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Tang O, Ayala C, Feler J, Perla KR, Bajaj A, Ganga A, Fridley J, Toms S, Gokaslan Z, Sullivan PZ. DISP-05. SOCIAL DETERMINANTS OF HEALTH AND INPATIENT SPINE TUMOR OUTCOMES: A NATIONWIDE ANALYSIS OF DISPARITIES FROM 2002-2019. Neuro Oncol 2022. [PMCID: PMC9660527 DOI: 10.1093/neuonc/noac209.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Earlier research has demonstrated that social determinants of health (SDoH) impact neuro-oncology access and outcomes, influencing patient disparities. This study aimed to elucidate the association between SDoH and inpatient spine tumor outcomes.
METHODS
All admissions with a spine tumor diagnosis in the National Inpatient Sample from 2002-2019 were identified. Four SDoH were analyzed: race and ethnicity, insurance, household income, and safety-net hospital (SNH) treatment. Hospitals in the top quartile of safety-net burden (percentage of patients receiving Medicaid or uninsured) were categorized as SNHs. Multivariable regression queried the association between 22 variables (patient, hospital, tumor, and severity characteristics) and six inpatient outcomes: mortality, discharge disposition, complications, length of stay (LOS), and hospitalization costs. Relative importance of predictors for discharge disposition were assessed using random forest models.
RESULTS
Of 6,593,391 total admissions with spine tumors, 219,380 (3.3%) underwent surgical intervention. Non-white race (odds ratio [OR] = 0.80–0.91, P = 0.001) and non-private insurance (OR = 0.76–0.83, P = 0.001) were associated with lower odds of surgery. Among surgical admissions, presenting severity, including myelopathy and plegia, was elevated among nonwhite, non-private insurance, and low-income admissions (all P = 0.001). Black race (OR = 0.70, P = 0.001), Medicare (OR = 0.70, P = 0.001), Medicaid (OR = 0.90, P=0.001), and lower income (OR = 0.88–0.93, all P = 0.001) were associated with decreased odds of favorable discharge disposition. Elevated LOS and costs were observed among non-white (LOS: +6-10%, costs: +5-9%, both P = 0.001) and Medicaid (LOS: +16%, costs: +6%, both P = 0.001) admissions. SNH treatment was also associated with higher mortality (OR = 1.49, P = 0.001) and complications (OR = 1.20, P = 0.001). From 2002-2019, disposition improved annually for Medicaid patients (OR = 1.03 per year, P = 0.022) but worsened for Black patients (OR = 0.98 per year, P = 0.046). Random forest models identified household income as the most important disposition predictor.
CONCLUSION
For spine tumor admissions, SDoH predicted surgical intervention, presenting severity, and perioperative outcomes. Over two decades, disparities improved for Medicaid patients but worsened for Black patients.
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Affiliation(s)
- Oliver Tang
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Cameron Ayala
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Joshua Feler
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | | | - Ankush Bajaj
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Arjun Ganga
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Jared Fridley
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Steven Toms
- Warren Alpert Medical School of Brown University , Providence, RI , USA
| | - Ziya Gokaslan
- Warren Alpert Medical School of Brown University , Providence, RI , USA
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Marques CG, Mwemerashyaka L, Martin K, Tang O, Uwamahoro C, Ndebwanimana V, Uwamahoro D, Moretti K, Sharma V, Naganathan S, Jing L, Garbern SC, Nkeshimana M, Levine AC, Aluisio AR. Utilisation of peripheral vasopressor medications and extravasation events among critically ill patients in Rwanda: A prospective cohort study. Afr J Emerg Med 2022; 12:154-159. [PMID: 35505668 PMCID: PMC9046616 DOI: 10.1016/j.afjem.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction In high-income settings, vasopressor administration to treat haemodynamic instability through a central venous catheter (CVC) is the preferred standard. However, due to lack of availability and potential for complications, CVCs are not widely used in low- and middle-income countries. This prospective cohort study evaluated the use of peripheral vasopressors and associated incidence of extravasation events in patients with haemodynamic instability at the Centre Hospitalier Universitaire Kigali, Rwanda. Methods Patients ≥18 years of age receiving peripheral vasopressors in the emergency centre (EC) or intensive care unit (ICU) for >1 hour were eligible for inclusion. The primary outcome was extravasation events. Patients were followed hourly until extravasation, medication discontinuation, death, or CVC placement. Extravasation incidence with 95% confidence intervals (CI) were calculated using Poisson exact tests. Results 64 patients were analysed. The median age was 49 (Interquartile Range [IQR]:33-65) and 55% were female. Distributive shock was the most frequent aetiology (47%). Intravenous (IV) location was most commonly antecubital fossa/upper arm (31%) and forearm/hand (43%). IV gauges ≤18 were used in 58% of locations. Most patients were treated with adrenaline (66%) and noradrenaline (41%), and 11% received multiple vasopressors. The median treatment duration was 19 hours (IQR:8.5-37). Treatment discontinuation was predominantly due to mortality (41%) or resolution of instability (36%). There were two extravasation events (2.9%), both limited to soft tissue swelling. Extravasation incidence was 0.8 events per 1000 patient-hours (95% CI:0.2-2.2). Conclusion Extravasation incidence with peripheral vasopressors was low, even with long use durations, suggesting peripheral infusions may be an acceptable approach when barriers exist to CVC placement.
