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Forsha D, Ptomey L, Johnson T, Goth N, Kuzava L, France R, Kathol M, Artman M, Donnelly J. P1548 Changes in left ventricular deformation with weight loss in obese adolescents with intellectual and developmental delays (IDD). Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.969] [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
Funding Acknowledgements
AHA Career Development grant
Background
Adolescents with IDD have twice the prevalence of obesity as their typically developed peers, leading to frequent early obesity-related subclinical cardiac dysfunction, detected by strain echo. The effects of weight loss on cardiac deformation are unknown in this population.
Purpose
To evaluate early cardiac dysfunction in overweight IDD adolescents before and after a 6-month caloric restriction-weight loss program.
Methods
Subjects with IDD co-enrolling in a weight loss program were consented for this strain imaging study, excluding those with congenital heart disease. An echo measuring LVEF (bullet), 2D speckle longitudinal LV global strain (GLS) and strain rate (GLSr) from 3 apical views and global circumferential strain from a parasternal short axis view at the paps (GCS) was performed at baseline and 6 months. Analysis included paired T-test and regression analysis, p ≤ 0.05 significant.
Results
Overweight (5) and obese (15) adolescents (40% female) had baseline LV strain measurements that were mildly diminished with increased baseline body weight predicting diminished GLS (P = 0.034) and GCS (P = 0.046) on regression modeling. After 6 months, weight and BMI decreased significantly with improvements in GLS and GCS and non-significant trends towards improvement in GLSr and early diastolic global strain rate. BMI change at 6 months predicted change in GLS (p = 0.015) and GCS (p = 0.0087) on regression modeling. At baseline, LVEF and LV end-diastolic volume were normal with no change over 6 months (p > 0.55).
Conclusions
Baseline abnormalities in LV deformation with preserved LVEF are present in this young, obese IDD population with improvements in BMI predicting those in GLS and GCS after a 6-month caloric restriction-weight loss program. These data provide compelling justification for larger studies in this population.
n Baseline (mean ± SD) 6-mo. follow up 0-6 mo. change p-value Age (years) 20 17.0 ± 2.0 17.5 ± 2.1 0.5 ± 0.1 Weight (kg) 20 86.9 ± 22.2 83.1 ± 22.7 -3.7 ± 5.9 0.014 BMI (kg/m²) 20 32.2 ± 5.3 30.4 ± 5.7 -1.8 ± 2.2 0.0031 GLS (%) 20 16.9 ± 1.6 19.2 ± 2.7 2.4 ± 2.0 0.00023 GLSr 20 1.15 ± 0.018 1.22 ± 0.18 0.06 ± 0.16 0.096 EaGLSr 20 1.83 ± 0.038 2.01 ± 0.46 0.18 ± 0.45 0.098 GCS (%) 20 19.1 ± 2.3 22.0 ± 2.6 2.82 ± 2.6 0.00019 LV deformation before and after weight loss. GLS, GLSr, and GCS are reported as positive values (absolute values). Body Mass Index (BMI); Early Diastolic Global Longitudinal Strain Rate (EaGLSr)
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Affiliation(s)
- D Forsha
- Children"s Mercy Hospital, Kansas City, United States of America
| | - L Ptomey
- University of Kansas Medical Center, Kansas City, United States of America
| | - T Johnson
- Children"s Mercy Hospital, Kansas City, United States of America
| | - N Goth
- Children"s Mercy Hospital, Kansas City, United States of America
| | - L Kuzava
- Children"s Mercy Hospital, Kansas City, United States of America
| | - R France
- Children"s Mercy Hospital, Kansas City, United States of America
| | - M Kathol
- Children"s Mercy Hospital, Kansas City, United States of America
| | - M Artman
- Children"s Mercy Hospital, Kansas City, United States of America
| | - J Donnelly
- University of Kansas Medical Center, Kansas City, United States of America
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Abelson A, Nelson PA, Edgar GJ, Shashar N, Reed DC, Belmaker J, Krause G, Beck MW, Brokovich E, France R, Gaines SD. Expanding marine protected areas to include degraded coral reefs. Conserv Biol 2016; 30:1182-1191. [PMID: 26991947 DOI: 10.1111/cobi.12722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 02/08/2016] [Accepted: 03/08/2016] [Indexed: 05/12/2023]
Abstract
Marine protected areas (MPAs) are a commonly applied solution to coral reef degradation, yet coral reefs continue to decline worldwide. We argue that expanding the range of MPAs to include degraded reefs (DR-MPA) could help reverse this trend. This approach requires new ecological criteria for MPA design, siting, and management. Rather than focusing solely on preserving healthy reefs, our approach focuses on the potential for biodiversity recovery and renewal of ecosystem services. The new criteria would help identify sites with the highest potential for recovery and the greatest resistance to future threats (e.g., increased temperature and acidification) and sites that contribute to MPA connectivity. The DR-MPA approach is a compliment rather than a substitute for traditional MPA design approaches. We believe that the DR-MPA approach can enhance the natural, or restoration-assisted, recovery of DRs and their ecosystem services; increase total reef area available for protection; promote more resilient and better-connected MPA networks; and improve conditions for human communities dependent on MPA ecosystem services.
