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Peahl AF, Pennathur H, Zacharek N, Naccarato A, Heberle-Rose H, Goodman J, Smith RD, Cohn A, Stout MJ, Fendrick AM, Moniz MH. Retrospective Use of Patients' Characteristics to Assess Variation in Prenatal Care Utilization. Am J Perinatol 2023. [PMID: 37579763 DOI: 10.1055/s-0043-1771505] [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: 08/16/2023]
Abstract
OBJECTIVE We used patients' medical and psychosocial risk factors to explore prenatal care utilization and health outcomes to inform prenatal care tailoring. STUDY DESIGN This retrospective cohort study assessed patients who gave birth at an academic institution from January 1 to December 31, 2018, using electronic health record (EHR) data. Patients were categorized into four phenotypes based on medical/psychosocial risk factors available in the EHR: Completely low risk; High psychosocial risk only; High medical risk only; and Completely high risk. We examined patient characteristics, visit utilization, nonvisit utilization (e.g., phone calls), and outcomes (e.g., preterm birth, preeclampsia) across groups. RESULTS Of 4,681 patients, the majority were age 18 to 35 (3,697, 79.0%), White (3,326, 70.9%), multiparous (3,263, 69.7%), and Completely high risk (2,752, 58.8%). More Black and Hispanic patients had psychosocial risk factors than White patients. Patients with psychosocial risk factors had fewer prenatal visits (10, interquartile range [IQR]: 8-12) than those without (11, IQR: 9-12). Patients with psychosocial risk factors experienced less time in prenatal care, more phone calls, and fewer EHR messages across the same medical risk group. Rates of preterm birth and gestational hypertension were incrementally higher with additional medical/psychosocial risk factors. CONCLUSION Data readily available in the EHR can assess the compounding influence of medical/psychosocial risk factor on patients' care utilization and outcomes. KEY POINTS · Medical and psychosocial needs in pregnancy can inform patient phenotypes and are associated with prenatal care use and outcomes.. · Patient phenotypes are associated with prenatal care use and outcomes.. · Patients with high psychosocial risk spent less time in prenatal care and had more phone calls in pregnancy.. · Tailored prenatal care models may proactively address differences in patient's needs..
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Affiliation(s)
- Alex F Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, University of Michigan Program on Women's Healthcare Effectiveness Research, Ann Arbor, Michigan
| | - Harini Pennathur
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Nicholas Zacharek
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Amanda Naccarato
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Hannah Heberle-Rose
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Jordan Goodman
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Roger D Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Amy Cohn
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - A Mark Fendrick
- University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
- Department of Obstetrics and Gynecology, University of Michigan Program on Women's Healthcare Effectiveness Research, Ann Arbor, Michigan
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Liang AC, Gliwa C, Loder CM, Dalton VK, Smith RD. Tubal Sterilization Requests at a Single Institution Following the Supreme Court Decision to Overturn the Constitutional Right to Abortion. JAMA 2023; 330:374-375. [PMID: 37490094 PMCID: PMC10370256 DOI: 10.1001/jama.2023.11073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/05/2023] [Indexed: 07/26/2023]
Abstract
This study uses data from electronic health records to examine the rate of tubal sterilization requests in 3 periods before and after the US Supreme Court’s 2022 Dobbs v Jackson Women’s Health Organization decision, compared with the same periods in 2019 and 2021, at a single institution in Michigan.
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Affiliation(s)
- Angela C. Liang
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Catherine Gliwa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Charisse M. Loder
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Roger D. Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Law C, Berger N, Faccioli M, Caine CA, Bateman IJ, Smith RD. Improving nutrition through carbon reduction policies: an online randomized experiment. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There has been increasing policy interest in changing dietary patterns to reduce diet-related diseases and improve population health. Meanwhile, the food choices people make every day have a determining impact on the climate change, with food systems responsible for a third of global greenhouse gas emissions. Current policies focused on dietary health are designed, implemented and evaluated in relative isolation, and there is a critical open question concerning the extent of possible synergy with an additional focus on carbon removal.
Methods
We analysed the changes in UK households’ food purchases from an online, randomized control experiment (n = 3933) designed to contrast respondents’ current food purchase behaviour with that under a range of potential tax and labelling policies targeting improvement in dietary health, alone or combined with those designed to reduce carbon emissions. We assessed changes in the healthiness of food baskets between interventions through indicators of: i) purchase of calories; ii) % of calories purchased from 23 food groups; and iii) relative changes in nutrient composition of food purchased.
Results
Food labelling and fiscal measures for both health and decarbonisation have a positive impact on dietary health, by reducing the calorie content of food purchases (p < 0.001). Adding carbon reduction considerations into health policies achieves nutritional improvement by further reducing fat and increasing fibre, resulting in a reduction of up to 193 kcal/person/day (95%CI: 172-214).
Conclusions
With an additional focus on planetary health, the combined (health + carbon) tax and food labelling policies could achieve a reduction in calorie content at a magnitude close to the Public Health England's estimate of average excess calories consumed by adults (195kcal).
Key messages
• Policies focused on achieving both nutrition and carbon reduction goals could achieve greater improvements in food choices and produce win-win scenarios.
• There is a need for greater dialogue and policy development between public health and environmental researchers, practitioners and policy makers.
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Affiliation(s)
- C Law
- School of Agriculture Policy and Development, University of Reading , Reading, UK
- Population Health Innovation Lab, LSHTM , London, UK
| | - N Berger
- Population Health Innovation Lab, LSHTM , London, UK
- Department of Epidemiology and Public Health , Sciensano, Brussels, Belgium
| | - M Faccioli
- School of International Studies, University of Trento , Trento, Italy
- Department of Economics, University of Exeter Business School , Exeter, UK
| | - CA Caine
- Exeter University Law School, Exeter University , Exeter, UK
| | - IJ Bateman
- Department of Economics, University of Exeter Business School , Exeter, UK
| | - RD Smith
- University of Exeter Medical School , Exeter, UK
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Tinker DD, Zimmermann N, Kimball TR, Smith RD, Lang SM. Sudden cardiac death in adult with prior history of Kawasaki disease without coronary artery involvement: A case report. Progress in Pediatric Cardiology 2021. [DOI: 10.1016/j.ppedcard.2021.101379] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stout MJ, Van De Ven CJM, Parekh VI, Pardo JL, Garifullin M, Xu M, Fenner DE, Smith RD. Use of Electronic Medical Records to Estimate Changes in Pregnancy and Birth Rates During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2111621. [PMID: 34081139 PMCID: PMC8176329 DOI: 10.1001/jamanetworkopen.2021.11621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The influence of the COVID-19 pandemic on fertility rates has been suggested in the lay press and anticipated based on documented decreases in fertility and pregnancy rates during previous major societal and economic shifts. Anticipatory planning for birth rates is important for health care systems and government agencies to accurately estimate size of economy and model working and/or aging populations. OBJECTIVE To use projection modeling based on electronic health care records in a large US university medical center to estimate changes in pregnancy and birth rates prior to and after the COVID-19 pandemic societal lockdowns. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all pregnancy episodes within a single US academic health care system retrospectively from 2017 and modeled prospectively to 2021. Data were analyzed September 2021. EXPOSURES Pre- and post-COVID-19 pandemic societal shutdown measures. MAIN OUTCOMES AND MEASURES The primary outcome was number of new pregnancy episodes initiated within the health care system and use of those episodes to project birth volumes. Interrupted time series analysis was used to assess the degree to which COVID-19 societal changes may have factored into pregnancy episode volume. Potential reasons for the changes in volumes were compared with historical pregnancy volumes, including delays in starting prenatal care, interruptions in reproductive endocrinology and infertility services, and preterm birth rates. RESULTS This cohort study documented a steadily increasing number of pregnancy episodes over the study period, from 4100 pregnancies in 2017 to 4620 in 2020 (28 284 total pregnancies; median maternal [interquartile range] age, 30 [27-34] years; 18 728 [66.2%] White women, 3794 [13.4%] Black women; 2177 [7.7%] Asian women). A 14% reduction in pregnancy episode initiation was observed after the societal shutdown of the COVID-19 pandemic (risk ratio, 0.86; 95% CI, 0.79-0.92; P < .001). This decrease appeared to be due to a decrease in conceptions that followed the March 15 mandated COVID-19 pandemic societal shutdown. Prospective modeling of pregnancies currently suggests that a birth volume surge can be anticipated in summer 2021. CONCLUSIONS AND RELEVANCE This cohort study using electronic medical record surveillance found an initial decline in births associated with the COVID-19 pandemic societal changes and an anticipated increase in birth volume. Future studies can further explore how pregnancy episode volume changes can be monitored and birth rates projected in real-time during major societal events.