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Affiliation(s)
- Catalina G. Marques
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA USA
- Corresponding author.
| | - Lucien Mwemerashyaka
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Kyle Martin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
| | - Oliver Tang
- Brown University Warren Alpert Medical School, Providence, RI USA
| | - Chantal Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Vincent Ndebwanimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Doris Uwamahoro
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Katelyn Moretti
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
- Brown University Warren Alpert Medical School, Providence, RI USA
| | - Vinay Sharma
- Michigan State University College of Human Medicine, East Lansing, Michigan USA
| | - Sonya Naganathan
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
- Brown University Warren Alpert Medical School, Providence, RI USA
| | - Ling Jing
- Case Western Reserve University School of Medicine, Cleveland, Ohio USA
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
- Brown University Warren Alpert Medical School, Providence, RI USA
| | - Menelas Nkeshimana
- Department of Anaesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
- Brown University Warren Alpert Medical School, Providence, RI USA
| | - Adam R. Aluisio
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI USA
- Brown University Warren Alpert Medical School, Providence, RI USA
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Pierre-Louis YS, Perla KMR, Perez GM, Jean-Charles S, Tang O, Nwaiwu CA, Weil R, Shah NS, Heffernan DS, Moreira C. The Insurance Coverage Paradox – Characterizing Outcomes among Dual-Eligible Hemorrhagic Stroke Patients. J Clin Neurosci 2022; 97:99-105. [DOI: 10.1016/j.jocn.2021.12.023] [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] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
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Barrios-Anderson A, Liu DD, Snead J, Wu E, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan Z. In Reply to the Letter to the Editor Regarding "The National Student Neurosurgical Research Conference: A Research Conference for Medical Students". World Neurosurg 2021; 157:259. [PMID: 34929779 DOI: 10.1016/j.wneu.2021.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jameson Snead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Esther Wu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David J Lee
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Robbins
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jesus Aguirre
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Tang
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Catherine M Garcia
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Francesco Pucci
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Matthew N Anderson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Elias Shaaya
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Ziya Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
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Tang O, Binder Z, Tian L, Chang WJ, Yoder T, Lacey S, Melenhorst J, O’Rourke DM. IMMU-16. CHARACTERISTICS OF EGFRVIII-DIRECTED CART CELL INFUSION PRODUCT ASSOCIATED WITH CLINICAL RESPONSE IN RECURRENT GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
A therapeutic approach for chimeric antigen receptor T (CART) cell therapy in glioblastoma is targeting the epidermal growth factor receptor variant III (EGFRvIII), present in approximately 30% of glioblastomas. While earlier research demonstrated that phenotypic and genotypic characteristics in patient T cells and CART product may predict therapeutic success for hematologic malignancies, no study has investigated such determinants for clinical response in glioblastoma.
METHODS
We analyzed apheresis and infusion products for patients in the first-in-human trial of EGFRvIII-directed CART for recurrent glioblastoma (NCT02209376, n=9). Inherent T cell phenotypes were characterized by flow cytometry assay using a panel of 27 markers. Clinical response was quantified via engraftment in peripheral circulation and time-on-trial (ToT).
RESULTS
Mean area under the curve (AUC) peripheral CART engraftment for the study period was 213 log10 copies/μg (SD=173) and mean ToT was 134 days (SD=173). For the CAR+/CD4+ population in the infusion product, PD1 positivity was positively associated with AUC engraftment (r=0.753, P=0.012) and ToT (r=0.800, P=0.010). On immune checkpoint inhibitor analysis, CTLA-4, TIM3, and LAG3 did not exhibit significant associations with AUC engraftment or ToT. For activation markers, PD1/GRZB (r=0.794, P=0.011) and PD1/HLA-DR (r=0.769, P=0.016) were directly associated with ToT. PD1/GRZB was also predictive of AUC engraftment (r=0.794, P=0.011). For the CAR+/CD8+ population, PD1 positivity correlated with elevated AUC engraftment (r=0.639, P=0.047). In the CAR-/CD4+ population, PD1 remained positively correlated with AUC engraftment (r=0.690, P=0.027) and ToT (r=0.726, P=0.027). No significant associations were observed for apheresis products.
CONCLUSION
PD1 in CART infusion products predicted peripheral engraftment and ToT in recurrent glioblastoma. Double-positive cells for PD1 and activation markers also displayed a positive correlation, suggesting PD1 highlights a population of activated CAR T cells. Further characterization of predictors of EGFRvIII-directed CART treatment efficacy may improve selection of patients and starting T cell populations for clinical expansion.
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Affiliation(s)
- Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Zev Binder
- University of Pennsylvania, Philadelphia, PA, USA
| | - Lifeng Tian
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Todd Yoder
- University of Pennsylvania, Philadelphia, PA, USA
| | - Simon Lacey
- University of Pennsylvania, Philadelphia, PA, USA
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Barrios-Anderson A, Wu E, Liu DD, Snead J, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan ZL. A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research. Surg Neurol Int 2021; 12:490. [PMID: 34754540 PMCID: PMC8571239 DOI: 10.25259/sni_742_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background In a competitive landscape for neurosurgical residency admission, research productivity is increasingly important. Medical school applicants to neurosurgery report high numbers of "scholarly products" as published by the National Residency Match Program. Despite increased student involvement in research and productivity, to the best of our knowledge, no previous reported studies have examined student perspectives on their involvement in neurosurgical research. Methods For 2 consecutive years (February 2019 and February 2020), medical students (n = 55) from around the United States presented original research at the Student Neurosurgical Research Conference. Participants were administered a mixed-method survey designed to assess experiences and perspectives on engaging in neurosurgical research. Survey responses were analyzed independently by two researchers to assess for common themes and perspectives. Results Medical students engaged in all types of research work across nearly every neurosurgical subfield with "Basic/Bench Lab work" (38.5%) and "Chart Review" (23.1%) representing the majority of projects. Students commonly cited "curiosity/interest," and "residency application competitiveness" as main reasons for participation in research. About 66% of respondents reported experiencing anxiety/concern about research productivity "often" or "very often." Thematic analysis revealed that sources of research-related stress were (1) having enough publications to match into residency, and (2) having enough time in medical school to engage in research. Conclusion Medical students engaging in neurosurgical research are highly motivated students driven by scientific curiosity and pressure to prepare for competitive residency applications. Students experience anxiety due to time constraints in medical curricula and increasing demands for scholarly productivity.
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Affiliation(s)
- Adriel Barrios-Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Esther Wu
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - David D Liu
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Jameson Snead
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - David J Lee
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - James Robbins
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Jesus Aguirre
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Oliver Tang
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Catherine M Garcia
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Francesco Pucci
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Matthew N Anderson
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Sohail Syed
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Elias Shaaya
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Ziya L Gokaslan
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
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Coorey C, Tang O, Yang J, Figtree G. Machine learning analysis of metabolomic biomarkers for diagnosis of heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is emerging evidence that the pathophysiological mechanisms of heart failure are associated with alterations in serum metabolites. Such metabolomic signatures may be useful for heart failure diagnosis, stratification and prognosis.