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Affiliation(s)
- A Abelson
- Department of Zoology, Tel Aviv University, Tel Aviv, 69978, Israel.
| | - P A Nelson
- H. T. Harvey & Associates, 983 University Avenue, Building D, Los Gatos, CA, 95032-7637, U.S.A
| | - G J Edgar
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart Tasmania, 7001, Australia
| | - N Shashar
- Eilat Campus, Ben-Gurion University, Eilat, Israel
| | - D C Reed
- Marine Science Institute University of California, Santa Barbara, CA, 93106-6150, U.S.A
| | - J Belmaker
- Department of Zoology, Tel Aviv University, Tel Aviv, 69978, Israel
| | - G Krause
- Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research (AWI), Earth System Knowledge Platform (ESKP), Bussestrasse 24, D-27570, Bremerhaven, Germany
| | - M W Beck
- Global Marine Team of The Nature Conservancy at the Institute of Marine Sciences, University of California, 1156 High Street, Santa Cruz, CA, 95064, U.S.A
| | - E Brokovich
- The Israel Society of Ecology and Environmental Sciences, Kehilat New-York Street, Tel Aviv, 6775323, Israel
| | - R France
- Department of Environmental Sciences, Dalhousie University, Truro, NS B2N 5E3, Canada
| | - S D Gaines
- Bren School of Environmental Science & Management, University of California, Santa Barbara, CA, 93106-6150, U.S.A
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Alamshah A, McGavigan AK, Spreckley E, Kinsey-Jones JS, Amin A, Tough IR, O'Hara HC, Moolla A, Banks K, France R, Hyberg G, Norton M, Cheong W, Lehmann A, Bloom SR, Cox HM, Murphy KG. L-arginine promotes gut hormone release and reduces food intake in rodents. Diabetes Obes Metab 2016; 18:508-18. [PMID: 26863991 PMCID: PMC4982043 DOI: 10.1111/dom.12644] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/31/2016] [Accepted: 02/07/2016] [Indexed: 12/14/2022]
Abstract
AIMS To investigate the anorectic effect of L-arginine (L-Arg) in rodents. METHODS We investigated the effects of L-Arg on food intake, and the role of the anorectic gut hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), the G-protein-coupled receptor family C group 6 member A (GPRC6A) and the vagus nerve in mediating these effects in rodents. RESULTS Oral gavage of L-Arg reduced food intake in rodents, and chronically reduced cumulative food intake in diet-induced obese mice. Lack of the GPRC6A in mice and subdiaphragmatic vagal deafferentation in rats did not influence these anorectic effects. L-Arg stimulated GLP-1 and PYY release in vitro and in vivo. Pharmacological blockade of GLP-1 and PYY receptors did not influence the anorectic effect of L-Arg. L-Arg-mediated PYY release modulated net ion transport across the gut mucosa. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) administration of L-Arg suppressed food intake in rats. CONCLUSIONS L-Arg reduced food intake and stimulated gut hormone release in rodents. The anorectic effect of L-Arg is unlikely to be mediated by GLP-1 and PYY, does not require GPRC6A signalling and is not mediated via the vagus. I.c.v. and i.p. administration of L-Arg suppressed food intake in rats, suggesting that L-Arg may act on the brain to influence food intake. Further work is required to determine the mechanisms by which L-Arg suppresses food intake and its utility in the treatment of obesity.