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Affiliation(s)
- Molly J Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | | | - Vikas I Parekh
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Office of Capacity Operations, University of Michigan, Ann Arbor
| | - Jennifer L Pardo
- Office of Capacity Operations, University of Michigan, Ann Arbor
| | - Maxim Garifullin
- Office of Capacity Operations, University of Michigan, Ann Arbor
| | - Min Xu
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Roger D Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Peahl AF, Powell A, Berlin H, Smith RD, Krans E, Waljee J, Dalton VK, Heisler M, Moniz MH. Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021; 224:384.e1-384.e11. [PMID: 33039393 PMCID: PMC7543890 DOI: 10.1016/j.ajog.2020.10.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Randomized controlled trials document the safety and efficacy of reduced frequency prenatal visit schedules and virtual visits, but real-world data are lacking. Our institution created a prenatal care delivery model incorporating these alternative approaches to continue safely providing prenatal care during the coronavirus disease 2019 pandemic. OBJECTIVE To evaluate institutional-level adoption and patient and provider experiences with the coronavirus disease 2019 prenatal care model. STUDY DESIGN We conducted a single-site evaluation of a coronavirus disease 2019 prenatal care model incorporating a reduced frequency visit schedule and virtual visits deployed at a suburban academic institution on March 20, 2020. We used electronic health record data to evaluate institution-level model adoption, defined as changes in overall visit frequency and proportion of virtual visits in the 3 months before and after implementation. To evaluate the patient and provider experience with the coronavirus disease 2019 model, we conducted an online survey of all pregnant patients (>20 weeks' gestation) and providers in May 2020. Of note, 3 domains of care experience were evaluated: (1) access, (2) quality and safety, and (3) satisfaction. Quantitative data were analyzed with basic descriptive statistics. Free-text responses coded by the 3 survey domains elucidated drivers of positive and negative care experiences. RESULTS After the coronavirus disease 2019 model adoption, average weekly prenatal visit volume fell by 16.1%, from 898 to 761 weekly visits; the average weekly proportion of prenatal visits conducted virtually increased from 10.8% (97 of 898) to 43.3% (330 of 761); and the average visit no-show rate remained stable (preimplementation, 4.3%; postimplementation, 4.2%). Of those eligible, 74.8% of providers (77 of 103) and 15.0% of patients (253 of 1690) participated in the surveys. Patient respondents were largely white (180 of 253; 71.1%) and privately insured (199 of 253; 78.7%), reflecting the study site population. The rates of chronic conditions and pregnancy complications also differed from national prevalence. Provider respondents were predominantly white (44 of 66; 66.7%) and female (50 of 66; 75.8%). Most patients and almost all providers reported that virtual visits improved access to care (patients, 174 of 253 [68.8%]; providers, 74 of 77 [96.1%]). More than half of respondents (patients, 124 of 253 [53.3%]; providers, 41 of 77 [62.1%]) believed that virtual visits were safe. Nearly all believed that home blood pressure cuffs were important for virtual visits (patients, 213 of 231 [92.2%]; providers, 63 of 66 [95.5%]). Most reported satisfaction with the coronavirus disease 2019 model (patients, 196 of 253 [77.5%]; providers, 64 of 77 [83.1%]). In free-text responses, drivers of positive care experiences were similar for patients and providers and included perceived improved access to care through decreased barriers (eg, transportation, childcare), perceived high quality of virtual visits for low-risk patients and increased safety during the pandemic, and improved satisfaction through better patient counseling. Perceived drivers of negative care experience were also similar for patients and providers, but less common. These included concerns that unequal access to virtual visits could deepen existing maternity care inequities, concerns that the lack of home devices (eg, blood pressure cuffs) would affect care quality and safety, and dissatisfaction with poor patient-provider continuity and inadequate expectation setting for the virtual visit experience. CONCLUSION Reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers. Future research is needed to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the coronavirus disease 2019 pandemic to inform broader health policy decisions.
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Smith RD, McHugh GA, Quicke JG, Dziedzic KS, Healey EL. Comparison of reliability, construct validity and responsiveness of the IPAQ-SF and PASE in adults with osteoarthritis. Musculoskeletal Care 2021; 19:473-483. [PMID: 33683799 DOI: 10.1002/msc.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study assessed the measurement properties of two commonly used self-report physical activity (PA) measures: the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Physical Activity Scale for the elderly (PASE) in adults with osteoarthritis. METHODS Secondary analysis of the MOSAICS cluster randomised controlled trial baseline and 3-month follow-up questionnaires, total scores and subdomains of the IPAQ-SF and PASE were compared. Intra-class correlations (ICC) were used to assess test-retest reliability, measurement error was assessed using standard error of measurement (SEM), smallest detectable change (SDC) and 95% limits of agreement (LoA). Responsiveness was assessed using effect size (ES), standard responsive measurement (SRM) and response ratio (RR). RESULTS There was moderate correlation (r = 0.56) between the total IPAQ-SF scores (score ranges 0-16,398) and the total PASE scores (score ranges 0-400). Subdomain correlations were also moderate (ranges 0.39-0.57). The PASE showed greater reliability compared to the IPAQ-SF (ICC = 0.68; 0.61-0.74 95% CI and ICC = 0.64; 0.55-0.72, respectively). Measurement errors in both measures were large: PASE SEM = 46.7, SDC = 129.6 and 95% LoA ranges = -117 to 136, the IPAQ-SF SEM = 3532.2 METS-1 min-1 week , SDC = 9790.8 and 95% LoA ranges = -5222 to 5597. Responsiveness was poor: ES -0.14 and -0.16, SRM -0.21 and -0.21, and RR 0.12 and 0.09 for the IPAQ-SF and PASE, respectively. DISCUSSION The IPAQ-SF and PASE appear limited in reliability, measurement error and responsiveness. Researchers and clinicians should be aware of these limitations, particularly when comparing different levels of PA and monitoring PA levels changes over time in those with osteoarthritis.
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Affiliation(s)
- R D Smith
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - G A McHugh
- School of Healthcare, University of Leeds, Leeds, UK
| | - J G Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - K S Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
| | - E L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK
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Werner C, Mathkour MH, Scullen T, Houghton D, Lea G, Dallapiazza RF, Kahn LW, Smith RD. Effects of Medical Comorbidities on the Surgical Outcomes of Deep Brain Stimulation for Parkinson's Disease. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_651] [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: 11/15/2022] Open
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Zahedi K, Brooks M, Barone S, Rahmati N, Murray Stewart T, Dunworth M, Destefano-Shields C, Dasgupta N, Davidson S, Lindquist DM, Fuller CE, Smith RD, Cleveland JL, Casero RA, Soleimani M. Ablation of polyamine catabolic enzymes provokes Purkinje cell damage, neuroinflammation, and severe ataxia. J Neuroinflammation 2020; 17:301. [PMID: 33054763 PMCID: PMC7559641 DOI: 10.1186/s12974-020-01955-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polyamine catabolism plays a key role in maintaining intracellular polyamine pools, yet its physiological significance is largely unexplored. Here, we report that the disruption of polyamine catabolism leads to severe cerebellar damage and ataxia, demonstrating the fundamental role of polyamine catabolism in the maintenance of cerebellar function and integrity. METHODS Mice with simultaneous deletion of the two principal polyamine catabolic enzymes, spermine oxidase and spermidine/spermine N1-acetyltransferase (Smox/Sat1-dKO), were generated by the crossbreeding of Smox-KO (Smox-/-) and Sat1-KO (Sat1-/-) animals. Development and progression of tissue injury was monitored using imaging, behavioral, and molecular analyses. RESULTS Smox/Sat1-dKO mice are normal at birth, but develop progressive cerebellar damage and ataxia. The cerebellar injury in Smox/Sat1-dKO mice is associated with Purkinje cell loss and gliosis, leading to neuroinflammation and white matter demyelination during the latter stages of the injury. The onset of tissue damage in Smox/Sat1-dKO mice is not solely dependent on changes in polyamine levels as cerebellar injury was highly selective. RNA-seq analysis and confirmatory studies revealed clear decreases in the expression of Purkinje cell-associated proteins and significant increases in the expression of transglutaminases and markers of neurodegenerative microgliosis and astrocytosis. Further, the α-Synuclein expression, aggregation, and polyamination levels were significantly increased in the cerebellum of Smox/Sat1-dKO mice. Finally, there were clear roles of transglutaminase-2 (TGM2) in the cerebellar pathologies manifest in Smox/Sat1-dKO mice, as pharmacological inhibition of transglutaminases reduced the severity of ataxia and cerebellar injury in Smox/Sat1-dKO mice. CONCLUSIONS These results indicate that the disruption of polyamine catabolism, via coordinated alterations in tissue polyamine levels, elevated transglutaminase activity and increased expression, polyamination, and aggregation of α-Synuclein, leads to severe cerebellar damage and ataxia. These studies indicate that polyamine catabolism is necessary to Purkinje cell survival, and for sustaining the functional integrity of the cerebellum.
