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Hyde EK, Throndson K, Arcinas LA, Shah AH, Hiebert B, Yamashita MH, Lee Samson D, Maric A, Love R, Poettcker D, Arora RC, Seifer CM, Kass M. Validation of the Emory Risk Score in the Transcatheter Aortic Valve Implantation Population: A Canadian Perspective. CJC Open 2022; 4:1060-1068. [PMID: 36562015 PMCID: PMC9764109 DOI: 10.1016/j.cjco.2022.08.010] [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: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background Permanent pacemaker (PPM) implantation may be indicated post-transcatheter aortic valve implantation (TAVI). The Emory Risk Score (ERS) is a validated predictive risk score of the need for a PPM post-TAVI using a balloon-expandable valve. Our objectives were to determine the validity of the ERS in our local TAVI population with both balloon-expandable and self-expanding valves and to identify additional electrocardiographic (ECG) parameters predictive of the need for a PPM post-TAVI. Methods Retrospective chart and electronic database reviews were performed to collect demographic and procedural information. Two expert readers reviewed all ECGs. Independent factors associated with PPM implantation were examined with multivariable logistic regression via a stepwise selection process with calculation of the area under the receiver operating characteristic curve to assess model discrimination. Results The overall PPM implantation rate was 11.7%; rates were 9% for the Sapien 3 valves, 10% for the Evolut Pro valves, and 17% for the Evolut R valves. The ERS was found to not be predictive of need for PPM post-TAVI for the entire cohort. Right bundle branch block was the only ERS parameter independently associated with new PPM implant (8.5% vs 25%, odds ratio = 3.59, P = 0.01). No additional ECG parameters met the criteria for statistical significance. Conclusions The poor predictive value of the ERS in determining the need for a PPM post-TAVI in our patient population suggests that further refinement of a formula (or risk-calculator) is warranted. Identification of a precise risk-calculator is likely to facilitate patient mobilization and reduce inpatient healthcare resource utilization.
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Affiliation(s)
- Emily K. Hyde
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Corresponding author: Emily Hyde, CR1040 – 369 av. Taché Ave., Winnipeg, Manitoba R2H 2A6, Canada. Tel.: +1-204-235-3391.
| | - Karen Throndson
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Liane A. Arcinas
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H. Shah
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brett Hiebert
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anita Maric
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Reid Love
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Denise Poettcker
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colette M. Seifer
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Malek Kass
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Punia Bangar S, Whiteside WS, Dunno KD, Cavender GA, Dawson P, Love R. Starch-based bio-nanocomposites films reinforced with cellulosic nanocrystals extracted from Kudzu (Pueraria montana) vine. Int J Biol Macromol 2022; 203:350-360. [PMID: 35104472 DOI: 10.1016/j.ijbiomac.2022.01.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 12/11/2022]
Abstract
In the current study, starch-based active nanocomposite films reinforced with cellulosic nanocrystals (CNCs) of Kudzu were developed as an alternative option to existing biodegradable plastic packaging. Firstly, Kudzu CNCs were prepared by subjecting Kudzu fibers to the processes such as depolymerization followed by bleaching, acid hydrolysis, and mechanical dispersion. Further, nanocomposite films were formulated by blending pearl millet starch (PMS) and glycerol (30%) with different Kudzu CNCs compositions (0-7 wt%) using the solution casting process. The prepared PMS/Kudzu CNCs nanocomposite films were analyzed for their morphological (SEM and TEM), thermal (TGA and DSC), structural (FTIR), mechanical (tensile strength (TS), elongation at break and young modulus), and water barrier properties. The PMS/Kudzu CNCs films possessed improved crystallinity, heat and moisture-barrier properties, TS, and young-modulus after reinforcement. The optimum reinforcer concentration of CNCs was 5%. The Kudzu CNCs reinforced starch film offers a promising candidate for developing biodegradable films.
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Affiliation(s)
- Sneh Punia Bangar
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, USA
| | | | - Kyle D Dunno
- Department of Packaging Science, Rochester Institute of Technology, Rochester, New York, USA
| | | | - Paul Dawson
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, USA
| | - Reid Love
- Department of Food, Nutrition and Packaging Sciences, Clemson University, Clemson, USA
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James R, Griffin JGL, Senior C, Love R. The role of the Radiographer in osteoporosis and fracture prevention services - a narrative review. Radiography (Lond) 2021; 27 Suppl 1:S34-S38. [PMID: 34417105 DOI: 10.1016/j.radi.2021.07.020] [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: 05/04/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore relevant literature and policy around the role of the radiographer working within osteoporosis services. Discussion will examine the value of radiographers in these services, as well as current limitations and future opportunities for advancing practice in these domains. KEY FINDINGS Osteoporosis and fracture prevention are a public health issue that must be addressed to improve patient outcomes following fractures. DXA radiographers currently fulfill an important role in the diagnosis of osteoporosis and collaborative working between radiology and osteoporosis services is to be encouraged. Radiographers are able to extend their role into advanced practice within osteoporosis services such as fracture liaison and rheumatology, they have expert knowledge and experience to bring to these roles and post graduate education can further increase radiographer's expertise in this field. The inability of diagnostic radiographers to become independent prescribers is a current limitation for radiographers working within osteoporosis services. CONCLUSION The role of the radiographer working within DXA and osteoporosis services is evolving and is an exciting area of advanced practice. Promoting this specialty within radiography may help to improve job satisfaction as well as recruitment and retention rates. As radiographers scope of practice in osteoporosis changes and evolves, it is hoped that current legislation may change to allow independent prescribing for diagnostic radiographers, which can in turn streamline patient pathways and reduce the burden on primary and secondary care.