Purpose
To evaluate the utility of including metabolomic biomarkers in addition to traditional cardiac biomarkers in a machine learning prediction model of heart failure diagnosis in the well-characterised Canagliflozin Cardiovascular Assessment Study (CANVAS) cohort.
Methods
A subgroup of the CANVAS/CANVAS-R study cohort was analysed. 101 metabolites in plasma were measured by HPLC (HILIC)-mass spectrometry. A 10-times 5-fold cross-validated support vector machine model with radial basis kernel function was constructed to predict heart failure diagnosis using traditional biomarkers alone and using the combination of traditional biomarkers and metabolomic biomarkers. Model performance and variable importance were both evaluated by area under the curve (AUC) of the receiver operating characteristics (ROC) curve. Results are shown as mean ± standard deviation.
Results
967 patients (of which 402 patients had heart failure) were included in the analysis with 341 females, mean age 63±8 years and mean body mass index (BMI) 33±5 kg/m2. All patients had diabetes mellitus with mean HbA1c 8.2±0.9%. The prediction model based on only traditional biomarkers had mean AUC 72±3% and the prediction model based on both traditional biomarkers and metabolomic biomarkers had mean AUC 80±3%. The top metabolomic biomarkers for predicting heart failure were threonine, L-homoserine, creatine and deoxyadenosine.
Conclusion
Metabolomic biomarkers improved diagnostic performance of a heart failure prediction model and captured variation not encompassed by traditional cardiac biomarkers.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Janssen Research and Development
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Affiliation(s)
- C Coorey
- Royal North Shore Hospital, Sydney, Australia
| | - O Tang
- University of Sydney, Sydney, Australia
| | | | - G Figtree
- Royal North Shore Hospital, Sydney, Australia
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Tang O, Wong K, Ganguli R, Zahiri K, Burns N, Paracha S, Kozel G, Tang K, Schuur J. Emergency Absentee Voting for Hospitalized Patients and Voting During COVID-19: A 50-State Study. West J Emerg Med 2021; 22:1000-1009. [PMID: 35354012 PMCID: PMC8328173 DOI: 10.5811/westjem.2021.4.50884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Voters facing illness or disability are disproportionately under-represented in terms of voter turnout. Earlier research has indicated that enfranchisement of these populations may reinforce the implementation of policies improving health outcomes and equity. Due to the confluence of the coronavirus 2019 (COVID-19) pandemic and the 2020 election, we aimed to assess emergency absentee voting processes, which allow voters hospitalized after regular absentee deadlines to still obtain an absentee ballot, and election changes due to COVID-19 in all 50 states.
Methods: We performed a cross-sectional study collecting 34 variables pertaining to emergency voting processes and COVID-19-related election changes, including deadlines, methods of submission for applications and ballots, and specialized services for patients. Data were obtained from, in order of priority, state boards of elections websites, poll worker manuals, application forms, and state legislation. We verified all data through direct correspondence with state boards of elections.
Results: Emergency absentee voting processes are in place in 39 states, with the remaining states having universal vote-by-mail (n = 5) or extended regular absentee voting deadlines (n = 6). The emergency absentee period most commonly began within 24 hours following the normal absentee application deadline, which was often seven days before an election (n = 11). Unique aspects of emergency voting processes included patients designating an “authorized agent” to deliver their applications and ballots (n = 38), electronic ballot delivery (n = 5), and in-person teams that deliver ballots directly to patients (n = 18). Documented barriers in these processes nationwide include unavailable online information (n = 11), restrictions mandating agents to be family members (n = 7), physician affidavits or signatures (n = 9), and notary or witness signature requirements (n = 15). For the November 2020 presidential election, 12 states expanded absentee eligibility to allow COVID-19 as a reason to request an absentee ballot, and 18 states mailed absentee ballot applications or absentee ballots to all registered voters.
Conclusion: While 39 states operate emergency absentee voting processes for hospitalized voters, there are considerable areas for improvement and heterogeneity in guidelines for these protocols. For future election cycles, information on emergency voting and broader election reforms due to COVID-19 may be useful for emergency providers and patients alike to improve the democratic participation of voters experiencing illness.
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Affiliation(s)
- Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kelly Wong
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Reetam Ganguli
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Keyana Zahiri
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Burns
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Saba Paracha
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Giovanni Kozel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Jeremiah Schuur
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Peng J, Zhou H, Tang O, Chang K, Wang P, Zeng X, Shen Q, Wu J, Xiao Y, Patel SH, Hu C, Jin K, Xiao B, Boxerman J, Gao X, Wen PY, Bai HX, Huang RY, Yang L. Evaluation of RAPNO criteria in medulloblastoma and other leptomeningeal seeding tumors using MRI and clinical data. Neuro Oncol 2021; 22:1536-1544. [PMID: 32215549 DOI: 10.1093/neuonc/noaa072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group has made recommendations for response assessment in patients with medulloblastoma (MBL) and leptomeningeal seeding tumors, these criteria have yet to be evaluated. METHODS We examined MR imaging and clinical data in a multicenter retrospective cohort of 269 patients with MBL diagnoses, high grade glioma, embryonal tumor, germ cell tumor, or choroid plexus papilloma. Interobserver agreement, objective response (OR) rates, and progression-free survival (PFS) were calculated. Landmark analyses were performed for OR and progression status at 0.5, 1.0, and 1.5 years after treatment initiation. Cox proportional hazards models were used to determine the associations between OR and progression with overall survival (OS). Subgroup analyses based on tumor subgroup and treatment modality were performed. RESULTS The median follow-up time was 4.0 years. In all patients, the OR rate was .0.565 (95% CI: 0.505-0.625) by RAPNO. The interobserver agreement of OR determination between 2 raters (a neuroradiologist and a neuro-oncologist) for the RAPNO criteria in all patients was 83.8% (k statistic = 0.815; P < 0.001). At 0.5-, 1.0-, and 1.5-year landmarks, both OR status and PFS determined by RAPNO were predictive of OS (hazard ratios [HRs] for 1-year landmark: OR HR = 0.079, P < 0.001; PFS HR = 10.192, P < 0.001). In subgroup analysis, OR status and PFS were predictive of OS for all tumor subtypes and treatment modalities. CONCLUSION RAPNO criteria showed excellent consistency in the treatment response evaluation of MBL and other leptomeningeal seeding tumors. OR and PFS determined by RAPNO criteria correlated with OS.