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Affiliation(s)
- Kamyar Zahedi
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, 45220, USA.
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
- Research Services, Veterans Affairs Medical Center, Albuquerque, NM, 87108, USA.
- Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, 915 Camino de Salud, Bldg. 289, IDTC 3315, Albuquerque, NM, 87113, USA.
- Present Address: Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, Albuquerque, NM, 87131, USA.
| | - Marybeth Brooks
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, 45220, USA
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
- Present Address: Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, Albuquerque, NM, 87131, USA
| | - Sharon Barone
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, 45220, USA
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
- Research Services, Veterans Affairs Medical Center, Albuquerque, NM, 87108, USA
- Present Address: Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, Albuquerque, NM, 87131, USA
| | - Negah Rahmati
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02129, USA
| | - Tracy Murray Stewart
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Matthew Dunworth
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Christina Destefano-Shields
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Nupur Dasgupta
- The Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Steve Davidson
- Department of Anesthesiology and Pain Research Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Diana M Lindquist
- Department of Radiology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Christine E Fuller
- Upstate Medical University Department of Pathology, Syracuse, NY, 13219, USA
| | - Roger D Smith
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - John L Cleveland
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, USA
| | - Robert A Casero
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Manoocher Soleimani
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, 45220, USA.
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
- Research Services, Veterans Affairs Medical Center, Albuquerque, NM, 87108, USA.
- Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, 915 Camino de Salud, Bldg. 289, IDTC 3315, Albuquerque, NM, 87113, USA.
- Present Address: Department of Internal Medicine, Division of Nephrology, University of New Mexico College of Medicine, Albuquerque, NM, 87131, USA.
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Peahl AF, Smith RD, Moniz MH. Prenatal care redesign: creating flexible maternity care models through virtual care. Am J Obstet Gynecol 2020; 223:389.e1-389.e10. [PMID: 32425200 PMCID: PMC7231494 DOI: 10.1016/j.ajog.2020.05.029] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/04/2022]
Abstract
Each year, nearly 4 million pregnant patients in the United States receive prenatal care—a crucial preventive service that improves pregnancy outcomes for mothers and their children. National guidelines currently recommend 12–14 in-person prenatal visits, a schedule that has remained unchanged since 1930. When scrutinizing the standard prenatal visit schedule, it becomes clear that prenatal care is overdue for a redesign. We have strong evidence of the benefits of prenatal services, such as screening for gestational diabetes and maternal vaccination. However, how to deliver these services is not clear. Studies of prenatal services consistently demonstrate that such care can be delivered in fewer than 14 visits and that patients do not need to visit clinics in person to receive all maternity services. Telemedicine has emerged as a promising care delivery option for patients seeking greater flexibility, and early trials leveraging virtual care and remote monitoring have shown positive maternal and fetal outcomes with high patient satisfaction. Our institution has worked for the past year on a new prenatal care pathway. Our initial work assessed the literature, elicited patient perspectives, and captured the insights of experts in patient-centered care delivery. There are 2 key principles that guide prenatal care redesign: (1) design care delivery around essential services, using in-person care for services that cannot be delivered remotely and offering video visits for other essential services, and (2) creation of flexible services for anticipatory guidance and psychosocial support that allow patients to tailor support to meet their needs through opt-in programs. The rise of coronavirus disease 2019 prompted us to extend this early work and rapidly implement a redesigned prenatal care pathway. In this study, we outline our experience in transitioning to a new prenatal care model with 4 in-person visits, 1 ultrasound visit, and 4 virtual visits (the 4-1-4 prenatal plan). We then explore how insights from this implementation can inform patient-centered prenatal care redesign during and beyond the coronavirus disease 2019 pandemic.
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Berger N, Cummins S, Smith RD, Cornelsen L. Patterns of beverage purchases amongst British households: a latent class analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Policies to tackle obesity have increasingly targeted drinks, in particular sugar-sweetened beverages (SSBs), as a major source of excess sugar and energy. However, precision targeting of policies is difficult as information on what types of consumers they might affect, and to what degree, is missing. To fill this gap, we categorised consumers on the basis of drink purchase behaviour and explored whether they are patterned by socio-demographic characteristics, total food purchasing and weight status.
Methods
We used latent class (LC) analysis to characterise patterns of drink purchases using the 2016 UK Kantar FMCG household purchase panel. We restricted analyses to frequent purchasers of drinks (n = 8,675) and used 6 drink categories: SSB; diet drink; fruit-/milk-based drinks; beer & cider; wine; and water. We used multinomial logistic and linear models to relate household characteristics, BMI and food purchase behaviours to LC membership.
Results
We identified 7 LCs. Disadvantaged households were more frequent in LCs with high volumes of SSBs ('SSB') and diet drinks ('Diet'). Higher BMI was more likely in LCs 'Diet' and 'SSB'. LC 'SSB' obtained higher total energy, relatively less energy from fruits and vegetables, and more energy from less healthy products, compared to others. LCs 'Diet' and 'SSB' obtained relatively more energy from sweet snacks.
Conclusions
Households who mainly purchased high volumes of SSBs or diet drinks were at greater risk of obesity and tended to purchase less healthy foods, including a high proportion of energy from sweet snacks. These households might additionally benefit from policies targeting unhealthy foods, such as sweet snacks, as a way of reducing excess energy intake.
Key messages
The effects of fiscal policies on SSB consumption is likely to vary across types of beverage consumers. Fiscal policies should be extended to sweet snacks as a major source of excess energy.
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Affiliation(s)
- N Berger
- Population Health Innovation Lab, LSHTM, London, UK
- Sciensano, Brussels, Belgium
| | - S Cummins
- Population Health Innovation Lab, LSHTM, London, UK
| | - R D Smith
- Faculty of Public Health and Policy, LSHTM, London, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - L Cornelsen
- Population Health Innovation Lab, LSHTM, London, UK
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Werner C, Mathkour M, Scullen T, Houghton D, Lea G, Dallapiazza RF, Kahn L, Smith RD. Effects of Medical Comorbidities on the Surgical Outcomes of Deep Brain Stimulation for Parkinson Disease: A Retrospective, Single-Institution Study. World Neurosurg 2020; 144:e347-e352. [PMID: 32853766 DOI: 10.1016/j.wneu.2020.08.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Advancing age and greater number of medical comorbidities are well-known risk factors for higher rates of surgical complications and undesirable outcomes. We sought to determine the risk of increasing medical comorbidities on surgical outcomes for patients with Parkinson disease undergoing deep brain stimulation (DBS) surgery. METHODS We retrospectively reviewed 107 consecutive patients who underwent DBS for Parkinson disease at Ochsner Medical Center in 2008-2018. Patients were stratified into 3 groups based on Elixhauser comorbidity index (ECI) at the time of surgery: 0, 1, or ≥2. Outcome measures were changes in Unified Parkinson's Disease Rating Scale III scores, changes in medications, and surgical complications. Analysis of variance, paired t test, and nonparametric equivalents were used for statistical analysis. RESULTS Of patients, 31 (29.0%) had ECI score 0, 44 (41.1%) had ECI score 1, and 32 (29.9%) had ECI score ≥2. For all groups, Unified Parkinson's Disease Rating Scale III scores decreased significantly postoperatively (P = 0.0014, P < 0.0001, P < 0.0001). All groups had a reduction in mean levodopa equivalent daily dose after surgery; however, only the group with ≥2 comorbidities achieved statistical significance (P = 0.0026). The rate of postoperative complications was significantly correlated with comorbidity score on univariate logistic regression analysis (P = 0.0425). CONCLUSIONS Our findings indicate that DBS is efficacious in patients with multiple medical comorbidities. However, patients with ≥1 medical comorbidities may be more likely to have complications. The most common observed complication was wound infection. Patients with medical comorbidities may still benefit significantly from DBS when performed at experienced centers.