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MESH Headings
- Animals
- Appetite Depressants/administration & dosage
- Appetite Depressants/adverse effects
- Appetite Depressants/pharmacology
- Appetite Depressants/therapeutic use
- Arginine/administration & dosage
- Arginine/adverse effects
- Arginine/therapeutic use
- Cells, Cultured
- Dietary Supplements/adverse effects
- Energy Intake/drug effects
- Energy Metabolism/drug effects
- Gastrointestinal Agents/administration & dosage
- Gastrointestinal Agents/adverse effects
- Gastrointestinal Agents/pharmacology
- Gastrointestinal Agents/therapeutic use
- Glucagon-Like Peptide 1/agonists
- Glucagon-Like Peptide 1/blood
- Glucagon-Like Peptide 1/metabolism
- In Vitro Techniques
- Injections, Intraperitoneal
- Injections, Intraventricular
- Intestinal Mucosa/cytology
- Intestinal Mucosa/drug effects
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Obesity/diet therapy
- Obesity/drug therapy
- Obesity/metabolism
- Obesity/pathology
- Peptide YY/agonists
- Peptide YY/blood
- Peptide YY/metabolism
- Random Allocation
- Rats, Wistar
- Receptors, G-Protein-Coupled/agonists
- Receptors, G-Protein-Coupled/antagonists & inhibitors
- Receptors, G-Protein-Coupled/genetics
- Receptors, G-Protein-Coupled/metabolism
- Weight Loss/drug effects
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Affiliation(s)
- A Alamshah
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - A K McGavigan
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - E Spreckley
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - J S Kinsey-Jones
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - A Amin
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - I R Tough
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - H C O'Hara
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - A Moolla
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - K Banks
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - R France
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - G Hyberg
- AstraZeneca R&D, Mölndal, Sweden
| | - M Norton
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - W Cheong
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - A Lehmann
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - S R Bloom
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - H M Cox
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K G Murphy
- Section of Endocrinology and Investigative Medicine, Department of Medicine, Imperial College London, London, UK
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McGavigan AK, O'Hara HC, Amin A, Kinsey-Jones J, Spreckley E, Alamshah A, Agahi A, Banks K, France R, Hyberg G, Wong C, Bewick GA, Gardiner JV, Lehmann A, Martin NM, Ghatei MA, Bloom SR, Murphy KG. L-cysteine suppresses ghrelin and reduces appetite in rodents and humans. Int J Obes (Lond) 2014; 39:447-55. [PMID: 25219528 PMCID: PMC4276721 DOI: 10.1038/ijo.2014.172] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND High-protein diets promote weight loss and subsequent weight maintenance, but are difficult to adhere to. The mechanisms by which protein exerts these effects remain unclear. However, the amino acids produced by protein digestion may have a role in driving protein-induced satiety. METHODS We tested the effects of a range of amino acids on food intake in rodents and identified l-cysteine as the most anorexigenic. Using rodents we further studied the effect of l-cysteine on food intake, behaviour and energy expenditure. We proceeded to investigate its effect on neuronal activation in the hypothalamus and brainstem before investigating its effect on gastric emptying and gut hormone release. The effect of l-cysteine on appetite scores and gut hormone release was then investigated in humans. RESULTS l-Cysteine dose-dependently decreased food intake in both rats and mice following oral gavage and intraperitoneal administration. This effect did not appear to be secondary to behavioural or aversive side effects. l-Cysteine increased neuronal activation in the area postrema and delayed gastric emptying. It suppressed plasma acyl ghrelin levels and did not reduce food intake in transgenic ghrelin-overexpressing mice. Repeated l-cysteine administration decreased food intake in rats and obese mice. l-Cysteine reduced hunger and plasma acyl ghrelin levels in humans. CONCLUSIONS Further work is required to determine the chronic effect of l-cysteine in rodents and humans on appetite and body weight, and whether l-cysteine contributes towards protein-induced satiety.
