MA, Wiggins C, Feakins RM, McBride N, Newland AC, Kelsey SM. Clinical Regression and Remission of Primary Refractory Angiocentric Lymphoma Following Autologous Tumour Peptide Antigen-charged Dendritic Cells After High-dose Chemotherapy and Autologous Stem Cell Rescue. ACTA ACUST UNITED AC 2016; 3:277-89. [PMID: 27413880 DOI: 10.1080/10245332.1998.11746400] [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] [Indexed: 12/11/2022]
Abstract
We report on the case of a 34-year old man with a previously refractory high-grade non-Hodgkin's Lymphoma which regressed following dendritic cell based immunotherapy after high-dose chemotherapy. Antigen presenting cells known as dendritic cells were cultured from harvested autologous peripheral blood progenitor cells. The dendritic cells were then exposed to unfractionated tumour peptides derived from a skin biopsy section inflitrated with lymphoma. These charged dendritic cells infused into the patient together with autologous T-lymphocytes after high-dose chemotherapy with peripheral blood stem cell rescue. Although the lymphoma relapsed after the high-dose chemotherapy it regressed again following the dendritic cell infusion. The patient's T-lymphocytes demonstrated in vitro reactivity to tumour peptides whereas the lymphocytes of controls did not. We propose that the lymphoma regression occurred because of a T cell mediated response against the tumour induced by the charged dendritic cells.
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Affiliation(s)
- D Taussig
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - M A Williams
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - C Wiggins
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - R M Feakins
- b Histopathology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - N McBride
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - A C Newland
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
| | - S M Kelsey
- a Department of Haematology , St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London , Whitechapel, London E1 2AD
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