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Affiliation(s)
- Cassidy Werner
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Tyler Scullen
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - David Houghton
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Georgia Lea
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | | | - Lora Kahn
- Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Roger D Smith
- Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA
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Zhen Y, Smith RD, Finkelman FD, Shao WH. Ezh2-mediated epigenetic modification is required for allogeneic T cell-induced lupus disease. Arthritis Res Ther 2020; 22:133. [PMID: 32503684 PMCID: PMC7275547 DOI: 10.1186/s13075-020-02225-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The mechanisms involved in the pathogenesis of autoimmune disorders, including systemic lupus erythematosus (SLE), have not been fully elucidated. Some of these mechanisms involve epigenetic regulation of gene expression. The histone methyltransferase Ezh2 contributes to epigenetic regulation of gene expression, is highly expressed in germinal center (GC) B cells and follicular T helper (TFH) cells, and may be involved in lupus pathogenesis. METHODS The murine bm12 model of lupus-like chronic graft versus host disease (cGVHD) was induced by intra-peritoneal injection of negatively isolated allogeneic CD4+ T cells. Lupus-like disease development was monitored by ELISA determination of serum anti-dsDNA and anti-chromatin antibody titers. Immune cell activation and Ezh2 expression were evaluated by flow cytometry and Western blotting. RESULTS Decreased autoantibody production and GC formation are observed when Ezh2-deficient CD4+ T cells are used instead of wild-type (WT) to induce cGVHD and when mice that receive allogeneic WT donor T cells to induce cGVHD are treated with GSK503, an Ezh2-specific inhibitor. In the bm12 cGVHD model, WT donor T cells are normally fully activated 1 week after infusion into an allogeneic host, exhibit a TFH cell (PD-1hi/CXCR5hi) phenotype with upregulated Ezh2, and activate B cells to form germinal centers (GCs). In contrast, Ezh2-deficient donor T cells generate fewer TFH cells that fail to activate B cells or promote GC formation. Despite similar T-independent, LPS-induced B cell responses, OVA-immunized CD4.Ezh2-KO mice had a skewed low-affinity IgM phenotype in comparison to similarly treated WT mice. In addition, early after OVA immunization, more CD4+ T cells from B6.CD4.Ezh2-KO mice had a CD44lo/CD62Llo phenotype, which suggests arrested or delayed activation, than CD4+ T cells from ovalbumin-immunized B6.WT mice. CONCLUSION Ezh2 gene deletion or pharmacological Ezh2 inhibition suppresses autoantibody production and GC formation in bm12 lupus-like cGVHD and decreases affinity maturation and isotype switching in response to immunization with a T cell-dependent antigen. Ezh2 inhibition may be useful for the treatment of lupus and other autoimmune disorders.
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Affiliation(s)
- Yuxuan Zhen
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Roger D Smith
- Department of Pathology, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Fred D Finkelman
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA.,Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Wen-Hai Shao
- Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA.
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Peahl AF, Kountanis JA, Smith RD. Postoperative urinary catheter removal for Enhanced Recovery After Cesarean protocols. Am J Obstet Gynecol 2020; 222:634. [PMID: 31981514 DOI: 10.1016/j.ajog.2020.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/17/2020] [Indexed: 11/24/2022]
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15
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Hanna JA, Scullen T, Kahn L, Mathkour M, Gouveia EE, Garces J, Evans LM, Lea G, Houghton DJ, Biro E, Bui CJ, Sulaiman OA, Smith RD. Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson's disease: long-term outcomes with up to 7 years of follow-up. J Neurosurg 2019; 131:807-812. [PMID: 30265192 DOI: 10.3171/2018.4.jns171909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 04/17/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is the procedure of choice for Parkinson's disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefits associated with the treatment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population. METHODS PD patients treated with DBS at the authors' institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defined as having an age at surgery ≥ 70 years, and 2) young patients, defined as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unified Parkinson's Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests. RESULTS A total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced significant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more significant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more significant reductions in daily doses (young 0.65 vs elderly 3.567, p = 0.0344). Both groups experienced significant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not significant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group. CONCLUSIONS This study found long-term improvements in motor function and medication requirements in both elderly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these findings.
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Affiliation(s)
- Joshua A Hanna
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Tyler Scullen
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Lora Kahn
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Mansour Mathkour
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | | | - Juanita Garces
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | | | - Georgia Lea
- 3Movement Disorders, Ochsner Clinic Foundation, New Orleans; and
| | - David J Houghton
- 3Movement Disorders, Ochsner Clinic Foundation, New Orleans; and
| | - Erin Biro
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Cuong J Bui
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Olawale A Sulaiman
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
| | - Roger D Smith
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana
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Triebwasser JE, Kamdar NS, Langen ES, Moniz MH, Basu T, Syrjamaki J, Thomason AC, Smith RD, Morgan DM. Hospital contribution to variation in rates of vaginal birth after cesarean. J Perinatol 2019; 39:904-910. [PMID: 30952949 PMCID: PMC6592715 DOI: 10.1038/s41372-019-0373-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). STUDY DESIGN This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation. RESULT Hospital-level adjusted rates varied nearly tenfold (3.7%-35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23-6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59-8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11-7.72]). The median OR suggested significant variation by hospital after adjustment. CONCLUSION The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.
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Affiliation(s)
- Jourdan E Triebwasser
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA.
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA, USA.
| | - Neil S Kamdar
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA
- University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Elizabeth S Langen
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Michelle H Moniz
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Tanima Basu
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - John Syrjamaki
- University of Michigan, Department of Urology, Ann Arbor, MI, USA
| | - Alexandra C Thomason
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Roger D Smith
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Daniel M Morgan
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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Kahn L, Smith RD, Dumont AS, Bui CJ, Valle-Giler EP. Commentary: The Tulane University-Ochsner Clinic Foundation Neurosurgery Program: 75 Years of History, Including the Program's Rebirth After Katrina. Neurosurgery 2019; 84:E437-E442. [DOI: 10.1093/neuros/nyz081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
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Fisher G, Smith RD, Saridogan E, Vashisht A, Allen S, Arumuham V, Cutner A. Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery. Facts Views Vis Obgyn 2019; 11:111-117. [PMID: 31824632 PMCID: PMC6897523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Surgery for deep endometriosis often requires input from urological surgeons. This study aims to determine pre-operative and intra-operative factors that influence the need for urological input in laparoscopic resection of rectovaginal endometriosis and to assess the usefulness of a scoring system to predict this. METHODS We conducted a retrospective cohort study of 230 patients undergoing laparoscopic excision of deep endometriosis, at a tertiary referral centre for endometriosis in London UK, 2011 to 2015. Data from pre-operative assessment, surgery and post-operative follow up were analysed and patients were categorised according to their pre-operative and intra-operative risk factors. The primary outcome measure was the requirement of intra-operative input by urological surgeons. RESULTS The median age was 35 years. In addition to the excision of endometriosis, 19.6% patients (45 patients) underwent hysterectomy, 14.8% (34 patients) required JJ stent placement, 6.1% (14 patients) had bowel resections and 2.6% (6 patients) required an ileostomy. 93.9% (216 patients) were considered normal-risk pre-operatively, of whom 89.4% (193/216) did not require any intra-operative urological input. 10.6% of this normal-risk group (23/216) required JJ stents, of whom 69.6% (16/23) also required a hysterectomy or bowel resection. Post operative complications occurred in 0.9% (2/216) of normal-risk patients, with none having required intra-operative urological reconstruction.Six percent (14 patients) were deemed to be increased-risk pre-operatively, of whom 78.6% (11/14) required JJ stent insertion. Thirty-six percent of increased-risk patients (5/14) had pre-operative renal dysfunction demonstrated on MAG3/DMSA and 80.0% of these (4/5) required intra-operative ureteric reconstruction. CONCLUSIONS Patients considered normal-risk pre-operatively, planned for excision, without hysterectomy or bowel resection, can be safely managed without specific urology input. Patients with risk-features are highly likely to require urological input, particularly for JJ stent insertion. Patients with pre-operative renal dysfunction, demonstrated on MAG3/DMSA, have a high chance of requiring intra-operative ureteric reconstruction and are best managed with pre-planned reconstructive urologist input.