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Affiliation(s)
- R James
- Somerset Foundation Trust, United Kingdom.
| | - J G L Griffin
- Royal Osteoporosis Society, Bath, United Kingdom; University Hospitals Plymouth NHS Trust, United Kingdom
| | - C Senior
- Dorset County Hospital NHS Foundation Trust, United Kingdom
| | - R Love
- Dorset County Hospital NHS Foundation Trust, United Kingdom
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Schwass DR, Lyons KM, Love R, Tompkins GR, Meledandri CJ. Antimicrobial Activity of a Colloidal AgNP Suspension Demonstrated In Vitro against Monoculture Biofilms: Toward a Novel Tooth Disinfectant for Treating Dental Caries. Adv Dent Res 2018; 29:117-123. [PMID: 29355416 DOI: 10.1177/0022034517736495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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]
Abstract
A novel silver nanoparticle (AgNP) formulation was developed as a targeted application for the disinfection of carious dentine. Silver nitrate (AgNO3) was chemically reduced using sodium borohydrate (NaBH4) in the presence of sodium dodecyl sulfate (SDS) to form micelle aggregate structures containing monodisperse 6.7- to 9.2-nm stabilized AgNPs. AgNPs were characterized by measurement of electrical conductivity and dynamic light scattering, scanning electron microscopy, transmission electron microscopy, and inductively coupled plasma mass spectrometry. Antimicrobial activity of AgNPs was tested against planktonic cultures of representative gram-positive and gram-negative oral bacteria using well diffusion assays on tryptic soy broth media and monoculture biofilms grown with brain heart infusion ± sucrose anaerobically at 37°C on microtiter plates. Biofilm mass was measured by crystal violet assay. Effects were compared to silver diamine fluoride and chlorhexidine (negative controls) and 70% isopropanol (positive control) exposed cultures. In the presence of AgNPs, triplicate testing against Streptococcus gordonii DL1, C219, G102, and ATCC10558 strains; Streptococcus mutans UA159; Streptococcus mitis I18; and Enterococcus faecalis JH22 for planktonic bacteria, the minimum inhibitory concentrations were as low as 7.6 µg mL-1 and the minimum bacteriocidal concentrations as low as 19.2 µg mL-1 silver concentration. Microplate readings detecting crystal violet light absorption at 590 nm showed statistically significant differences between AgNP-exposed biofilms and where no antimicrobial agents were used. The presence of sucrose did not influence the sensitivity of any of the bacteria. By preventing in vitro biofilm formation for several Streptococcus spp. and E. faecalis, this AgNP formulation demonstrates potential for clinical application inhibiting biofilms.
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Affiliation(s)
- D R Schwass
- 1 Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - K M Lyons
- 1 Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - R Love
- 1 Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - G R Tompkins
- 1 Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - C J Meledandri
- 1 Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand.,2 MacDiarmid Institute for Advanced Materials and Nanotechnology, and Department of Chemistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
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Karon S, Toth M, Palmer L, Bercaw L, Johnson R, Jones J, Love R. WHO LIVES WHERE? LIVING SITUATION AND COMPARATIVE NEEDS OF OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | - R Love
- Research Triangle Institute (RTI) International
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Love R, Adams J, van Sluijs EMF, Foster C, Humphreys D. A cumulative meta-analysis of the effects of individual physical activity interventions targeting healthy adults. Obes Rev 2018; 19:1164-1172. [PMID: 29701299 PMCID: PMC6099338 DOI: 10.1111/obr.12690] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 01/22/2023]
Abstract
Despite a large and increasing evidence base on physical activity interventions, the high rates of physical inactivity and associated chronic diseases are continuing to increase globally. The purpose of this cumulative meta-analysis was to investigate the evolution of randomized controlled trial evidence of individual-level physical activity interventions to asses if new trials are contributing novel evidence to the field. Through a two-staged search process, primary studies examining the effects of interventions targeted at increasing physical activity within healthy adult populations were pooled and selected from eligible systematic reviews. Cumulative meta-analyses were performed on effect sizes immediately post-intervention (n = 62), and for long-term behaviour change (≥12-month post-baseline; n = 27). Sufficiency and stability of the evidence was assessed through application of pre-published indicators. Meta-analyses suggest overall positive intervention effects on physical activity. The evidence base for effectiveness immediately post-intervention reached levels of sufficiency and stability in 2007; and for long-term follow-up in 2011. In the time since, intervention effectiveness has not substantially changed, and further trials are unlikely to change the direction and magnitude of effect. Substantial evidence exists demonstrating that physical activity interventions can modify individual behaviour in controlled settings. Researchers are urged to shift focus towards investigating the optimization, implementation, sustainability and cost-effectiveness of interventions.
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Affiliation(s)
- R Love
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - J Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - E M F van Sluijs
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - C Foster
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - D Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Karon S, Knowles M, Vreeland E, Love R, Chiri G. CHALLENGES AND OPPORTUNITIES TO EXPAND THE PACE INTEGRATED CARE MODEL TO NEW POPULATIONS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Karon
- RTI International, Research Triangle Park, North Carolina
| | - M. Knowles
- RTI International, Research Triangle Park, North Carolina
| | - E. Vreeland
- RTI International, Research Triangle Park, North Carolina
| | - R. Love
- RTI International, Research Triangle Park, North Carolina
| | - G. Chiri
- RTI International, Research Triangle Park, North Carolina
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Kowatsch-Beyer K, Norris-Turner A, Love R, Denkowski P, Wang SH. Utilization of a latent tuberculosis infection referral system by newly resettled refugees in central Ohio. Int J Tuberc Lung Dis 2013; 17:320-5. [PMID: 23407220 DOI: 10.5588/ijtld.12.0439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A resettlement medical screening program that refers refugees with a positive tuberculin skin test (TST) to a public health tuberculosis (TB) clinic for evaluation for latent tuberculosis infection (LTBI). OBJECTIVE To identify the proportion of refugees that were TST-positive, how many attended after referral for medical evaluation, what characteristics influenced follow-up, and whether programmatic changes would increase follow-up rates. DESIGN Refugee characteristics and follow-up information were extracted from the resettlement medical records of 224 adult refugees screened in Columbus, Franklin County, Ohio, in 2008. Programmatic modifications in the referral system were implemented in December 2010. RESULTS Of 224 refugees screened, 115 (51%) had a TST induration ≥ 5 mm, 113 (98.3%) were referred and 60 (53.1%) attended the Columbus Public Health (CPH) TB clinic for evaluation. Resettling from East Asia (Myanmar, Viet Nam; OR 12.48, 95%CI 2.32-67.06) and TST induration size ≥ 10 mm (OR 9.38, 95%CI 1.41-62.26) were significantly associated with follow-up at the CPH. Implementation of scheduled appointments, telephone reminders and transportation arrangements increased follow-up to 93.5%. CONCLUSIONS Collaborative strategies can improve follow-up rates of TST-positive refugees during resettlement medical screening, facilitate LTBI treatment and prevent the development of active TB.