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Affiliation(s)
- A K McGavigan
- Department of Investigative Medicine, Imperial College London, London, UK
| | - H C O'Hara
- Department of Investigative Medicine, Imperial College London, London, UK
| | - A Amin
- Department of Investigative Medicine, Imperial College London, London, UK
| | - J Kinsey-Jones
- Department of Investigative Medicine, Imperial College London, London, UK
| | - E Spreckley
- Department of Investigative Medicine, Imperial College London, London, UK
| | - A Alamshah
- Department of Investigative Medicine, Imperial College London, London, UK
| | - A Agahi
- Department of Investigative Medicine, Imperial College London, London, UK
| | - K Banks
- Department of Investigative Medicine, Imperial College London, London, UK
| | - R France
- Department of Investigative Medicine, Imperial College London, London, UK
| | - G Hyberg
- AstraZeneca R&D, Mölndal, Sweden
| | - C Wong
- Department of Investigative Medicine, Imperial College London, London, UK
| | - G A Bewick
- 1] Department of Investigative Medicine, Imperial College London, London, UK [2] Division of Diabetes & Nutritional Sciences, King's College London, London, UK
| | - J V Gardiner
- Department of Investigative Medicine, Imperial College London, London, UK
| | - A Lehmann
- 1] AstraZeneca R&D, Mölndal, Sweden [2] NextRx, Gothenburg, Sweden
| | - N M Martin
- Department of Investigative Medicine, Imperial College London, London, UK
| | - M A Ghatei
- Department of Investigative Medicine, Imperial College London, London, UK
| | - S R Bloom
- Department of Investigative Medicine, Imperial College London, London, UK
| | - K G Murphy
- Department of Investigative Medicine, Imperial College London, London, UK
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France R, Sampson L, Bravery R, Low J, Candy B. Volunteer activity in end–of-life care: a national survey of current practice. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000264.25] [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: 11/04/2022]
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Abstract
BACKGROUND Pancreatic sepsis can occur after contrast injection into an obstructed or disrupted pancreatic duct. Whether stents cause or prevent pancreatic sepsis is unknown. Accordingly, the pancreatic duct bacteriology in patients with pancreatic duct stents was retrospectively reviewed and contrasted with biliary cultures taken from patients at the time of bile duct stent retrieval and/or exchange. METHODS Of 61 patients (29 men, 32 women; 72 stents; mean age 51 [16] years, range 14-88 years), 36 with pancreatic duct stents had pancreatic duct cultures obtained at the time of stent exchange and/or retrieval. The results of these cultures were compared with bile duct cultures taken from 36 patients at the time of biliary stent exchange/retrieval. Eleven of the 36 patients with pancreatic duct stents also had bile duct stents. Data collected included stent patency, clinical sepsis at initial stent placement or retrieval, administration of antibiotics before the procedure, indication for stent placement, stent duration, and culture results. RESULTS At stent retrieval and/or exchange, all 61 patients with pancreatic and/or biliary stents had contamination of the respective ducts with multiple enteric bacteria (mean 3.4 organisms in patients with pancreatic duct stents vs. 3.3 in those with bile duct stents). Clostridium perfringens was found in 17% and 0% of patients with, respectively, bile duct and pancreatic duct stents. Among the most common indications for pancreatic duct stent placement were stricture (28), sphincterotomy (9), leak (7), stones (3), and dilated pancreatic duct (1). Indications for a biliary stent included benign stricture (29), malignancy (6), stones (2), cholangitis (1), chronic pancreatitis (1), and dilated common bile duct (1). Pancreatic cultures were taken at a median of 85 days (interquartile range 60-126; range 13-273) and biliary cultures at a median of 87 days (interquartile range 45-149; range 19-927) after stent placement. Eleven patients, 6 with a bile duct stent, 4 with a pancreatic duct stent, and one with dual stents, developed pre-exchange/retrieval clinical sepsis; 3 had pancreatic sepsis. All had received antibiotics at initial placement. In the 11 patients with sepsis (12 stents), 8 stents were completely occluded at exchange/retrieval, 3 were partially occluded, and one was patent. In 50 patients (60 stents), no clinical sepsis developed; 7 stents were patent, 31 partially occluded, and 22 completely obstructed. CONCLUSIONS (1) Comparable to patients with biliary stents, all patients with pancreatic stents had contamination of the pancreatic ductal system by enteric flora. (2) In contrast to the 17% of patients with bile duct stents who had intraductal Clostridium perfringens, there were no instances of contamination with this organism in patients with pancreatic stent (p = 0.025), although, after adjusting for multiple comparisons, statistical significance was lost. (3) There was a tendency for stent occlusion to predispose to pancreatic sepsis, but occlusion by itself was insufficient (p = 0.106). (4) Further investigation is required to define the additional variables that are associated with the development of pancreatic sepsis.