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Affiliation(s)
- G Fisher
- Endometriosis Unit, Department of Women’s Health, University College Hospital London, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - RD Smith
- Department of Endoluminal Endourology, Institute of Urology, University College Hospital
London, 16-18 Westmoreland Street, London, W1G 8PH, United Kingdom
| | - E Saridogan
- Endometriosis Unit, Department of Women’s Health, University College Hospital London, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - A Vashisht
- Endometriosis Unit, Department of Women’s Health, University College Hospital London, 235 Euston Rd, London, NW1 2BU, United Kingdom
| | - S Allen
- Department of Endoluminal Endourology, Institute of Urology, University College Hospital
London, 16-18 Westmoreland Street, London, W1G 8PH, United Kingdom
| | - V Arumuham
- Department of Endoluminal Endourology, Institute of Urology, University College Hospital
London, 16-18 Westmoreland Street, London, W1G 8PH, United Kingdom
| | - A Cutner
- Endometriosis Unit, Department of Women’s Health, University College Hospital London, 235 Euston Rd, London, NW1 2BU, United Kingdom
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Klumpner TT, Kountanis JA, Langen ES, Smith RD, Tremper KK. Use of a novel electronic maternal surveillance system to generate automated alerts on the labor and delivery unit. BMC Anesthesiol 2018; 18:78. [PMID: 29945569 PMCID: PMC6020333 DOI: 10.1186/s12871-018-0540-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Maternal early warning systems reduce maternal morbidity. We developed an electronic maternal surveillance system capable of visually summarizing the labor and delivery census and identifying changes in clinical status. Automatic page alerts to clinical providers, using an algorithm developed at our institution, were incorporated in an effort to improve early detection of maternal morbidity. We report the frequency of pages generated by the system. To our knowledge, this is the first time such a system has been used in peripartum care. Methods Alert criteria were developed after review of maternal early warning systems, including the Maternal Early Warning Criteria (MEWC). Careful consideration was given to the frequency of pages generated by the surveillance system. MEWC notification criteria were liberalized and a paging algorithm was created that triggered paging alerts to first responders (nurses) and then managing services due to the assumption that paging all clinicians for each vital sign triggering MEWC would generate an inordinate number of pages. For preliminary analysis, to determine the effect of our automated paging algorithm on alerting frequency, the paging frequency of this system was compared to the frequency of vital signs meeting the Maternal Early Warning Criteria (MEWC). This retrospective analysis was limited to a sample of 34 patient rooms uniquely capable of storing every vital sign reported by the bedside monitor. Results Over a 91-day period, from April 1 to July 1, 2017, surveillance was conducted from 64 monitored beds, and the obstetrics service received one automated page every 2.3 h. The most common triggers for alerts were for hypertension and tachycardia. For the subset of 34 patient rooms uniquely capable of real-time recording, one vital sign met the MEWC every 9.6 to 10.3 min. Anecdotally, the system was well-received. Conclusions This novel electronic maternal surveillance system is designed to reduce cognitive bias and improve timely clinical recognition of maternal deterioration. The automated paging algorithm developed for this software dramatically reduces paging frequency compared to paging for isolated vital sign abnormalities alone. Long-term, prospective studies will be required to determine its impact on patient outcomes.
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Affiliation(s)
- Thomas T Klumpner
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5048, USA.
| | - Joanna A Kountanis
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5048, USA
| | - Elizabeth S Langen
- Department of Obstetrics and Gynecology, Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Roger D Smith
- Department of Obstetrics and Gynecology, Von Voigtlander Women's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Tremper
- Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5048, USA.
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Slavik J, Wang S, Tao L, Shukla A, Clancy R, Ellsworth R, Smith RD, Rodland KD, Cutler ML, Shriver CD, Iida J. Abstract P1-03-05: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-03-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- J Slavik
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - S Wang
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - L Tao
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - A Shukla
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - R Clancy
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - R Ellsworth
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - RD Smith
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - KD Rodland
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - ML Cutler
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - CD Shriver
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
| | - J Iida
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA; Pacific Northwest National Laboratory, Richland, WA; Henry-Jackson Foundation, Windber, PA; USUHS, Bethesda, MD; Walter Reed National Military Medical Center, Bethsda, MD
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Debbink MLP, Lawrence ER, Smith RD, Langen ES. 566: Does lithotomy position reduce the time from hysterotomy to delivery in cesarean section for arrest of descent? Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.093] [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: 11/26/2022]
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Triebwasser JE, Kamdar N, Moniz MH, Langen ES, Syrjamaki J, Smith RD, Morgan DM. 587: Hospital contribution to variation in rates of vaginal birth after cesarean: A Michigan Value Collaborative study. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.115] [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]
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Zahedi K, Barone S, Destefano-Shields C, Brooks M, Murray-Stewart T, Dunworth M, Li W, Doherty JR, Hall MA, Smith RD, Cleveland JL, Casero RA, Soleimani M. Activation of endoplasmic reticulum stress response by enhanced polyamine catabolism is important in the mediation of cisplatin-induced acute kidney injury. PLoS One 2017; 12:e0184570. [PMID: 28886181 PMCID: PMC5590979 DOI: 10.1371/journal.pone.0184570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/26/2017] [Indexed: 12/22/2022] Open
Abstract
Cisplatin-induced nephrotoxicity limits its use in many cancer patients. The expression of enzymes involved in polyamine catabolism, spermidine/spermine N1-acetyltransferase (SSAT) and spermine oxidase (SMOX) increase in the kidneys of mice treated with cisplatin. We hypothesized that enhanced polyamine catabolism contributes to tissue damage in cisplatin acute kidney injury (AKI). Using gene knockout and chemical inhibitors, the role of polyamine catabolism in cisplatin AKI was examined. Deficiency of SSAT, SMOX or neutralization of the toxic products of polyamine degradation, H2O2 and aminopropanal, significantly diminished the severity of cisplatin AKI. In vitro studies demonstrated that the induction of SSAT and elevated polyamine catabolism in cells increases the phosphorylation of eukaryotic translation initiation factor 2α (eIF2α) and enhances the expression of binding immunoglobulin protein BiP/GRP78) and CCAAT-enhancer-binding protein homologous protein (CHOP/GADD153). The increased expression of these endoplasmic reticulum stress response (ERSR) markers was accompanied by the activation of caspase-3. These results suggest that enhanced polyamine degradation in cisplatin AKI may lead to tubular damage through the induction of ERSR and the consequent onset of apoptosis. In support of the above, we show that the ablation of the SSAT or SMOX gene, as well as the neutralization of polyamine catabolism products modulate the onset of ERSR (e.g. lower BiP and CHOP) and apoptosis (e.g. reduced activated caspase-3). These studies indicate that enhanced polyamine catabolism and its toxic products are important mediators of ERSR and critical to the pathogenesis of cisplatin AKI.
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Affiliation(s)
- Kamyar Zahedi
- Departments of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
| | - Sharon Barone
- Departments of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
| | - Christina Destefano-Shields
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Marybeth Brooks
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Tracy Murray-Stewart
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Matthew Dunworth
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Weimin Li
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL, United States of America
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, United States of America
| | - Joanne R. Doherty
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, United States of America
| | - Mark A. Hall
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, United States of America
| | - Roger D. Smith
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - John L. Cleveland
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, United States of America
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Robert A. Casero
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Manoocher Soleimani
- Departments of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
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Soleimani M, Barone S, Xu J, Alshahrani S, Brooks M, McCormack FX, Smith RD, Zahedi K. Prostaglandin-E2 Mediated Increase in Calcium and Phosphate Excretion in a Mouse Model of Distal Nephron Salt Wasting. PLoS One 2016; 11:e0159804. [PMID: 27442254 PMCID: PMC4956050 DOI: 10.1371/journal.pone.0159804] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/10/2016] [Indexed: 01/29/2023] Open
Abstract
Contribution of salt wasting and volume depletion to the pathogenesis of hypercalciuria and hyperphosphaturia is poorly understood. Pendrin/NCC double KO (pendrin/NCC-dKO) mice display severe salt wasting under basal conditions and develop profound volume depletion, prerenal renal failure, and metabolic alkalosis and are growth retarded. Microscopic examination of the kidneys of pendrin/NCC-dKO mice revealed the presence of calcium phosphate deposits in the medullary collecting ducts, along with increased urinary calcium and phosphate excretion. Confirmatory studies revealed decreases in the expression levels of sodium phosphate transporter-2 isoforms a and c, increases in the expression of cytochrome p450 family 4a isotypes 12 a and b, as well as prostaglandin E synthase 1, and cyclooxygenases 1 and 2. Pendrin/NCC-dKO animals also had a significant increase in urinary prostaglandin E2 (PGE-2) and renal content of 20-hydroxyeicosatetraenoic acid (20-HETE) levels. Pendrin/NCC-dKO animals exhibit reduced expression levels of the sodium/potassium/2chloride co-transporter 2 (NKCC2) in their medullary thick ascending limb. Further assessment of the renal expression of NKCC2 isoforms by quantitative real time PCR (qRT-PCR) reveled that compared to WT mice, the expression of NKCC2 isotype F was significantly reduced in pendrin/NCC-dKO mice. Provision of a high salt diet to rectify volume depletion or inhibition of PGE-2 synthesis by indomethacin, but not inhibition of 20-HETE generation by HET0016, significantly improved hypercalciuria and salt wasting in pendrin/NCC dKO mice. Both high salt diet and indomethacin treatment also corrected the alterations in NKCC2 isotype expression in pendrin/NCC-dKO mice. We propose that severe salt wasting and volume depletion, irrespective of the primary originating nephron segment, can secondarily impair the reabsorption of salt and calcium in the thick ascending limb of Henle and/or proximal tubule, and reabsorption of sodium and phosphate in the proximal tubule via processes that are mediated by PGE-2.