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Affiliation(s)
- Jian Peng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hao Zhou
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ken Chang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Panpan Wang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaowei Zeng
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin Shen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Wu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanhe Xiao
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Chongyu Hu
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xiaoping Gao
- Department of Neurology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Harrison X Bai
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Radiology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Li Yang
- Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Wu D, Bubb K, Besnier M, Tang O, Di Bartolo B, Figtree G. CRISPR Mutation of a Single Reactive Cysteine of the Na+/K+ Pump’s ß1-Subunit Abolishes Redox-Dependent Cardiac Hypertrophy and Fibrosis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Garcia CM, Pertsch NJ, Leary OP, Rivera Perla KM, Tang O, Toms SA, Weil RJ. Early outcomes of supratentorial cranial surgery for tumor resection in older patients. J Clin Neurosci 2020; 83:88-95. [PMID: 33342625 DOI: 10.1016/j.jocn.2020.11.022] [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] [Received: 07/26/2020] [Revised: 09/15/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023]
Abstract
With longevity increasing in the United States, more older individuals are presenting with supratentorial brain tumors. Despite improved perioperative management, there is persistent disparity in surgical resection rates among patients aged 65 years or older. We aim to assess the effects of advanced age (≥65 years) on 30-day outcomes in patients with supratentorial tumors who underwent craniotomy for supratentorial tumor resection. Data obtained in adults who underwent supratentorial tumor resections was extracted from the prospectively-collected American College of Surgeons: National Surgical Quality Improvement Program (NSQIP; 2012-2018) database. Using multivariate regression, we compared odds of major and minor complications; prolonged length-of-stay (LOS); discharge anywhere other than home; and 30-day readmission, reoperation, and mortality rates between patients aged 18-64 years (the control cohort) and those 65-74 years or ≥75 years of age. Of the 14,234 patients who underwent craniotomy for supratentorial tumors and met inclusion criteria, 30.7% were ≥65 years of age; 71.4% of these were 65-74 years and 28.6% were ≥75 years old. Compared to the control group, both older subpopulations had more medical comorbidities. Both older subgroups had increased odds of major complications and prolonged LOS relative to the control group. Older patients had greater odds of mortality at 30 days. Advanced age, defined as ≥65 years, was significantly associated with higher odds of complications, prolonged LOS, and mortality within the 30-day post- operative period after adjusting for potential confounders. Age is one important consideration when prospectively risk-stratifying patients to minimize and mitigate suboptimal perioperative outcomes.
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Affiliation(s)
- Catherine M Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Nathan J Pertsch
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Owen P Leary
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Oliver Tang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
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Sastry RA, Pertsch NJ, Tang O, Shao B, Toms SA, Weil RJ. Frailty and outcomes after craniotomy for brain tumor. J Clin Neurosci 2020; 81:95-100. [PMID: 33222979 DOI: 10.1016/j.jocn.2020.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/06/2020] [Indexed: 12/22/2022]
Abstract
Frailty has been associated with increased morbidity and mortality in a variety of surgical disciplines. Few data exist regarding the relationship of frailty with adverse outcomes in craniotomy for brain tumor resection. We assessed the relationship between frailty and the incidence of major post-operative complication, discharge destination other than home, 30-day readmission, and 30-day mortality after elective craniotomy for brain tumor resection. A retrospective cohort study was conducted on 20,333 adult patients undergoing elective craniotomy for tumor resection in the 2012-2018 ACS-NSQIP Participant Use File. Multivariate logistic regression was performed using all covariates deemed eligible through clinical and statistical significance. 6,249 patients (30.7%) were low-frailty and 2,148 patients (10.6%) were medium-to-high frailty. In multivariate logistic regression adjusting for age, gender, BMI, ASA classification, smoking status, dyspnea, significant pre-operative weight loss, chronic steroid use, bleeding disorder, tumor type, and operative time, low frailty was associated with increased adjusted odds ratio of major complication (1.41, 95% CI: 1.23-1.60, p < 0.001), discharge destination other than home (1.32, 95% CI: 1.20-1.46, p < 0.001), 30-day readmission (1.29, 95% CI: 1.15-1.44, p < 0.001), and 30-day mortality (1.87, 95% CI: 1.41-2.47, p < 0.001). Moderate-to-high frailty was also associated with increased adjusted odds of major complication (1.61, 95% CI: 1.35-1.92, p < 0.001), discharge destination other than home (1.80, 95% CI: 1.58-2.05), 30-day readmission (1.39, 95% CI: 1.19-1.62, p < 0.001), and 30-day mortality (2.42, 95% CI: 1.74-3.38, p < 0.001). CONCLUSIONS: Frailty is associated with increased odds of major post-operative complication, discharge to destination other than home, 30-day readmission, and 30-day mortality.
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Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.
| | - Nathan J Pertsch
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Oliver Tang
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Steven A Toms
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Lifespan Health System, Providence, RI 02903, USA
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Barrios-Anderson A, Liu DD, Snead J, Wu E, Lee DJ, Robbins J, Aguirre J, Tang O, Garcia CM, Pucci F, Anderson MN, Syed S, Shaaya E, Gokaslan ZL. The National Student Neurosurgical Research Conference: A Research Conference for Medical Students. World Neurosurg 2020; 146:e398-e404. [PMID: 33130142 DOI: 10.1016/j.wneu.2020.10.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Medical students interested in neurosurgery are increasingly involved in research, and research conferences have proven valuable for developing medical research experience and exposure. A research conference was designed for medical students interested in neurosurgery to present research. METHODS Our team designed an annual research conference at the Warren Alpert Medical School of Brown University in conjunction with the Neurosurgery and Neurology Departments. In February 2019, we hosted the first Student Neurosurgical and Neurological Research Conference (SNRC), the first national research conference, to our knowledge, designed for medical students to present neurosurgical research in the United States. The conference consisted of student poster/oral presentations, keynote speeches from clinical faculty, and surgical skills workstations. In February 2020, we hosted the second SNRC. After each conference, participants (n = 55) completed a survey to assess student perspectives of the conference. RESULTS Fifty-five medical students from around the nation attended the conferences to present their research. One hundred percent of participants affirmed that the conference fulfilled their primary reason for attending, which for most (54.5%) was the opportunity to present research. Thematic analysis revealed that students especially appreciated the "lower stress environment" and "opportunity to get feedback on their research." Notably, 97.6% of students felt the conference strengthened or increased their interest in neurosurgery. CONCLUSIONS Participants felt that the SNRC was a valuable opportunity to present research in an environment conducive for practice and improvement. Research conferences primarily for medical students may support the development of young researchers while increasing and strengthening interest in the field of neurosurgery.