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Affiliation(s)
- Richard Kozarek
- Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington 98101, USA
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Kozarek RA, Brandabur JJ, Ball TJ, Gluck M, Patterson DJ, Attia F, France R, Traverso LW, Koslowski P, Gibbons RP. Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2002; 56:496-500. [PMID: 12297763 DOI: 10.1067/mge.2002.128105] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is controversy as to whether extracorporeal shock wave lithotripsy fragmentation and ERCP retrieval of pancreatic stones are associated with relief of chronic pain or relapsing attacks of pancreatitis. Our most recent experience with this technology is reviewed. METHODS Forty patients with chronic calcific pancreatitis who required extracorporeal shock wave lithotripsy between 1995 and 2000 to facilitate pancreatic duct stone removal were retrospectively reviewed. Data collected included patient presentation, number of lithotripsy and ERCP sessions required, complications, and outcomes measures to include pre- and post-ESWL pain scale, monthly oxycodone (5 mg)-equivalent pills ingested, yearly hospitalizations, and need for subsequent surgery. RESULTS A single extracorporeal shock wave lithotripsy session was required for 35 patients who underwent a total of 86 ERCPs to achieve complete stone extraction from the main pancreatic duct. Minor complications occurred in 20%. There was one episode of pancreatic sepsis that was treated with antibiotics and removal of an occluded pancreatic prosthesis. At a mean [SD] follow-up of 2.4 (0.6) years, 80% of patients had avoided surgery and there was a statistically significant decrease in pain scores (6.9 [1.3] vs. 2.9 [1.1]; p = 0.001), yearly hospitalizations for pancreatitis (3.9 [1.9] vs. 0.9 [0.9]; p = 0.001), and oxycodone-equivalent narcotic medication ingested monthly (125 [83] vs. 81 [80]; p = 0.03). CONCLUSIONS Extracorporeal shock wave lithotripsy fragmentation of pancreatic duct calculi in conjunction with endoscopic clearance of the main pancreatic duct is associated with significant improvement in clinical outcomes in most patients with chronic pancreatitis.
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Affiliation(s)
- Richard A Kozarek
- Sections of Gastroenterology, Urology, and General Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA
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Kozarek RA, Brandabur JJ, Ball TJ, Gluck M, Patterson DJ, Attia F, France R, Traverso LW, Koslowski P, Gibbons RP. Clinical outcomes in patients who undergo extracorporeal shock wave lithotripsy for chronic calcific pancreatitis. Gastrointest Endosc 2002. [PMID: 12297763 DOI: 10.1016/s0016-5107(02)70432-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is controversy as to whether extracorporeal shock wave lithotripsy fragmentation and ERCP retrieval of pancreatic stones are associated with relief of chronic pain or relapsing attacks of pancreatitis. Our most recent experience with this technology is reviewed. METHODS Forty patients with chronic calcific pancreatitis who required extracorporeal shock wave lithotripsy between 1995 and 2000 to facilitate pancreatic duct stone removal were retrospectively reviewed. Data collected included patient presentation, number of lithotripsy and ERCP sessions required, complications, and outcomes measures to include pre- and post-ESWL pain scale, monthly oxycodone (5 mg)-equivalent pills ingested, yearly hospitalizations, and need for subsequent surgery. RESULTS A single extracorporeal shock wave lithotripsy session was required for 35 patients who underwent a total of 86 ERCPs to achieve complete stone extraction from the main pancreatic duct. Minor complications occurred in 20%. There was one episode of pancreatic sepsis that was treated with antibiotics and removal of an occluded pancreatic prosthesis. At a mean [SD] follow-up of 2.4 (0.6) years, 80% of patients had avoided surgery and there was a statistically significant decrease in pain scores (6.9 [1.3] vs. 2.9 [1.1]; p = 0.001), yearly hospitalizations for pancreatitis (3.9 [1.9] vs. 0.9 [0.9]; p = 0.001), and oxycodone-equivalent narcotic medication ingested monthly (125 [83] vs. 81 [80]; p = 0.03). CONCLUSIONS Extracorporeal shock wave lithotripsy fragmentation of pancreatic duct calculi in conjunction with endoscopic clearance of the main pancreatic duct is associated with significant improvement in clinical outcomes in most patients with chronic pancreatitis.