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Affiliation(s)
- Manoocher Soleimani
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
- * E-mail:
| | - Sharon Barone
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
| | - Jie Xu
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Saeed Alshahrani
- Department of Pharmacology and Cell Biophysics and, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Marybeth Brooks
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Francis X. McCormack
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Roger D. Smith
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Kamyar Zahedi
- Center on Genetics of Transport, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Departments of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Research Services, Veterans Affairs Medical Center, Cincinnati, OH, United States of America
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Mathkour M, Garces J, Scullen T, Hanna J, Valle-Giler E, Kahn L, Arrington T, Houghton D, Lea G, Biro E, Bui CJ, Sulaiman OAR, Smith RD. Short- and Long-Term Outcomes of Deep Brain Stimulation in Patients 70 Years and Older with Parkinson Disease. World Neurosurg 2016; 97:247-252. [PMID: 27297246 DOI: 10.1016/j.wneu.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 02/07/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parkinson disease (PD) is a common neurodegenerative disease in elderly patients that may be treated with deep brain stimulation (DBS). DBS is an accepted surgical treatment in PD patients <70 years that demonstrates marked improvement in disease symptomology. Patients ≥70 years historically have been excluded from DBS therapy. Our objective is to evaluate the short- and long-term outcomes in patients with PD ≥70 years who underwent DBS at our center. METHODS In our single-center study, we retrospectively assessed a prospective registry of patients with PD treated with DBS who were ≥70 years old at the time of their procedure. Univariate analyses and 1-sample paired t test were used to evaluate data. Motor scores were evaluated with the Unified Parkinson's Disease Rating Scale III, and the effects on medication requirements were evaluated with levodopa equivalence daily doses (LEDD). RESULTS Thirty-seven patients were followed for an average of 42.2 months post-DBS. The average ages at diagnosis and at the time of DBS surgery were 63.05 years and 72.45 years, respectively. Significant reductions in the average Unified Parkinson's Disease Rating Scale III score were observed (preoperative 31.8; postoperative 15.6; P < 0.0001). Significant reductions in the average LEDD (preoperative 891.94 mg; postoperative 559.6 mg; P = 0.0008) and medication doses per day (preoperative 11.54; postoperative 7.97; P = 0.0112) also were present. CONCLUSION DBS is effective in treating elderly patients with PD. Patients experienced improvement in motor function, LEDD, and medication doses per day after DBS. Our results suggest that DBS is an effective treatment modality in elderly patients with PD.
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Affiliation(s)
- Mansour Mathkour
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Division of Neurosurgery, Department of Surgery, Jazan University, Jazan, Saudi Arabia.
| | - Juanita Garces
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Tyler Scullen
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Joshua Hanna
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Edison Valle-Giler
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Lora Kahn
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Teresa Arrington
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - David Houghton
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Georgia Lea
- Department of Movement Disorders, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Erin Biro
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Cuong J Bui
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Olawale A R Sulaiman
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Roger D Smith
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA
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Garces J, Mathkour M, Valle-Giler E, Scullen T, Berry JF, Smith RD. Primary Intraventricular Leiomyoma in an Immunocompetent Patient: First Case Report and Review of the Literature. World Neurosurg 2016; 90:698.e13-698.e18. [DOI: 10.1016/j.wneu.2016.01.088] [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] [Received: 11/01/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Smith RD, Carr A, Dakin SG, Snelling SJ, Yapp C, Hakimi O, Hakimi O. The response of tenocytes to commercial scaffolds used for rotator cuff repair. Eur Cell Mater 2016; 31:107-18. [PMID: 26815643 DOI: 10.22203/ecm.v031a08] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 01/31/2023] Open
Abstract
Surgical repairs of rotator cuff tears have high re-tear rates and many scaffolds have been developed to augment the repair. Understanding the interaction between patients' cells and scaffolds is important for improving scaffold performance and tendon healing. In this in vitro study, we investigated the response of patient-derived tenocytes to eight different scaffolds. Tested scaffolds included X-Repair, Poly-Tape, LARS Ligament, BioFiber (synthetic scaffolds), BioFiber-CM (biosynthetic scaffold), GraftJacket, Permacol, and Conexa (biological scaffolds). Cell attachment, proliferation, gene expression, and morphology were assessed. After one day, more cells attached to synthetic scaffolds with dense, fine and aligned fibres (X-Repair and Poly-Tape). Despite low initial cell attachment, the human dermal scaffold (GraftJacket) promoted the greatest proliferation of cells over 13 days. Expression of collagen types I and III were upregulated in cells grown on non-cross-linked porcine dermis (Conexa). Interestingly, the ratio of collagen I to collagen III mRNA was lower on all dermal scaffolds compared to synthetic and biosynthetic scaffolds. These findings demonstrate significant differences in the response of patient-derived tendon cells to scaffolds that are routinely used for rotator cuff surgery. Synthetic scaffolds promoted increased cell adhesion and a tendon-like cellular phenotype, while biological scaffolds promoted cell proliferation and expression of collagen genes. However, no single scaffold was superior. Our results may help understand the way that patients' cells interact with scaffolds and guide the development of new scaffolds in the future.
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Affiliation(s)
- R D Smith
- The Botnar Research Centre, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD,
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Simpson KM, Perez M, Tanaka A, Truong M, Smith RD. GEARS – An Objective Tool to Differentiate Robotic Surgical Skill and Experience. J Minim Invasive Gynecol 2015; 22:S10. [DOI: 10.1016/j.jmig.2015.08.033] [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: 10/22/2022]
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29
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Lin TY, Anderson GA, Norheim RV, Prost SA, LaMarche BL, Leach FE, Auberry KJ, Smith RD, Koppenaal DW, Robinson EW, Paša-Tolić L. An adaptable multiple power source for mass spectrometry and other scientific instruments. Rev Sci Instrum 2015; 86:094102. [PMID: 26429459 DOI: 10.1063/1.4930967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An Adaptable Multiple Power Source (AMPS) system has been designed and constructed. The AMPS system can provide up to 16 direct current (DC) (±400 V; 5 mA), 4 radio frequency (RF) (two 500 VPP sinusoidal signals each, 0.5-5 MHz) channels, 2 high voltage sources (±6 kV), and one ∼40 W, 250 °C temperature-regulated heater. The system is controlled by a microcontroller, capable of communicating with its front panel or a computer. It can assign not only pre-saved fixed DC and RF signals but also profiled DC voltages. The AMPS system is capable of driving many mass spectrometry components and ancillary devices and can be adapted to other instrumentation/engineering projects.
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Affiliation(s)
- T-Y Lin
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - G A Anderson
- GAA Custom Engineering, LLC, Benton City, Washington 99320, USA
| | - R V Norheim
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - S A Prost
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - B L LaMarche
- Hecate Software, Inc., Fort Worth, Texas 76110, USA
| | - F E Leach
- Photochem Technologies, Athens, Georgia 30602, USA
| | - K J Auberry
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - R D Smith
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - D W Koppenaal
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - E W Robinson
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - L Paša-Tolić
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington 99354, USA
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30
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Kahn L, Biro EE, Smith RD, Bui CJ. Spina bifida occulta and aperta: a review of current treatment paradigms. J Neurosurg Sci 2015; 59:79-90. [PMID: 25387659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Spina bifida remains a challenging neurosurgical entity to manage despite both an increased awareness of the disease as well as a decreased incidence due to folic acid supplementation. We review the spectrum of neural tube defects, which are the second most common serious congenital defect and the most common of the central nervous system, and discuss the latest management paradigms. The challenges of timely diagnosis and treatment of spina bifida occulta and the latest advances in fetal repair of spina bifida aperta (myelomeningocele) will be discussed. The authors review the literature and share their experience with managing neural tube defects.