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Affiliation(s)
- K Kowatsch-Beyer
- The Ohio State University College of Public Health, Columbus, Ohio 43210, USA
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Medina M, Huang N, Sethupathy P, Lowery E, Martin A, Love R, Iwashima M, Wigfield C. In Vivo Profiling of T-Cell Responses by Omental Cells (OC) in Experimental Lung Transplantation (LTx). J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.173] [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: 11/29/2022] Open
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10
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Cypel M, Levvey B, Van Raemdonck D, Erasmus M, Love R, Mason D, Glanville A, Stehlik J, Herz M, Whitson B, Puri V, Dark J, Hopkins P, Snell G, Keshavjee S. Favorable Outcomes of Donation after Cardiac Death in Lung Transplantation: A Multicenter Study. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hagen NA, Lapointe B, Ong-Lam M, Dubuc B, Walde D, Gagnon B, Love R, Goel R, Hawley P, Ngoc AH, du Souich P. A multicentre open-label safety and efficacy study of tetrodotoxin for cancer pain. ACTA ACUST UNITED AC 2012; 18:e109-16. [PMID: 21655148 DOI: 10.3747/co.v18i3.732] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cancer pain is highly prevalent, and existing treatments are often insufficient to provide adequate relief. OBJECTIVES We assessed the long-term safety and efficacy of subcutaneous tetrodotoxin treatment in reducing the intensity of chronic cancer-related pain. METHODS In this multicentre open-label longitudinal trial, 30 μg tetrodotoxin was administered subcutaneously twice daily for 4 days in a heterogeneous cohort of patients with persistent pain despite opioids and other analgesics. "Responder" was defined as a mean reduction of 30% or more in pain intensity from baseline; and "clinical responder" as some pain reduction, but less than 30%, plus agreement on the part of both the patient and the physician that a meaningful analgesic response to treatment had occurred. RESULTS Of 45 patients who entered the longitudinal trial, 41 had sufficient data for analysis. Of all 45 patients, 21 (47%) met the criteria for "responder" [16 patients (36%)] or "clinical responder" [5 patients (11%)]. Onset of pain relief was typically cumulative over days, and after administration ended, the analgesic effect subsided over the course of a few weeks. No evidence of loss of analgesic effect was observed during subsequent treatments (2526 patient-days in total and a maximum of 400 days in 1 patient). One patient withdrew from the study because of adverse events. Toxicity was usually mild (82%) or moderate (13%), and remained so through subsequent treatment cycles, with no evidence of cumulative toxicity or tolerance. CONCLUSIONS Long-term treatment with tetrodotoxin is associated with acceptable toxicity and, in a substantial minority of patients, resulted in a sustained analgesic effect. Further study of tetrodotoxin for moderate-to-severe cancer pain is warranted.
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Affiliation(s)
- N A Hagen
- Tom Baker Cancer Centre and Departments of Oncology, Clinical Neurosciences, and Medicine, University of Calgary, Calgary, AB.
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Duarte A, Myers A, Dilling D, Love R, Valentine V, Campbell G. 511 Analysis of Neural and Vascular Structures across the Airway Anastomosis in Lung Transplant Recipients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.522] [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: 10/18/2022] Open
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Emami B, Chollet C, Nagda S, Gao M, Melian E, Love R, Sethi A. NORMAL TISSUE TOXICITIES OF STEREOTACTIC BODY RADIATION THERAPY FOR THORACIC MALIGNANCIES. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The morphological and cytochemical changes in HeLa cells infected with herpes virus have been studied at frequent intervals during infection and related to the growth of virus and the multiplicity of the virus inoculum. Infection with a high multiplicity inoculum produced enlargement and extrusion of small ribonucleoprotein (RNP) bodies in the nucleoli (nucleolini) to form RNP bodies in the nucleoplasm (B bodies) beginning (1/2) hour after infection. 3 hours after infection, RNP of the pars amorpha appeared to diffuse into the adjacent nucleoplasm, where, (1/2) hour later, the classical type A inclusion or A body first appeared. The A bodies displaced the B bodies and the nucleoli and eventually filled the nucleus. 6 hours after infection, minute granules containing RNA, DNA, and non-histone protein appeared inside the A bodies (A granules) and increased in number until the late stages of infection, when they disappeared. 18 hours after infection, at the time when the A bodies came to fill the nucleus completely, extrusion of RNP from the nucleus produced cytoplasmic masses which have been termed C bodies. B bodies were formed in the majority of cells before the maturation of infectious virus, but the number of B bodies could not be correlated with the amount of virus in the cell or with the multiplicity of the inoculum. It is suggested that the formation of B bodies may be the result of inhibition of the onset of mitotic division by a mechanism which does not inhibit the formation of RNA in the nucleolini. The nature of the A bodies, the A granules, and the C bodies is discussed and it is concluded that the A granules may represent aggregations of maturing virus in the nucleus. The progression of some C mitotic metaphases to the formation of post-C mitotic multinucleated giant cells is described. These are distinct from syncytia formed by cell fusion.