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Affiliation(s)
- Richard A Kozarek
- Sections of Gastroenterology, Urology, and General Surgery, Virginia Mason Medical Center, Seattle, Washington 98101, USA
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France R, Westcott K, del Giorgio P, Klein G, Kalff J. Vertical foodweb structure of freshwater zooplankton assemblages estimated by stable nitrogen isotopes. ACTA ACUST UNITED AC 1996. [DOI: 10.1007/bf02515738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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France R, Culbert H, Peters R. Decreased Carbon and Nutrient Input to Boreal Lakes from Particulate Organic Matter Following Riparian Clear-Cutting. Environ Manage 1996; 20:579-583. [PMID: 8661623 DOI: 10.1007/bf01474657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The plankton communities of oligotrophic Canadian Shield lakes are strongly regulated by the allochthonous supply of total phosphorus (TP) and dissolved organic carbon (DOC), a proportion of both of which originate from particulate organic matter. Although decreased inputs of allochthonous leaf litter have been documented for small streams whose riparian forests have been removed, no such data exist for boreal lakes. Through estimates of airborne litter input from forested and clear-cut shorelines and laboratory measurements of concentrations released from leaf leachate, we determined that riparian deforestation resulted in reductions of DOC from 17.8 to 0.4 g/m shoreline/yr and of TP from 2.9 to 0.3 g/m shoreline/yr. Previous predictive models indicate that such reductions may be substantial enough to decrease basic metabolic processes of lake plankton communities by as much as 9% in primary production and 17% in respiration.
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Affiliation(s)
- R France
- Department of Biology, McGill University, 1205 Ave. Dr. Penfield, Montreal, Quebec H3A 1B1, Canada
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Whalen FL, France R. A lab's outreach for healthier school kids. MLO Med Lab Obs 1996; 28:59-61. [PMID: 10154377] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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France R, Robson M. Counselling in general practice. BMJ 1993; 306:390. [PMID: 8285930 PMCID: PMC1676470 DOI: 10.1136/bmj.306.6874.390-b] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Krishnan K, France R, Pelton S. Chronic pain and depression. Pain 1990. [DOI: 10.1016/0304-3959(90)92901-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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France R. Psychological services to general practice. Br Med J (Clin Res Ed) 1987; 295:454-5. [PMID: 3117167 PMCID: PMC1247323 DOI: 10.1136/bmj.295.6596.454-a] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
The pattern and frequency of neurovegetative symptoms was studied in 57 patients with chronic pain. Seventy-nine percent of these patients had a diagnosable depressive illness, but endogenous depression was rare (5%). Patients with chronic pain were divided into major depressives, minor/intermittent depressives and patients with no depression. A control group of nonendogenous major depressives without pain was also utilized. Major depressives differed from the other two chronic pain groups in that there was more frequent or severe early waking, weight loss, anorexia, diminished libido and initial insomnia. Diurnal variation of mood was not a characteristic of major depression with chronic pain, and did not differ in frequency from the other two chronic pain groups. Major depressives exhibited a profile of neurovegetative symptoms very similar to that found in the control group of major depressives. Over one-third of minor/intermittent depressed patients with chronic pain exhibited atypical (reversed) vegetative symptoms of hyperphagia and weight gain. This finding, together with our review of the literature, suggests an important and previously unrecognized link between atypical depression and chronic pain.
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Abstract
In a controlled, evaluated study of a behaviourally orientated clinical psychology service based in a health centre two randomised groups of patients were compared. Patients in the control group received usual primary care management; subject patients received the same, but in addition were able to consult a clinical psychologist in the health centre. Outcome was assessed by psychosocial and economic measures. These showed changes in favour of the subject condition, many of which were statistically significant.