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Affiliation(s)
- L Kahn
- Departmentof Neurosurgery, Tulane University School of Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA -
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Zahedi K, Barone S, Wang Y, Murray-Stewart T, Roy-Chaudhury P, Smith RD, Casero RA, Soleimani M. Proximal tubule epithelial cell specific ablation of the spermidine/spermine N1-acetyltransferase gene reduces the severity of renal ischemia/reperfusion injury. PLoS One 2014; 9:e110161. [PMID: 25390069 PMCID: PMC4229091 DOI: 10.1371/journal.pone.0110161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/09/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Expression and activity of spermidine/spermine N1-acetyltransferase (SSAT) increases in kidneys subjected to ischemia/reperfusion (I/R) injury, while its ablation reduces the severity of such injuries. These results suggest that increased SSAT levels contribute to organ injury; however, the role of SSAT specifically expressed in proximal tubule epithelial cells, which are the primary targets of I/R injury, in the mediation of renal damage remains unresolved. METHODS Severity of I/R injury in wt and renal proximal tubule specific SSAT-ko mice (PT-SSAT-Cko) subjected to bilateral renal I/R injury was assessed using cellular and molecular biological approaches. RESULTS Severity of the loss of kidney function and tubular damage are reduced in PT-SSAT-Cko- compared to wt-mice after I/R injury. In addition, animals treated with MDL72527, an inhibitor of polyamine oxidases, had less severe renal damage than their vehicle treated counter-parts. The renal expression of HMGB 1 and Toll like receptors (TLR) 2 and 4 were also reduced in PT-SSAT-Cko- compared to wt mice after I/R injury. Furthermore, infiltration of neutrophils, as well as expression of tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) transcripts were lower in the kidneys of PT-SSAT-Cko compared to wt mice after I/R injury. Finally, the activation of caspase3 was more pronounced in the wt compared to PT-SSAT-Cko animals. CONCLUSIONS Enhanced SSAT expression by proximal tubule epithelial cells leads to tubular damage, and its deficiency reduces the severity of renal I/R injury through reduction of cellular damage and modulation of the innate immune response.
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Affiliation(s)
- Kamyar Zahedi
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Veterans Affair Medical Center, Cincinnati, Ohio, United States of America
| | - Sharon Barone
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Veterans Affair Medical Center, Cincinnati, Ohio, United States of America
| | - Yang Wang
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Tracy Murray-Stewart
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Prabir Roy-Chaudhury
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Roger D. Smith
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Robert A. Casero
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Manoocher Soleimani
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Veterans Affair Medical Center, Cincinnati, Ohio, United States of America
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Valle-Giler EP, Garces J, Smith RD, Sulaiman WAR. One-stage resection of giant invasive thoracic schwannoma: case report and review of literature. Ochsner J 2014; 14:135-140. [PMID: 24688347 PMCID: PMC3963045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Schwannomas comprise approximately 25% of all spinal tumors, being the third most frequent soft-tissue tumor after hemangiomas and lipomas. Grade 5 invasive giant schwannomas erode the vertebral bodies, involve 2 or more levels, and invade the myofascial planes. Because 3 compartments are involved, these tumors represent a surgical challenge and frequently require staged surgeries with a multidisciplinary surgical team. CASE REPORT We report the case of a 62-year-old female who presented with intermittent upper back pain for 3 years. A magnetic resonance imaging scan of the thoracic spine showed a mass invading the vertebral body, pedicle, and lamina of T4 and part of T3 and T5. Needle biopsy confirmed the diagnosis of schwannoma. The patient underwent surgery using a parascapular extracavitary costotransversectomy approach. CONCLUSION Giant invasive spinal schwannomas are rare in the thoracic spine, and surgical approaches usually have entailed multiple-stage surgeries with the assistance of other surgical specialties. Our 1-stage complete surgical resection of a giant invasive spinal schwannoma used a parascapular costotransversectomy approach that maintained spinal stability and thus avoided the need for instrumentation.
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Affiliation(s)
| | - Juanita Garces
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA
| | - Roger D. Smith
- Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA
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Bruce JE, Anderson GA, Udseth HR, Smith RD. Large Molecule Characterization Based upon Individual Ion Detection with Electrospray Ionization-FTICR Mass Spectrometry. Anal Chem 2012; 70:519-25. [PMID: 21644751 DOI: 10.1021/ac9711706] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a new method for mass spectrometric measurements of high-molecular-weight species based on the summation of sequential Fourier transform ion cyclotron resonance (FTICR) spectra of individual multiply charged ions. This approach produces statistically useful mass spectra for large multiply charged molecular species formed by electrospray ionization and circumvents conventional limitations upon achievable resolving power and precision for high-molecular-weight species which arise due to Coulombic constraints. For very large molecules with tens to thousands of charges each, the total number of charges required to define the charge-state distribution, and thus provide accurate mass information, greatly exceeds the useful charge capacity of the FTICR cell. As trapped ion populations approach or exceed this capacity, FTICR performance degrades due to large frequency shifts, peak coalescence phenomena, and rapid loss of ion packet coherence, which effectively precludes high-resolution and precision measurements for molecules above ∼80-kDa size for a 7-T magnetic field strength. The present approach is based on the summation of many spectra having moderate populations of individual ions and relies on sensitivity sufficient for individual ion detection. While the number of trapped ions contributing to each mass spectrum may generally be insufficient to define the isotopic or charge-state distributions (and thus produce accurate information on the molecular weight distribution in a conventional fashion), the present data processing and summation approach suppresses the noise component (as well as smaller signals) that would otherwise be problematic. Importantly, this approach circumvents natural limitations for very high molecular weight species due to Coulombic interactions and thus provides a basis for much greater resolution and mass measurement accuracy than otherwise possible. This paper presents the details of this approach and its demonstration for the 66-kDa protein bovine serum albumin (where the conventional approach is also feasible) and discusses important aspects of the data manipulation.
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Affiliation(s)
- J E Bruce
- Environmental and Molecular Sciences Laboratory, Pacific Northwest National Laboratory, P.O. Box 999, Richland, Washington 99352
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Abstract
Injurious falls, particularly among the elderly, are a leading cause of morbidity, mortality and health and social care expenditure. Non injurious falls may result in significant quality of life losses through generating a fear of subsequent falls. Falls may be due to intrinsic (age-related physiological changes, diseases or polypharmacy) or extrinsic (environmental hazards and behavior) factors. Although interventions target both of these, much of the focus is upon extrinsic factors, through changes to behavior and the environment. This paper reviews the cost-effectiveness of such interventions in reducing the risk of new falls, or modifying the harm caused in the event of a fall, for the general unselected population of the elderly living independently in the community.
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Affiliation(s)
- R D Smith
- Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ UK.
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35
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Hay FR, Smith RD, Ellis RH, Butler LH. Developmental changes in the germinability, desiccation tolerance, hardseededness, and longevity of individual seeds of Trifolium ambiguum. Ann Bot 2010; 105:1035-52. [PMID: 20228084 PMCID: PMC2876000 DOI: 10.1093/aob/mcq037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 09/21/2009] [Accepted: 01/11/2010] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND AIMS Using two parental clones of outcrossing Trifolium ambiguum as a potential model system, we examined how during seed development the maternal parent, number of seeds per pod, seed position within the pod, and pod position within the inflorescence influenced individual seed fresh weight, dry weight, water content, germinability, desiccation tolerance, hardseededness, and subsequent longevity of individual seeds. METHODS Near simultaneous, manual reciprocal crosses were carried out between clonal lines for two experiments. Infructescences were harvested at intervals during seed development. Each individual seed was weighed and then used to determine dry weight or one of the physiological behaviour traits. KEY RESULTS Whilst population mass maturity was reached at 33-36 days after pollination (DAP), seed-to-seed variation in maximum seed dry weight, when it was achieved, and when maturation drying commenced, was considerable. Individual seeds acquired germinability between 14 and 44 DAP, desiccation tolerance between 30 and 40 DAP, and the capability to become hardseeded between 30 and 47 DAP. The time for viability to fall to 50 % (p(50)) at 60 % relative humidity and 45 degrees C increased between 36 and 56 DAP, when the seed coats of most individuals had become dark orange, but declined thereafter. Individual seed f. wt at harvest did not correlate with air-dry storage survival period. Analysing survival data for cohorts of seeds reduced the standard deviation of the normal distribution of seed deaths in time, but no sub-population showed complete uniformity of survival period. CONCLUSIONS Variation in individual seed behaviours within a developing population is inherent and inevitable. In this outbreeder, there is significant variation in seed longevity which appears dependent on embryo genotype with little effect of maternal genotype or architectural factors.