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Affiliation(s)
- R Love
- Department of Pathology, Jefferson Medical College, Philadelphia, and the M. R. C. Unit for Experimental Virus Research, University of Glasgow, Scotland
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McShane P, Bhorade S, Baz M, Valentine V, Arcasoy S, Love R, Seethamraju H, Garrity E, Alex C, Bag R, deOliveira A, Vigneswaran W, Charbeneau J, Krishnan J, Durazo R, Ahya V. 209: Sirolimus Is Associated with an Increase Risk of Venous Thromboembolism in Lung Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Gagermeier J, Alex C, Dilling D, Love R, Wigfield C, Rusinak J, O'Keefe P, Schriever C, Lurain N. 651: Increased Mortality in Ganciclovir Resistant CMV Infection in Lung Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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17
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Hobson R, Rolland S, Rotgans J, Schoonheim-Klein M, Best H, Chomyszyn-Gajewska M, Dymock D, Essop R, Hupp J, Kundzina R, Love R, Memon RA, Moola M, Neumann L, Ozden N, Roth K, Samwel P, Villavicencio J, Wright P, Harzer W. Quality assurance, benchmarking, assessment and mutual international recognition of qualifications. Eur J Dent Educ 2008; 12 Suppl 1:92-100. [PMID: 18289272 DOI: 10.1111/j.1600-0579.2007.00484.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of this report is to provide guidance to assist in the international convergence of quality assurance, benchmarking and assessment systems to improve dental education. Proposals are developed for mutual recognition of qualifications, to aid international movement and exchange of staff and students including and supporting developing countries. Quality assurance is the responsibility of all staff involved in dental education and involves three levels: internal, institutional and external. Benchmarking information provides a subject framework. Benchmarks are useful for a variety of purposes including design and validation of programmes, examination and review; they can also strengthen the accreditation process undertaken by professional and statutory bodies. Benchmark information can be used by institutions as part of their programme approval process, to set degree standards. The standards should be developed by the dental academic community through formal groups of experts. Assessment outcomes of student learning are a measure of the quality of the learning programme. The goal of an effective assessment strategy should be that it provides the starting point for students to adopt a positive approach to effective and competent practice, reflective and lifelong learning. All assessment methods should be evidence based or based upon research. Mutual recognition of professional qualifications means that qualifications gained in one country (the home country) are recognized in another country (the host country). It empowers movement of skilled workers, which can help resolve skills shortages within participating countries. These proposals are not intended to be either exhaustive or prescriptive; they are purely for guidance and derived from the identification of what is perceived to be 'best practice'.
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Bhorade S, Baz M, Ahya V, Seethamraju H, Valentine V, Arcasoy S, Love R, Alex C, Vigneswaran W, Krishnan J, Charbeneau J, Garrity E. 406: Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen Versus Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in Lung Transplantation. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.418] [Citation(s) in RCA: 3] [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: 10/22/2022] Open
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Tevaarwerk A, Stewart JA, Love R, Binkley NC, Black S, Eickhoff J, Mulkerin DL. Randomized trial to assess bone mineral density (BMD) effects of zoledronic acid (ZA) in postmenopausal women (PmW) with breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19558 Introduction: Osteoporotic fracture represents a major source of morbidity in PmW. Breast cancer patients can be at additional risk because of treatment related estrogen deprivation. The favorable effects of bisphosphonates in osteoporosis and potential reduction of metastases warrant evaluation of ZA in PmW at high risk for breast cancer relapse. We assessed whether ZA 4 mg IV every 12 weeks x 4 doses was associated with an increase in BMD. Secondary objectives included defining ZA’s toxicity profile in this setting, and assessing for differences in overall cancer relapse. Methods: PmW with node positive or stage III breast cancer diagnosed less than 5 years earlier were randomized to ZA or observation. BMD was assessed by dual energy xray absorptiometry (DXA) for all subjects at 0 and 12 months. A toxicity evaluation was performed pre- and post-treatment for patients receiving ZA. Study endpoint occurred when subjects completed the DXAs, had disease progression or declined further treatment. We calculated change in BMD between 0 and 12 months at the L1–4 spine and femur neck. Results: 66 women have enrolled since 2000; 49 women have completed DXAs at 0 and 12 months (observation 23, ZA 26). Median age was 52 (range 40–81 yr), median ECOG performance status was 0 (range 0–1), and most women received concurrent tamoxifen (observation 74%, ZA 61%). Over 12 months, L1–4 spine BMD decreased in the observation arm (-0.006 ± 0.034 g/cm2) and increased in the ZA arm (p<0.001; 0.050 ± 0.042 g/cm2). No significant BMD change occurred at the femur neck. Only three grade 3 events occurred (2 arthralgia, 1 myalgia). Side effects were mild and transient, but as frequent as 87% following dose 1. The most common side effects were fatigue, myalgia and arthralgia. No clinically significant changes in creatinine or calcium occurred. Osteonecrosis of the jaw was not observed. Of the 66 women enrolled, 7 have relapsed (observation 4, ZA 3) but time since diagnosis is less than 10 years for most patients. Conclusions: ZA administered every 12 weeks for 4 doses leads to a statistically and clinically significant change in BMD at the lumbar spine. Toxicity was mild but common. There are as yet no significant differences in cancer relapse. No significant financial relationships to disclose.
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Affiliation(s)
- A. Tevaarwerk
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - J. A. Stewart
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - R. Love
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - N. C. Binkley
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - S. Black
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - J. Eickhoff
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
| | - D. L. Mulkerin
- University of Wisconsin, Madison, WI; Ohio State University, Columbus, OH
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Luo DYW, Love R. PR06 NECROTISING FASCIITIS OR PYODERMA GANGRENOSUM ? AN INTERESTING CASE. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04127_6.x] [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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Lanuza D, Lefaiver C, Brown R, Bhorade S, Love R. 278: Gender differences in symptom experiences before and up to 6 months after lung transplant (LT). J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.297] [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: 10/23/2022] Open
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22
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Love R, Sawatzky JAV. Management of end-stage heart failure: improving palliative care. Can J Cardiovasc Nurs 2007; 17:13-18. [PMID: 17941564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
As a result of the aging Canadian population and improved heart failure management, more than 400,000 Canadians are currently living with heart failure. Despite recent advances in medical management, no cure exists and the annual mortality rate for heart failure remains as high as 40%. Research suggests that end-stage heart failure patients suffer to a degree that is equivalent to, or greater than that of terminal cancer patients. However, they do not receive the same degree of end-of-life care. This article discusses current issues related to the classification system, the lack of prognostic markers, and medical management of the end-stage heart failure patient, which act as barriers to implementing palliative care. Possible solutions to facilitate the effective and timely transition to palliative care, and achieve the goal of a peaceful death for the patient with end-stage heart failure are also discussed.