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Serafin D, Dimond M, France R. Factitious Vesicocutaneous Fistula: An Enigma in Diagnosis and Treatment. J Urol 1984. [DOI: 10.1016/s0022-5347(17)50791-0] [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: 11/16/2022]
Affiliation(s)
- D. Serafin
- Division of Plastic, Reconstructive and Maxillofacial Surgery and Division of Psychosomatic Medicine at Duke University Medical Center, Durham, North Carolina
| | - M. Dimond
- Division of Plastic, Reconstructive and Maxillofacial Surgery and Division of Psychosomatic Medicine at Duke University Medical Center, Durham, North Carolina
| | - R. France
- Division of Plastic, Reconstructive and Maxillofacial Surgery and Division of Psychosomatic Medicine at Duke University Medical Center, Durham, North Carolina
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Serafin D, Dimond M, France R. Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment. Plast Reconstr Surg 1983; 72:81-9. [PMID: 6867181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.
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France R. From a casebook of behaviour therapy in general practice (1). Practitioner 1982; 226:1119-24. [PMID: 7111144] [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: 01/23/2023]
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24
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France R. From a casebook of behaviour therapy in general practice (2). Practitioner 1982; 226:1128-33. [PMID: 7111145] [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: 01/23/2023]
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25
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France R, Robson M. Work of the clinical psychologist in general practice: preliminary communication. J R Soc Med 1982; 75:185-9. [PMID: 7069684 PMCID: PMC1437565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A randomized, controlled trial to assess the value of a health centre-based clinical psychology service is described. Outcome is measured by means of (1) psychosocial rating scales; (2) drug costs; and (3) the costs of relevant hospital referrals. At the end of the first year, the six general practitioners had admitted 239 patients to the trial and of these 81 had been followed up for 34 weeks after entry. This preliminary report reviews the data obtained from these patients. The main finding is a tendency, which reaches statistical significance at some points, for those patients with access to a clinical psychologist to improve more rapidly on the psychosocial measures than the controls.
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Abstract
In a study of myocardial magnesium and calcium levels in 1236 samples of heart muscle taken at necropsy in 28 centres in England and Wales, samples from patients who died from ischaemic heart disease had a mean Mg level 23 microgram/g lower and a mean Ca level 4 microgram/g higher than the mean for the total series after allowance had been made for a number of relevant factors. Mg levels were slightly higher and Ca levels slightly lower in sudden than in lingering deaths. There was no evidence of any association between the tissue levels and the levels of Mg or Ca in domestic tap-water, but there was a weak association between mean tissue Mg level and IHD mortality rates in the various towns.
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Abstract
Studies demonstrating the antagonism by prostaglandins (PGs) of antidiuretic hormone (ADH) action led to the proposal that renal medullary PGs may act to attenuate the physiologic effects of ADH via a negative-feedback loop. Therefore, we examined urinary PG excretion, an indicator of renal PG synthesis, in rats with hereditary diabetes insipidus (DI) utilizing gas chromatography-mass spectrometry. The DI rats, devoid of ADH, excrete much less prostaglandin E2 (PGE2) than normal Long-Evans rats (39 +/- 5 vs. 228 +/- 53 ng/24 h, means +/- SE, P less than 0.005). DI and normal rats were treated for 35 days with ADH while separate groups of DI and normal controls received vehicle only. The ADH treatment increased urinary PGE2 excretion in DI rats to 233 +/- 35 ng/24 h whereas PGE2 excretion was unaffected by vehicle treatment. ADH treatment in normal rats similarly increased PGE2 excretion from 215 +/- 49 to 410 +/- 63 ng/24 h (P less than 0.05). To determine whether the rise in PGE2 excretion is the result of the rise in papillary osmolality, we subjected DI rats to dehydration, which increased urine osmolality from 130 +/- 10 to 302 +/- 12 mosmol/kg H2O but left urinary PGE2 unaffected. We conclude that ADH stimulates renal medullary PGE2 synthesis in vivo.