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Affiliation(s)
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jameson Snead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Esther Wu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - David J Lee
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Robbins
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jesus Aguirre
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Oliver Tang
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Catherine M Garcia
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Francesco Pucci
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Matthew N Anderson
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Elias Shaaya
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA; The Brown University Department of Neurosurgery, Providence, Rhode Island, USA
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Sastry RA, Pertsch N, Tang O, Shao B, Toms SA, Weil RJ. Frailty and Outcomes after Craniotomy or Craniectomy for Atraumatic Chronic Subdural Hematoma. World Neurosurg 2020; 145:e242-e251. [PMID: 33065346 DOI: 10.1016/j.wneu.2020.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/29/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Frailty is a measure of decreased physiologic reserve and has been associated with increased morbidity and mortality in a variety of surgical disciplines. No data exist regarding the relationship of frailty with adverse outcomes in craniotomy for chronic subdural evacuation. We assessed the relationship between frailty and the incidence of major postoperative complication, discharge destination other than home, 30-day readmission, and 30-day mortality after craniotomy for atraumatic subdural evacuation. METHODS A retrospective cohort study was conducted on a population of 1647 adult patients undergoing craniotomy for evacuation of atraumatic subdural hematoma in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program database. Frailty was assessed using the modified frailty index (mFI-5). Multivariable logistic regression was performed using all covariates deemed eligible through clinical relevance and statistical significance. RESULTS The overall rates of major complication (25.4%), discharge to destination other than home (49.8%), 30-day readmission (11.7%), and 30-day mortality (12.8%) in this analysis were high and rose with increasing frailty. In multivariable regression analyses, medium frailty (mFI-5 = 2) was associated with increased odds of major complication (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.03-2.63), discharge to destination other than home (aOR 2.04, 95% CI 1.38-3.02), and 30-day mortality (aOR 2.27, 95% CI 1.08-4.78). High frailty (mFI-5 >2) was associated with increased odds of 30-day mortality (aOR 2.85, 95% CI 1.13-7.14). CONCLUSIONS Preoperative frailty, as determined by mFI-5, is associated with increased odds of major postoperative complication, discharge to destination other than home, and 30-day mortality after craniotomy for chronic subdural hematoma.
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Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
| | - Nathan Pertsch
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Oliver Tang
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Steven A Toms
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Robert J Weil
- Department of Neurosurgery, Rhode Island Hospital, Lifespan Health System, Providence, Rhode Island, USA
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Zhou H, Hu R, Tang O, Hu C, Tang L, Chang K, Shen Q, Wu J, Zou B, Xiao B, Boxerman J, Chen W, Huang RY, Yang L, Bai HX, Zhu C. Automatic Machine Learning to Differentiate Pediatric Posterior Fossa Tumors on Routine MR Imaging. AJNR Am J Neuroradiol 2020; 41:1279-1285. [PMID: 32661052 PMCID: PMC7357647 DOI: 10.3174/ajnr.a6621] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating the types of pediatric posterior fossa tumors on routine imaging may help in preoperative evaluation and guide surgical resection planning. However, qualitative radiologic MR imaging review has limited performance. This study aimed to compare different machine learning approaches to classify pediatric posterior fossa tumors on routine MR imaging. MATERIALS AND METHODS This retrospective study included preoperative MR imaging of 288 patients with pediatric posterior fossa tumors, including medulloblastoma (n = 111), ependymoma (n = 70), and pilocytic astrocytoma (n = 107). Radiomics features were extracted from T2-weighted images, contrast-enhanced T1-weighted images, and ADC maps. Models generated by standard manual optimization by a machine learning expert were compared with automatic machine learning via the Tree-Based Pipeline Optimization Tool for performance evaluation. RESULTS For 3-way classification, the radiomics model by automatic machine learning with the Tree-Based Pipeline Optimization Tool achieved a test micro-averaged area under the curve of 0.91 with an accuracy of 0.83, while the most optimized model based on the feature-selection method χ2 score and the Generalized Linear Model classifier achieved a test micro-averaged area under the curve of 0.92 with an accuracy of 0.74. Tree-Based Pipeline Optimization Tool models achieved significantly higher accuracy than average qualitative expert MR imaging review (0.83 versus 0.54, P < .001). For binary classification, Tree-Based Pipeline Optimization Tool models achieved an area under the curve of 0.94 with an accuracy of 0.85 for medulloblastoma versus nonmedulloblastoma, an area under the curve of 0.84 with an accuracy of 0.80 for ependymoma versus nonependymoma, and an area under the curve of 0.94 with an accuracy of 0.88 for pilocytic astrocytoma versus non-pilocytic astrocytoma. CONCLUSIONS Automatic machine learning based on routine MR imaging classified pediatric posterior fossa tumors with high accuracy compared with manual expert pipeline optimization and qualitative expert MR imaging review.