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Affiliation(s)
- Reid Love
- 12 Demers Place, Winnipeg, MB R3V 1W4.
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Affiliation(s)
- H Koprowski
- Viral and Rickettsial Research, Lederle Laboratories Division, American Cyanamid Company, Pearl River, New York
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Bhorade S, Ahya V, Kotloff R, Baz M, Valentine V, Arcasoy S, Love R, Durazo R, Vigneswaran W, Garrity E. 376. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.390] [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: 11/29/2022] Open
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25
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Bhorade S, Ahya V, Kotloff R, Baz M, Valentine V, Arcasoy S, Love R, Vigneswaran W, Garrity E. Six month results of sirolimus versus azathioprine in a tacrolimus based immunosuppressive regimen in lung transplantation. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.11.176] [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] Open
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Schroth MK, Grimm E, Frindt P, Galagan DM, Konno SI, Love R, Gern JE. Rhinovirus replication causes RANTES production in primary bronchial epithelial cells. Am J Respir Cell Mol Biol 1999; 20:1220-8. [PMID: 10340941 DOI: 10.1165/ajrcmb.20.6.3261] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The mechanisms by which rhinovirus (RV) infections produce lower airway symptoms in asthmatic individuals are not fully established. To determine effects of RV infection on lung epithelial cells, primary human bronchial epithelial (BE) cells were infected with either RV16 or RV49, and viral replication, cell viability, and cell activation were measured. Both viral serotypes replicated in BE cells at 33 degrees C (DeltaTCID50 / ml = 2 to 2.5 log units) and at 37 degrees C (DeltaTCID50 /ml = 1.6 log units), but only high doses of RV49 (10(6) TCID50 /ml) caused cytopathic effects and reduced cell viability. In addition, regulated on activation, normal T cells expressed and secreted (RANTES) secretion was increased in epithelial cells infected with RV16 or RV49 (243 and 398 pg/ml versus 13 pg/ml uninfected control cells), and a similar pattern was seen for RANTES messenger RNA. RV infection also caused increased secretion of interleukin-8 and granulocyte macrophage colony-stimulating factor, but did not alter expression of either intercellular adhesion molecule-1 or human leukocyte-associated antigen-DR. These observations suggest that RVs can replicate in lower airway cells in vivo, and support epidemiologic studies that link RV with lower respiratory illnesses. Further, RV-induced secretion of RANTES and other cytokines could trigger antiviral immune responses in vivo, but these effects could also contribute to the pathogenesis of respiratory symptoms in subjects with asthma.
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Affiliation(s)
- M K Schroth
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin 53792-4108, USA.
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Arndt GA, Kranner PW, Rusy DA, Love R. Single-lung ventilation in a critically ill patient using a fiberoptically directed wire-guided endobronchial blocker. Anesthesiology 1999; 90:1484-6. [PMID: 10319801 DOI: 10.1097/00000542-199905000-00037] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G A Arndt
- Department of Anesthesiology, University of Wisconsin Clinical Sciences Center, Madison 53792-3272, USA.
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Robins HI, Katschinski DM, Longo W, Grosen E, Wilding G, Gillis W, Kraemer C, Tiggelaar CL, Rushing D, Stewart JA, Spriggs D, Love R, Arzoomanian RZ, Feierabend C, Alberti D, Morgan K, Simon K, d'Oleire F. A pilot study of melphalan, tumor necrosis factor-alpha and 41.8 degrees C whole-body hyperthermia. Cancer Chemother Pharmacol 1999; 43:409-14. [PMID: 10100597 DOI: 10.1007/s002800050915] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the feasibilitv of sequencing (based on preclinical modeling) tumor necrosis factor-a (TNF) at two dose levels with melphalan (L-PAM) and 41.8 C whole-body hyperthermia (WBH) for 60 min. PATIENTS AND METHODS Nine patients with refractory cancer were treated from October 1995 to June 1997. The study encompassed a total of 20 trimodality treatment courses. Three patients were treated at TNF dose level I (50 microg/m2) and six patients were treated at TNF dose level II (100 microg/m2). TNF was delivered as a 24-h intravenous infusion, 48 h prior to the combination of L-PAM and WBH; L-PAM was given over 10 min at target temperature at a dose of 17.5 mg/ m2 based on a previous phase I WBH/L-PAM trial. WBH was administered with an Aquatherm radiant heat device. RESULTS Myelosuppression was the major toxicity associated with therapy, but there were no instances of bleeding or neutropenic fevers. Grade 3 thrombocytopenia was seen with 15% of treatments. Regarding absolute neutrophil count, 15% of treatments were associated with grade 3 toxicity, and 45% with grade 4 toxicity, and regarding white blood cell count, 50% of treatments were associated with grade 3 toxicity and 10% with grade 4 toxicity. The myelosuppression observed was equivalent to that seen in our earlier phase I study of WBH and L-PAM (without TNF). Only mild toxicities (grade 1 or 2) were associated with TNF; these were seen with <25% of treatments and included nausea, vomiting, diarrhea, fevers, and headache. There were no instances of hypotension. There was no relationship between toxicities observed and the two TNF dose levels. Mild WBH toxicities were seen with less than 15% of treatments; these included nausea, vomiting, and herpes simplex I. Responses included two complete remissions (malignant melanoma, TNF dose level I; breast cancer, TNF dose level II), and two disease stabilizations (both malignant melanoma, TNF dose level I). CONCLUSION We conclude that the combination of TNF, L-PAM, and WBH is well tolerated at the dose levels studied. The clinical results justify further clinical investigation for this trimodality treatment approach.