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France R, Gray ME, Stone WJ, Swift LL. Intracellular granules of the renal medulla in a case of potassium depletion due to renal potassium wasting. Electron microscopic comparison with renal medullary granules in the potassium-depleted rat. Am J Pathol 1978; 91:299-312. [PMID: 565595 PMCID: PMC2018195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An electron microscopic comparison was made of intracellular granules of the renal papilla and inner medulla in two types of potassium depletion: one in a 47-year-old white male with chronic potassium-wasting renal disease and the other in the experimentally depleted rat. The granules in both cases were composed of small and large vesicles; myelin figures; small particles; and dense bodies, with a partial, or complete, single limiting membrane. Ultrastructurally, the constituent elements of the granules were essentially the same in the two types of potassium depletion. It was concluded that the intracellular granules in the human tissue were the result of potassium depletion and a counterpart to those in the potassium-depleted rat.
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France R, Shelley WM, Gray ME. Abnormal intracellular granules of the renal papilla in a child with potassium depletion (Bartter's syndrome) and renal tuberous sclerosis. Johns Hopkins Med J 1974; 135:274-85. [PMID: 4411799] [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: 01/10/2023]
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France R, Stone WJ, Michelakis AM, Island DP, Merrill JM, Tolleson WJ. Renal potassium-wasting of unknown cause in a clinical setting of chronic potassium depletion: report of a case. South Med J 1973; 66:115-28. [PMID: 4683729 DOI: 10.1097/00007611-197301000-00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Killen DA, Gobbel WG, France R. Spontaneous aortico--left ventricular fistula associated with myxomatous transformation. Ann Thorac Surg 1969; 8:570-4. [PMID: 5387503 DOI: 10.1016/s0003-4975(10)66096-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bryant D, Cates RN, Singer GE, Walker CD, France R, Evans KM, Price J, Henley B, Porter AMW, Smith EL, Key IA, Whitehouse MS, Mason DP, Summerhayes J, Attenborough J, Cule J, May WJ, Faber VC, Bergel RE, Drake-Lee JWD, Hadfield GW, Whittingham W, Smith PS. Hospital Practitioner Grade. West J Med 1969. [DOI: 10.1136/bmj.1.5645.717-a] [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: 11/04/2022]
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Abstract
Three cases of left ventricular aneurysm secondary to external violence are reported. Each patient presented with a pseudoaneurysm of the left ventricle, following penetrating trauma in two instances and blunt trauma in the third instance. The interval between injury and diagnosis ranged from 5 months to 24 years. Two patients underwent successful resection of the aneurysm. Repair was not attempted in the third patient. Only 16 cases of post-traumatic left ventricular aneurysm have previously been reported. In 13 of the 19 cases available for review, the trauma was blunt and in six penetrating. The aneurysm could be determined to be a true aneurysm in five instances and a false aneurysm in eight instances. Complications (rupture, cardiac failure, embolism, and arrhythmia) proved fatal in eight cases. Each of the eight patients subjected to aneurysmectomy survived.
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Attenborough J, Aubrey DR, Auger H, Austin AJ, Bartlett CIS, Bellamy RCT, Bergel RC, Bryant D, Carpenter ME, Cates R, Christmas AR, Clyne GE, Collings-Wells JA, Crawshaw PFA, Cule JH, Dobbin LWB, Donovan B, Edwards J, Evans KM, Faber VC, France R, Gent NSC, Hadfield GW, Haskins TD, Henley B, Henry DO, Holden JJ, James JP, Kayll JN, Kent SG, Key IA, Kieft BT, Wright MFL, Lister CO, MacAdam AD, McNutt J, Mason JYJM, Mason DP, Mathewson J, May W, Morrison RWM, Narula YP, Price JCN, Norman JM, Page HJC, Perry JR, Poole PB, Porter AMW, Powell JK, Poyntz-Wright RC, Price DJ, Price J, Pritchard JNA, Robinson IH, Rust NE, Scriven JM, Singer GE, Smart PC, Smith PS, Summerhayes JLV, Tilly CR, Tipler HB, Trust DGL, Turner AG, Urquhart DRH, Walker CD, Wallace IW, Watson M, Whitehouse MS, Whittingham MA, Whittingham W, Williams EM, Winchurch B. Threat to Hospital Privileges. West J Med 1968. [DOI: 10.1136/bmj.1.5586.247] [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: 11/04/2022]
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France R, Buchanan RN, Sheldon MB. The So-Called Triple Symptom Complex of Behçet. Trans Am Clin Climatol Assoc 1950; 62:131-140. [PMID: 21407736 PMCID: PMC2241937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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