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Affiliation(s)
- H Zhou
- Department of Neurology (H.Z., L.T., B.X.), Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - R Hu
- From the School of Computer Science and Engineering (R.H., B.Z., C.Z.)
| | - O Tang
- Warren Alpert Medical School, Brown University (O.T.), Providence, Rhode Island
| | - C Hu
- Department of Neurology (C.H.), Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - L Tang
- Department of Neurology (H.Z., L.T., B.X.), Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - K Chang
- Department of Radiology (K.C.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Q Shen
- Radiology (Q.S., J.W.), Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - J Wu
- Radiology (Q.S., J.W.), Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - B Zou
- From the School of Computer Science and Engineering (R.H., B.Z., C.Z.)
| | - B Xiao
- Department of Neurology (H.Z., L.T., B.X.), Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - J Boxerman
- Department of Diagnostic Imaging (J.B., H.X.B.), Rhode Island Hospital
| | - W Chen
- Department of Pathology (W.C.), Hunan Children's Hospital, Changsha, Hunan, China
| | - R Y Huang
- Department of Radiology (R.Y.H.), Brigham and Women's Hospital, Boston, Massachusetts
| | - L Yang
- Departments of Neurology (L.Y.)
| | - H X Bai
- Department of Diagnostic Imaging (J.B., H.X.B.), Rhode Island Hospital
| | - C Zhu
- From the School of Computer Science and Engineering (R.H., B.Z., C.Z.)
- College of Literature and Journalism (C.Z.), Central South University, Changsha, Hunan, China
- Mobile Health Ministry of Education-China Mobile Joint Laboratory (C.Z.), China
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Garbern SC, Mbanjumucyo G, Umuhoza C, Sharma VK, Mackey J, Tang O, Martin KD, Twagirumukiza FR, Rosman SL, McCall N, Wegerich SW, Levine AC. Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda. Digit Health 2019; 5:2055207619879349. [PMID: 31632685 PMCID: PMC6769214 DOI: 10.1177/2055207619879349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022] Open
Abstract
Objective Critical care capabilities needed for the management of septic patients, such as continuous vital sign monitoring, are largely unavailable in most emergency departments (EDs) in low- and middle-income country (LMIC) settings. This study aimed to assess the feasibility and accuracy of using a wireless wearable biosensor device for continuous vital sign monitoring in ED patients with suspected sepsis in an LMIC setting. Methods This was a prospective observational study of pediatric (≥2 mon) and adult patients with suspected sepsis at the Kigali University Teaching Hospital ED. Heart rate, respiratory rate and temperature measurements were continuously recorded using a wearable biosensor device for the duration of the patients’ ED course and compared to intermittent manually collected vital signs. Results A total of 42 patients had sufficient data for analysis. Mean duration of monitoring was 32.8 h per patient. Biosensor measurements were strongly correlated with manual measurements for heart rate (r = 0.87, p < 0.001) and respiratory rate (r = 0.75, p < 0.001), although were less strong for temperature (r = 0.61, p < 0.001). Mean (SD) differences between biosensor and manual measurements were 1.2 (11.4) beats/min, 2.5 (5.5) breaths/min and 1.4 (1.0)°C. Technical or practical feasibility issues occurred in 12 patients (28.6%) although were minor and included biosensor detachment, connectivity problems, removal for a radiologic study or exam, and patient/parent desire to remove the device. Conclusions Wearable biosensor devices can be feasibly implemented and provide accurate continuous heart rate and respiratory rate monitoring in acutely ill pediatric and adult ED patients with sepsis in an LMIC setting.
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Affiliation(s)
- Stephanie C Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Gabin Mbanjumucyo
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Christian Umuhoza
- Department of Pediatrics, Pediatric Emergency Unit, University Teaching Hospital of Kigali, Kigali, Rwanda.,Department of Pediatrics, University of Rwanda, Kigali, Rwanda
| | - Vinay K Sharma
- Michigan State University College of Human Medicine, East Lansing, USA
| | - James Mackey
- Columbia University Mailman School of Public Health, New York, USA
| | | | - Kyle D Martin
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
| | - Francois R Twagirumukiza
- Department of Anesthesia, Emergency Medicine and Critical Care, University of Rwanda, Kigali, Rwanda
| | - Samantha L Rosman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, USA
| | - Natalie McCall
- Department of Pediatrics, Yale University, New Haven, USA
| | | | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA
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Larson V, Tang O, Ständer S, Miller L, Kang S, Kwatra S. 238 Association between prurigo nodularis and malignancy in middle-aged adults. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Zepecki J, Fajardo E, Snyder K, Guetta-Terrier C, Tang O, Sarkar A, Fiser A, Toms S. GENE-25. LOSS OF m6A RNA METHYLATION DURING GLIOMA STEM CELL DIFFERENTIATION IS REGULATED BY MIRNAS AND PROMOTES TRANSLATION EFFICIENCY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.451] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Kristin Snyder
- University of Minnesota, College of Veterinary Medicine, St. Paul, MN, USA
| | | | | | | | - Andras Fiser
- Albert Einstein College of Medicine, Bronx, NY, USA
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Danussi C, Bose P, Silberman P, Arnam JSV, Vitucci M, Tang O, Heguy A, Chan TA, Sulman EP, Lang F, Creighton CJ, Deneen B, Miller CR, Picketts DJ, Kannan K, Huse JT. Abstract 4322: Atrx inactivation drives motility and dysregulates differentiation in glioma cells of origin through global epigenomic remodeling. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Comprehensive genomic profiling in cancer continues to reveal frequent alterations in epigenetic regulators, firmly implicating chromatin biology in the oncogenic process. For instance, genetic inactivation of the SWI/SNF chromatin regulator ATRX (α-thalassemia mental retardation X-linked) represents a defining molecular alteration in both adult and pediatric malignant glioma, and occurs frequently in other cancers as well. ATRX deficiency has been linked to a wide spectrum of physiological dysfunction, including aberrant gene regulation, abnormal telomere maintenance, genomic instability, and aneuploidy. However, the precise oncogenic mechanism(s) induced by ATRX deficiency remain unclear, particularly those involving epigenomic dysregulation. To model these events in putative glioma cells of origin, we inactivated Atrx in primary murine neuroepithelial progenitors (mNPCs). Atrx loss, especially when coupled with Tp53 inactivation, promoted mNPC motility while also modulating differentiation state and potential, effectively recapitulating characteristic disease phenotypes and molecular features. Moreover, these phenotypes correlated with altered gene expression profiles in functionally relevant molecular networks (e.g. cell differentiation and migration). Integrating these transcriptional changes with shifts in chromatin accessibility occurring with Atrx deficiency, along with genome-wide Atrx distribution as determined by ChIP-seq, revealed highly significant spatial correlations between differentially expressed genes, regions of altered chromatin compaction, and genomic sites normally occupied by Atrx. Finally, target genes mediating specific Atrx-deficient phenotypes in vitro exhibited similarly selective misexpression in ATRX-mutant human glioma tissues and cell lines. These findings demonstrate that, in appropriate cellular and molecular contexts, ATRX deficiency and its epigenomic sequelae are sufficient to induce disease-defining oncogenic phenotypes.