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Affiliation(s)
- H I Robins
- University of Wisconsin Comprehensive Cancer Center, Madison 53792, USA
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Garrity ER, Hertz MI, Trulock EP, Keenan R, Love R. Suggested guidelines for the use of tacrolimus in lung-transplant recipients. J Heart Lung Transplant 1999; 18:175-6. [PMID: 10328140 DOI: 10.1016/s1053-2498(98)00022-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- T Borrowman
- Division of Cardiology, University of Utah Health and Science Center, Salt Lake City 84132, USA
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Nunley D, Dauber J, Iacono A, Keenan R, Zeevi A, Cornwell R, Love R, Meyer K, Soergel P, Peterson K. Unopposed neutrophil elastase in bronchoalveolar lavage from transplant recipients with cystic fibrosis. Am J Respir Crit Care Med 1999; 159:258-61. [PMID: 9872847 DOI: 10.1164/ajrccm.159.1.9712068] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Large numbers of neutrophils with unopposed neutrophil elastase (NE) proteolytic activity are found in lower respiratory tract secretions from most patients with advanced cystic fibrosis (CF). To determine whether antielastase defenses may be overwhelmed in epithelial lining fluid after lung transplantation, we measured NE activity (cleavage of the specific substrate, MeO-Suc-Ala-Ala-Pro-Val-pNA) in bronchoalveolar lavage fluids (BALF) obtained for surveillance or diagnostic purposes at various intervals (1 mo to 7 yr after transplantation) from 52 recipients who had undergone double or bilateral lung transplantation for end-stage CF. Unopposed NE activity was found in BALF from 14 recipients, most of whom also had >= 10(5) colony forming units (cfu) of Pseudomonas aeruginosa in BALF. Ten of the 14 recipients with unopposed NE in bronchoalveolar lavage (BAL) had developed obliterative bronchiolitis (OB), but only 8 of the 38 subjects without unopposed NE activity had OB (p = 0. 002; Fisher exact test). We conclude that antiprotease defenses in lower respiratory tract secretions of CF patients receiving lung allografts are sufficient in the majority of patients to prevent unopposed NE activity. However, the presence of unopposed NE activity in BAL from lung allografts of patients with CF is associated with progressive, irreversible OB and graft failure.
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Affiliation(s)
- D Nunley
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and University of Wisconsin Medical School, Madison, Wisconsin, USA
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Conley RR, Tamminga CA, Bartko JJ, Richardson C, Peszke M, Lingle J, Hegerty J, Love R, Gounaris C, Zaremba S. Olanzapine compared with chlorpromazine in treatment-resistant schizophrenia. Am J Psychiatry 1998; 155:914-20. [PMID: 9659857 DOI: 10.1176/ajp.155.7.914] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of olanzapine with that of chlorpromazine plus benztropine in patients with treatment-resistant schizophrenia. METHOD One hundred three previously treatment-resistant patients with schizophrenia diagnosed according to the DSM-III-R criteria were given a prospective 6-week trial of 10-40 mg/day of haloperidol. Eighty-four of them failed to respond to that trial and agreed to be randomly assigned to an 8-week fixed-dose trial of either 25 mg/day of olanzapine alone or 1200 mg/day of chlorpromazine plus 4 mg/day of benztropine mesylate. RESULTS Fifty-nine (70%) of the 84 subjects completed the trial. The primary outcome measures were Brief Psychiatric Rating Scale total score and positive symptom score, Scale for the Assessment of Negative Symptoms global score, and Clinical Global Impression score. An analysis of variance for the subjects who completed the study showed no difference in efficacy between the two drugs. Seven percent of the olanzapine-treated patients responded according to a priori criteria; no chlorpromazine-treated patients responded. The olanzapine-treated patients had fewer motor and cardiovascular side effects than the chlorpromazine-treated patients. Extrapyramidal symptoms and akathisia were similar in the two groups, although no antiparkinsonian drugs were used in the olanzapine group. CONCLUSIONS Olanzapine and chlorpromazine showed similar efficacy, and the total amount of improvement with either drug was modest. Olanzapine-treated patients had fewer side effects than chlorpromazine-treated patients.
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Affiliation(s)
- R R Conley
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore 21228, USA
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39
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40
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DeRenzo EG, Conley RR, Love R. Assessment of capacity to give consent to research participation: state-of-the-art and beyond. J Health Care Law Policy 1998; 1:66-87. [PMID: 15573430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- E G DeRenzo
- Department of Clinical Bioethics, National Institutes of Health, USA
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Steinberg S, Azar G, Love R, Lee R, Choe E, Flint L. Dopexamine prevents depression of mesenteric blood flow caused by positive end-expiratory pressure in rats. Surgery 1996; 120:597-601; discussion 601-2. [PMID: 8862366 DOI: 10.1016/s0039-6060(96)80005-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effects of two vasoactive agents, dopamine and dopexamine, on the depression of mesenteric blood flow caused by positive end-expiratory pressure (PEEP) during mechanical ventilation. METHODS Sprague-Dawley rats were mechanically ventilated with either no PEEP (control group) or increasing levels of PEEP (PEEP group) up to 20 cm H2O pressure. We evaluated PEEP's effect on blood pressure, cardiac output (CO), and the mesenteric microcirculation with a continuous infusion of 2.5 or 12.5 micrograms/kg/min dopamine or 1, 3, or 5 micrograms/kg/min dopexamine. RESULTS PEEP caused a 20% to 25% decrease in mean arterial pressure and a 30% decrease in CO at both 15 and 20 cm H2O of PEEP (all p < 0.05 versus baseline). Low dose dopamine partially corrected the decrease in CO to 16% and 21% below baseline at 15 and 20 cm H2O of PEEP, respectively (both p < 0.05 versus PEEP group) and partially ameliorated the depression of mesenteric blood flow associated with the application of PEEP. High dose dopamine did not positively affect either CO or mesenteric blood flow. Dopexamine had little effect on CO compared with dopamine. All three doses of dopexamine blocked the effect of PEEP on mesenteric blood flow (p < 0.05 compared with the PEEP group at all levels of PEEP, p < 0.05 compared with the low dose dopamine group at 15 and 20 cm H2O of PEEP). CONCLUSIONS Dopexamine is superior to dopamine in protecting mesenteric blood flow in the face of increasing levels of PEEP.
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Affiliation(s)
- S Steinberg
- Department of Surgery, Tulane University School of Medicine, New Orleans, La, USA
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Abstract
Clozapine is a tricyclic dibenzodiazepine derivative used as an antipsychotic in adults. Clozapine's safety in children has not been established. This report describes three unintentional clozapine ingestions in pediatric patients. These are the first reported cases of clozapine intoxication in children. All three patients demonstrated dramatic alterations in mental status and tone, and two demonstrated extrapyramidal effects. Serum clozapine levels obtained in two patients were within the average range of steady state plasma concentrations for adults. These cases show the dramatic presentations of pediatric ingestion of clozapine and the differences between adult and pediatric intoxications.
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Affiliation(s)
- S Mady
- Department of Emergency Medicine, University of Rochester, USA
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Azar G, Love R, Choe E, Flint L, Steinberg S. Neither dopamine nor dobutamine reverses the depression in mesenteric blood flow caused by positive end-expiratory pressure. J Trauma 1996; 40:679-85; discussion 685-7. [PMID: 8614064 DOI: 10.1097/00005373-199605000-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Positive end-expiratory pressure (PEEP) has been shown to cause a depression of mesenteric blood flow (MBF) and redistribution of blood flow away from the mesenteric vascular bed. OBJECTIVE We sought to determine whether two commonly used vasoactive agents, dopamine, a known mesenteric vasodilator and inotrope, and dobutamine, with its inotropic properties, would correct the MBF depression caused by PEEP. DESIGN, MATERIAL, AND METHODS: Sprague-Dawley rats, 180 to 250 g, were treated with mechanical ventilation and either no PEEP (control group) or increasing levels (0, 10, 15, and 20 cm of H2O pressure) of PEEP (PEEP group). Also, we evaluated PEEP's effect on MBF and cardiac output (CO) under the influence of a continuous infusion of 2.5 or 12.5 microgram/kg/min of dopamine or 2.5 or 12.5 microgram/kg/min of dobutamine. Cardiac output and, using in vivo videomicroscopy, mesenteric A1, A2, and A3 arteriolar intraluminal radii and A1 arteriolar optical Doppler velocities were measured. After 20 cm of H2O pressure PEEP was attained, two boluses of 2 mL of 0.9 normal saline were given. The MBF was calculated from vessel radius and red blood cell velocity. MEASUREMENTS AND MAIN RESULTS There were no significant changes from baseline in mean arterial pressure or A2 or A3 diameters in any of the groups. Both MBF and CO were unchanged over time in the control group. The MBF was reduced 78% (p < 0.05) and the CO was reduced 31% (p < 0.05) from baseline at 20 cm of H2O pressure PEEP. After 4 mL of normal saline, the MBF was still 53% below baseline (p < 0.05), while the CO had returned to baseline in the PEEP group. Low-dose dopamine partially ameliorated both the decrease in CO and MBF caused by PEEP, but 4 mL of normal saline was required in addition to the low-dose dopamine to return MBF to baseline levels while on 20 cm of H2O pressure PEEP. High-dose dopamine with the addition of 4 mL of normal saline returned CO to baseline on 20 cm of H2O pressure PEEP, but MBF remained approximately 46% below baseline despite fluid boluses. Neither low-dose nor high-dose dobutamine, with or without fluid boluses, had an appreciable positive effect on CO or MBF. CONCLUSIONS It is clear that inotropes are not a replacement for adequate fluid loading to correct the depression in cardiac output and mesenteric blood flow associated with the use of mechanical ventilation and PEEP. Low-dose dopamine may serve as an adjunct to adequate fluid resuscitation to improve MBF.
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Affiliation(s)
- G Azar
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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Gayther SA, Warren W, Mazoyer S, Russell PA, Harrington PA, Chiano M, Seal S, Hamoudi R, van Rensburg EJ, Dunning AM, Love R, Evans G, Easton D, Clayton D, Stratton MR, Ponder BA. Germline mutations of the BRCA1 gene in breast and ovarian cancer families provide evidence for a genotype-phenotype correlation. Nat Genet 1995; 11:428-33. [PMID: 7493024 DOI: 10.1038/ng1295-428] [Citation(s) in RCA: 368] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Mutations in the BRCA1 gene, discovered in 1994, are associated with an 80-90% lifetime risk of breast cancer. We have analysed 60 families with a history of breast and/or ovarian cancer for germline mutations in BRCA1. Twenty-two different mutations were detected in 32 families (53%), of which 14 are previously unreported. We observed a significant correlation between the location of the mutation in the gene and the ratio of breast to ovarian cancer incidence within each family. Our data suggest a transition in risk such that mutations in the 3' third of the gene are associated with a lower proportion of ovarian cancer. Haplotype analysis supports previous data which suggest some BRCA1 mutation carriers have common ancestors; however, we have found at least two examples where recurrent mutations appear to have arisen independently.