Citation Format: Carla Danussi, Promita Bose, Pedro Silberman, John S. Van Arnam, Mark Vitucci, Oliver Tang, Adriana Heguy, Timothy A. Chan, Erik P. Sulman, Frederick Lang, Chad J. Creighton, Benjamin Deneen, C Ryan Miller, David J. Picketts, Kasthuri Kannan, Jason T. Huse. Atrx inactivation drives motility and dysregulates differentiation in glioma cells of origin through global epigenomic remodeling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4322.
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Affiliation(s)
- Carla Danussi
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Promita Bose
- 2Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Mark Vitucci
- 3University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oliver Tang
- 2Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Adriana Heguy
- 4New York University School of Medicine, New York, NY
| | | | - Erik P. Sulman
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick Lang
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - C Ryan Miller
- 3University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jason T. Huse
- 1University of Texas MD Anderson Cancer Center, Houston, TX
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Danussi C, Bose P, Parthasarathy P, Silberman P, Van Arnam JS, Vitucci M, Tang O, Heguy A, Chan T, Sulman E, Lang F, Creighton CJ, Deneen B, Miller CR, Picketts D, Kannan K, Huse J. GENE-24. ATRX DEFICIENCY IN GLIOMA CELLS OF ORIGIN PROMOTES DISEASE-DEFINING PHENOTYPES BY WAY OF GLOBAL EPIGENOMIC REMODELING. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.398] [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: 11/13/2022] Open
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Hansen T, Tang O, Figtree G, Bubb K, Sweadner K. FXYD1 is an Endogenous Protector Against Redox-Mediated Vascular Dysfunction. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patel H, Heng EL, Aleem A, Chung N, Tang O, John M, Patel M, Green L, Theobald N. Delivering results to clients: a question of satisfying needs or desires? Int J STD AIDS 2016; 17:109-11. [PMID: 16464272 DOI: 10.1258/095646206775455694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Demand for genitourinary (GU) medicine services is outstripping supply. Improving efficiency can modulate the supply side of the equation, e.g. decreasing the number of clients having to return for their results. This survey explored how clients at two central London GU medicine clinics would like to receive their results and their views were reflected against what was offered by London GU medicine clinics. There was a significant difference between the result delivery services that the clients wanted and what the clinics provided ( P <0.0001, χ2). Of the clients, 92% wanted to know their results regardless of outcome whereas 22% of London clinics would only inform clients of positive results. This study questions the importance and feasibility of patient choice, an important aspect of the National Strategy for Sexual Health and HIV. Clinics may not individually be able to provide choice but between them, they do provide a wide range of alternatives for the client.
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Affiliation(s)
- H Patel
- Imperial College, London SW7 2AZ, UK.
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Saad S, Stanners SR, Yong R, Tang O, Pollock CA. Notch mediated epithelial to mesenchymal transformation is associated with increased expression of the Snail transcription factor. Int J Biochem Cell Biol 2010; 42:1115-22. [PMID: 20348013 DOI: 10.1016/j.biocel.2010.03.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 03/15/2010] [Accepted: 03/22/2010] [Indexed: 11/30/2022]
Abstract
Notch signalling pathway has been implicated as an important contributor to epithelial to myofibroblast transformation (EMT) in tumourigenesis. However, its role in kidney tubular cells undergoing EMT is not defined. This study assessed Notch signalling and the downstream effects on Snail in cultured proximal tubular epithelial cells. EMT was induced by exposure to transforming growth factor beta-1 (TGFbeta(1)) and angiotensin II (AngII). The expressions of Notch1, Snail, E-cadherin and alpha-smooth muscle actin (alpha-SMA) were determined by Western blot. Matrix Metalloproteinase (MMP)-2 and -9 production were determined by zymography. The specific roles of Notch1-ICD and Snail were determined by gene expression or siRNA technique respectively. TGFbeta(1) and AngII resulted in EMT as characterized by the expected decrease in E-cadherin expression, an increase in alpha-SMA, MMP-2 and MMP-9 expression and associated increase of Notch1 and Snail. Over-expression of Notch1-ICD similarly resulted in increased Snail expression, loss of E-cadherin and increase dalpha-SMA. Inhibiting Snail degradation by pre-treatment with lithium chloride (LiCl) led to a further decrease in E-cadherin expression in cells concurrently exposed to TGFbeta(1)+AngII, confirming that Snail is a repressor of E-cadherin. Silencing of Snail blocked TGFbeta(1)+AngII induced EMT. Inhibition of Notch activation, by concurrent exposure to DAPT during the induction of EMT attenuated the decrease in E-cadherin expression, limited the increase in alpha-SMA and MMP-2 and -9 expression and decreased Snail expression. These results suggest a direct role for Notch signalling via the Snail pathway in the development of EMT and renal fibrosis.
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Affiliation(s)
- S Saad
- Department of Medicine, Kolling Institute of Medical Research, University of Sydney, Australia.