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Affiliation(s)
- S A Gayther
- CRC Human Cancer Genetics Research Group, Addenbrooke's Hospital, Cambridge, UK
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Love R, Choe E, Lippton H, Flint L, Steinberg S. Positive end-expiratory pressure decreases mesenteric blood flow despite normalization of cardiac output. J Trauma 1995; 39:195-9. [PMID: 7674385 DOI: 10.1097/00005373-199508000-00003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Positive end-expiratory pressure (PEEP) is a commonly used adjunct to mechanical ventilation and is known to have deleterious effects on cardiac output (CO). Its effects on regional blood flow are not well known. We evaluated the effect of PEEP on the mesenteric microcirculation and CO. Sprague-Dawley rats were treated with mechanical ventilation and either no PEEP (Control) or increasing levels of PEEP (PEEP). Using in vivo video-microscopy, mesenteric A1 arteriolar optical Doppler velocities and A1 and A3 (the first- and third-order arterioles branching off the feeding mesenteric arcade) intraluminal diameters were measured (n = 6/group). In a separate set of experimental animals, CO was determined by thermodilution technique (n = 5/group). Additionally, after the PEEP group attained a PEEP level of 20-cm H2O PEEP, two boluses of 2 mL 0.9 normal saline (NS) were given intravenously. The Control groups had the same determinations performed over the same time course as the PEEP group but were not exposed to any PEEP. Mesenteric blood flow (MBF) was calculated from vessel diameter and red blood cell velocity. The MBF and CO fell progressively as PEEP was increased from 10- to 15- to 20-cm H2O pressure. MBF was reduced 75% (p < 0.05) and the CO was reduced 31% (p < 0.05) from baseline at 20-cm H2O pressure PEEP. After 4 mL normal saline, the MBF was still 45% below baseline (p < 0.05) while the CO had returned to baseline. In conclusion, both MBF and CO are decreased significantly with increasing PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Love
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
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Jacoby RF, Marshall DJ, Kailas S, Schlack S, Harms B, Love R. Genetic instability associated with adenoma to carcinoma progression in hereditary nonpolyposis colon cancer. Gastroenterology 1995; 109:73-82. [PMID: 7797042 DOI: 10.1016/0016-5085(95)90270-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Genetic instability related to defective DNA mismatch repair genes may be involved in the pathogenesis of carcinoma in hereditary nonpolyposis colon cancer (HNPCC). However, nonneoplastic tissues from patients inheriting defects in human MSH2 or human MLH1 do not show significant genetic instability. The aim of this study was to determine whether acquisition of genetic instability at the adenoma stage promotes malignant transformation by studying adenoma-carcinoma progression in HNPCC. METHODS Dinucleotide repeat loci were analyzed by polymerase chain reaction from microdissected adenoma and/or carcinoma stages from formalin-fixed paraffin-embedded HNPCC tumors. RESULTS Although genetic instability was observed at some loci in almost all cases, the proportion of microsatellite loci altered was significantly less (P < 0.01) in completely benign adenomas (24%) than in benign areas of adenomas with malignancy (54%). Molecular fingerprints indicated intratumor heterogeneity, with evolution of related subclones of neoplastic cells. However, in all cases of tumor progression, at least one subclone from the adenoma stage was closely related to the carcinoma. CONCLUSIONS Some genetic instability develops at the benign adenoma stage in most HNPCC tumors. Adenomas with a greater rate of genetic instability are more likely to progress to carcinoma. Topographic genotyping data provides evidence supporting the hypothesis of adenoma-carcinoma progression in HNPCC.
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Affiliation(s)
- R F Jacoby
- Division of Gastroenterology, University of Wisconsin, Madison, USA
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Love R, Greer G, McKay J. Fort Worth District Dental Society mass disaster dental team's Mt. Carmel fire experience: clinical overview. Tex Dent J 1993; 110:11-17. [PMID: 8273017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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48
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Saffle JR, Davis B, Kagan R, Purdue G, Fitzpatrick K, Clark W, Cruse W, Jordan M, Love R, Devaney M. Development of a computerized registry for the patient with burns: Part II. J Burn Care Rehabil 1993; 14:368-75. [PMID: 8360246 DOI: 10.1097/00004630-199305000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- J R Saffle
- University of Utah Medical Center, Salt Lake City 84132
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Soutar C, Campbell S, Gurr D, Lloyd M, Love R, Cowie H, Cowie A, Seaton A. Important deficits of lung function in three modern colliery populations. Relations with dust exposure. Am Rev Respir Dis 1993; 147:797-803. [PMID: 8466112 DOI: 10.1164/ajrccm/147.4.797] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To determine whether dust-related "clinically important" deficits of lung function still occur in British coal miners we have analyzed the relationship between lifetime cumulative exposure to respirable dust and risk of defined functional deficits in a population of miners who were examined between 1981 and 1986. The study group consisted of a sample of men who had worked at any one of three collieries (South Wales, Yorkshire, and North East England) between 1970, when new dust standards were introduced, and date of medical survey. There were 1,671 men studied, including men who had left the collieries. "Clinically important" deficits of FEV1 from predicted values derived in this population were defined by comparisons with questionnaire data on exercise tolerance limited by breathlessness. The mean FEV1 of men in the South Wales colliery, for example, who said they had to stop for breath when walking at their own pace on level ground was 942 ml less than the predicted value for nonsmokers after taking age and stature into account. Individual cumulative exposures to respirable dust were calculated from a long-term program of measurements of dust concentrations and occupational records commencing in 1953. In the three colliery populations, 24, 24, and 12% in South Wales, Yorkshire, and the North East, respectively, had FEV1 deficits that were at least as severe as the average deficit associated with the severe grade of exertional dyspnea described above. In all collieries deficits were more common in smokers than in nonsmokers, and more common in men who had left the industry than in men still within it.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Soutar
- Institute of Occupational Medicine, Edinburgh, Scotland
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Abstract
In this study we examined the relative effects of reducing eyedrop size (from 30 microliters to 10 microliters) and eyelid closure on the ocular efficacy and systemic absorption of 10% phenylephrine. Thirteen subjects participated in a quadruple crossover study that involved dilation with a 10-microliters and a 30-microliters drop of phenylephrine with and without eyelid closure. The 10-microliters drop was just as effective for pupillary dilation as the 30-microliters drop. Eyelid closure improved dilation for both drop sizes. Both eyelid closure and reducing the drug volume decreased systemic absorption of phenylephrine as measured by plasma concentration. When used together, eyelid closure and the smaller drop size reduced plasma concentration by 45%. The therapeutic index for 10% phenylephrine appears to be improved by using a 10-microliters drop followed by eyelid closure.
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Affiliation(s)
- J T Whitson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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