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Tang O, Chan C, Kan A, Ho P. A Prospective Randomized Comparison of Sublingual and Oral Misoprostol When Combined With Mifepristone for Medical Abortion at 12-20 Weeks Gestation. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.414] [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: 11/28/2022]
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Patel H, Heng EL, Aleem A, Chung N, John M, Tang O, Theobald N. GU medicine consultants' and clients' opinions on general practitioner involvement with sexual health care. Int J STD AIDS 2004; 15:779. [PMID: 15537470 DOI: 10.1258/0956462042395140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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26
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Bardsley PA, Howard P, Tang O, Empey D, Harrison B, Peake MD, O'Reilly J, Riordan JF, Wilkinson J, Arnaud F. Sequential treatment with low dose almitrine bismesylate in hypoxaemic chronic obstructive airways disease. Eur Respir J 1992; 5:1054-61. [PMID: 1426214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Daily dose schedules of 100-200 mg of almitrine bismesylate improve arterial blood gases in patients with hypoxaemic chronic obstructive airways disease (COPD) but dose related side effects are evident. In the present study, daily doses approximately half of those previously used were employed in a randomised double blind manner in 85 patients (age 35-79 years) with hypoxaemic COPD. After a one month period to check stability of arterial blood gases, patients were allocated to almitrine (A) or placebo (P) using an unequal code (60% A, 40% P). Tablets, 50-100 mg daily were stopped for one month after 3, 6 and 9 months to counteract drug accumulation. 50 patients in group A and 35 in group P were comparable on entry; mean age 65 (SD = 8) yrs., Pao2 7.8 (0.7) kPa (58.3 (5.0) mmHg), PaCO2 5.8 (0.8) kPa (43.2 (6.0) mmHg), forced expiratory volume in one second--FEV1 0.89 (0.25) l and 6 minute walking distance 296 (97) metres. The improvement in baseline PaO2 values was the same 0.8-1.3 kPa (6-9.8 mmHg) as with previous higher dose therapy. Approximately one third of patients did not respond, defined as PaO2 elevation > 0.67 kPa (5 mmHg). The sequential dosing scheme stabilised blood levels of almitrine within the therapeutic range of 280-300 ng.ml-1. After withdrawal of therapy arterial blood gases and spirometry reverted to pre-treatment levels, suggesting no permanent reversal of pathophysiology. Dose related side effects of breathlessness, indigestion and peripheral neuropathy were not observed. Nerve conduction studies revealed no difference in peripheral nerve dysfunction in hypoxaemic COPD between active and placebo therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Bardsley PA, Howard P, Tang O, Empey D, Harrison B, Peake MD, O'Reilly J, Riordan JF, Wilkinson J, Arnaud F, et A. Sequential treatment with low dose almitrine bismesylate in hypoxaemic chronic obstructive airways disease. Eur Respir J 1992. [DOI: 10.1183/09031936.93.05091054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Daily dose schedules of 100-200 mg of almitrine bismesylate improve arterial blood gases in patients with hypoxaemic chronic obstructive airways disease (COPD) but dose related side effects are evident. In the present study, daily doses approximately half of those previously used were employed in a randomised double blind manner in 85 patients (age 35-79 years) with hypoxaemic COPD. After a one month period to check stability of arterial blood gases, patients were allocated to almitrine (A) or placebo (P) using an unequal code (60% A, 40% P). Tablets, 50-100 mg daily were stopped for one month after 3, 6 and 9 months to counteract drug accumulation. 50 patients in group A and 35 in group P were comparable on entry; mean age 65 (SD = 8) yrs., Pao2 7.8 (0.7) kPa (58.3 (5.0) mmHg), PaCO2 5.8 (0.8) kPa (43.2 (6.0) mmHg), forced expiratory volume in one second--FEV1 0.89 (0.25) l and 6 minute walking distance 296 (97) metres. The improvement in baseline PaO2 values was the same 0.8-1.3 kPa (6-9.8 mmHg) as with previous higher dose therapy. Approximately one third of patients did not respond, defined as PaO2 elevation > 0.67 kPa (5 mmHg). The sequential dosing scheme stabilised blood levels of almitrine within the therapeutic range of 280-300 ng.ml-1. After withdrawal of therapy arterial blood gases and spirometry reverted to pre-treatment levels, suggesting no permanent reversal of pathophysiology. Dose related side effects of breathlessness, indigestion and peripheral neuropathy were not observed. Nerve conduction studies revealed no difference in peripheral nerve dysfunction in hypoxaemic COPD between active and placebo therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Jarratt JA, Morgan CN, Twomey JA, Abraham R, Sheaff PC, Pilling JB, Payan J, Mitchell JD, Tang O, Arnaud F. Neuropathy in chronic obstructive pulmonary disease: a multicentre electrophysiological and clinical study. Eur Respir J 1992; 5:517-24. [PMID: 1319353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The incidence and type of neuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed. In a selected group of 89 patients, abnormal nerve conduction studies were found in 44%. Electrophysiological signs of a generalized peripheral neuropathy were found in 5-18%, depending on diagnostic criteria. Lesions which were thought to be due to compression or other forms of trauma were present in a further 24%. In the patients with peripheral neuropathy, the changes were distally predominant, affected mainly sensory fibres, and were consistent with an axonal type of neuropathy. There was a significant correlation between age and the incidence of peripheral neuropathy. Electrophysiological evidence of neuropathy was three times as common as clinical evidence. Much of the variation in the reported incidence of neuropathy in COPD is probably due to imprecise diagnostic criteria.
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Affiliation(s)
- J A Jarratt
- Dept of Medicine, Royal Hallamshire Hospital, Sheffield, UK
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Jarratt JA, Morgan CN, Twomey JA, Abraham R, Sheaff PC, Pilling JB, Payan J, Mitchell JD, Tang O, Arnaud F, et A. Neuropathy in chronic obstructive pulmonary disease: a multicentre electrophysiological and clinical study. Eur Respir J 1992. [DOI: 10.1183/09031936.93.05050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence and type of neuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed. In a selected group of 89 patients, abnormal nerve conduction studies were found in 44%. Electrophysiological signs of a generalized peripheral neuropathy were found in 5-18%, depending on diagnostic criteria. Lesions which were thought to be due to compression or other forms of trauma were present in a further 24%. In the patients with peripheral neuropathy, the changes were distally predominant, affected mainly sensory fibres, and were consistent with an axonal type of neuropathy. There was a significant correlation between age and the incidence of peripheral neuropathy. Electrophysiological evidence of neuropathy was three times as common as clinical evidence. Much of the variation in the reported incidence of neuropathy in COPD is probably due to imprecise diagnostic criteria.
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Tang O, Larsen S. [A case of combined fracture of the sternum and of the thoracic spine]. Ugeskr Laeger 1973; 135:1695-6. [PMID: 4773380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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