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Affiliation(s)
- F R Hay
- Seed Conservation Department, Royal Botanic Gardens Kew, Wakehurst Place, Ardingly, West Sussex, UK.
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Smith RD. National health system reform. J La State Med Soc 2009; 161:293-294. [PMID: 19927946] [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: 05/28/2023]
Abstract
The Louisiana State Medical Society (LSMS) believes reform of the nation's health care system is long overdue and we are extremely pleased the debate on reform is now underway in the Congress. We share your concerns about the availability of quality health care coverage for all Americans, multiple choices of health care financing mechanisms in a open market setting, affordable and portable coverage options, and the elimination of fraud and abuse that siphons precious resources needed to assure the continued viability of the delivery systems. We have examined the current proposals in light of the above concerns and with the compendium of LSMS health care reform policies. Although some of the concepts are compatible with those policies the majority of proposed changes differ significantly from our vision of needed system reform. The conscious injection of a progressive pattern of more government control of the health care system, even the actual delivery of the care itself, is the most alarming and objectionable aspect of the proposals. Therefore, the Louisiana State Medical Society's key points of concern regarding the current proposals are detailed in this letter.
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Smith RD. Contemporary hysteroscopic methods for female sterilization. Int J Gynaecol Obstet 2009; 108:79-84. [DOI: 10.1016/j.ijgo.2009.07.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/20/2009] [Indexed: 11/16/2022]
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Yu RC, Resnekov O, Abola AP, Andrews SS, Benjamin KR, Bruck J, Burbulis IE, Colman-Lerner A, Endy D, Gordon A, Holl M, Lok L, Pesce CG, Serra E, Smith RD, Thomson TM, Tsong AE, Brent R. The Alpha Project: a model system for systems biology research. IET Syst Biol 2009; 2:222-33. [PMID: 19045818 DOI: 10.1049/iet-syb:20080127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
One goal of systems biology is to understand how genome-encoded parts interact to produce quantitative phenotypes. The Alpha Project is a medium-scale, interdisciplinary systems biology effort that aims to achieve this goal by understanding fundamental quantitative behaviours of a prototypic signal transduction pathway, the yeast pheromone response system from Saccharomyces cerevisiae. The Alpha Project distinguishes itself from many other systems biology projects by studying a tightly bounded and well-characterised system that is easily modified by genetic means, and by focusing on deep understanding of a discrete number of important and accessible quantitative behaviours. During the project, the authors have developed tools to measure the appropriate data and develop models at appropriate levels of detail to study a number of these quantitative behaviours. The authors have also developed transportable experimental tools and conceptual frameworks for understanding other signalling systems. In particular, the authors have begun to interpret system behaviours and their underlying molecular mechanisms through the lens of information transmission, a principal function of signalling systems. The Alpha Project demonstrates that interdisciplinary studies that identify key quantitative behaviours and measure important quantities, in the context of well-articulated abstractions of system function and appropriate analytical frameworks, can lead to deeper biological understanding. The authors' experience may provide a productive template for systems biology investigations of other cellular systems.
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Affiliation(s)
- R C Yu
- Molecular Sciences Institute, Berkeley, USA
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Beutels P, Edmunds WJ, Smith RD. Partially wrong? Partial equilibrium and the economic analysis of public health emergencies of international concern. Health Econ 2008; 17:1317-22. [PMID: 18246542 DOI: 10.1002/hec.1339] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We argue that traditional health economic analysis is ill-equipped to estimate the cost effectiveness and cost benefit of interventions that aim at controlling and/or preventing public health emergencies of international concern (such as pandemic influenza or severe acute respiratory syndrome). The implicit assumption of partial equilibrium within both the health sector itself and--if a wider perspective is adopted--the economy as a whole would be violated by such emergencies. We propose an alternative, with the specific aim of accounting for the behavioural changes and capacity problems that are expected to occur when such an outbreak strikes.
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Affiliation(s)
- P Beutels
- Unit Health Economics and Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
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Andrews CG, Langler RF, Smith RD. α-Benzoyloxylation of dimethyl trisulfide and a novel reaction of the resultant trisulfide benzoate. J Sulphur Chem 2008. [DOI: 10.1080/17415990802183884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christopher G. Andrews
- a Department of Chemistry , Mount Allison University , Sackville, New Brunswick, Canada , E4L 1G8
| | - Richard F. Langler
- a Department of Chemistry , Mount Allison University , Sackville, New Brunswick, Canada , E4L 1G8
| | - Roger D. Smith
- a Department of Chemistry , Mount Allison University , Sackville, New Brunswick, Canada , E4L 1G8
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Laster MA, Smith RD, Nicholson KL, Nicholson JDW, Miller RK, Griffin DB, Harris KB, Savell JW. Dry versus wet aging of beef: Retail cutting yields and consumer sensory attribute evaluations of steaks from ribeyes, strip loins, and top sirloins from two quality grade groups. Meat Sci 2008; 80:795-804. [PMID: 22063599 DOI: 10.1016/j.meatsci.2008.03.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 03/19/2008] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
Top Choice (n=48) and Select (n=48) paired bone-in ribeye rolls, bone-in strip loins, and boneless top sirloin butts were assigned randomly to one of two aging treatments, dry or wet, and were aged for 14, 21, 28 or 35d. Cutting tests, performed to determine retail yields and processing times, showed dry-aged subprimals had lower total saleable yield percentages and increased processing times compared to wet-aged subprimals. Sensory and Warner-Bratzler shear evaluation was conducted to determine palatability characteristics. For the most part, aging treatment and aging period did not affect consumer sensory attributes. However, ribeye and top loin steaks from the Top Choice quality grade group received higher sensory ratings than their Select counterparts. For top sirloin steaks, no consumer sensory attributes were affected by aging treatment, aging period, or quality grade group.
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Affiliation(s)
- M A Laster
- Meat Science Section, Department of Animal Science, Texas A&M University, 2471 TAMU, College Station, TX 77843-2471, USA
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Smith RD, Nicholson KL, Nicholson JDW, Harris KB, Miller RK, Griffin DB, Savell JW. Dry versus wet aging of beef: Retail cutting yields and consumer palatability evaluations of steaks from US Choice and US Select short loins. Meat Sci 2007; 79:631-9. [PMID: 22063024 DOI: 10.1016/j.meatsci.2007.10.028] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 10/23/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
Paired beef short loins from US Choice (n=48) and US Select (n=48) carcasses were assigned to be dry or wet aged for 14, 21, 28 or 35d. After aging, short loins were processed to determine retail yields and processing times. Upon completion of cutting tests, steaks were served to consumers to assess palatability characteristics. Retail cutting tests showed that dry-aged short loins had reduced yields and increased cutting times when compared to wet-aged short loins. Consumers were unable to determine differences between dry- and wet-aged steaks and for aging periods; however, USDA quality grade had a significant impact on consumer perception of palatability attributes.
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Affiliation(s)
- R D Smith
- Meat Science Section, Department of Animal Science, Texas A&M University, 2471 TAMU, College Station, TX 77843-2471, USA
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Armah HB, Wang G, Omalu BI, Tesh RB, Gyure KA, Chute DJ, Smith RD, Dulai P, Vinters HV, Kleinschmidt-DeMasters BK, Wiley CA. Systemic distribution of West Nile virus infection: postmortem immunohistochemical study of six cases. Brain Pathol 2007; 17:354-62. [PMID: 17610522 PMCID: PMC8095553 DOI: 10.1111/j.1750-3639.2007.00080.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [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: 12/01/2022] Open
Abstract
Rare cases of West Nile virus (WNV)-associated inflammation outside the central nervous system (CNS) have been reported. We evaluated the systemic distribution of WNV in postmortem tissues during encephalitis in six patients using immunohistochemistry. WNV antigens were detected in neurons of CNS (all 6 cases), kidney (4 cases), lungs (2 cases), pancreas (2 cases), thyroid (2 cases), intestine (2 cases), stomach (1 case), esophagus (1 case), bile duct (1 case), skin (1 case), prostate (1 case) and testis (1 case). In systemic organs epithelial cells were infected. In none of the six cases were viral antigens identified in hepatocytes, heart, adrenal gland, nerves, skeletal muscles, bone, vessels and fat. All cases in which viral antigens were identified in systemic organs in addition to CNS were severely immunocompromised transplant recipients. With the exception of testis and brain, most foci of infection were not associated with inflammation. While the absence of inflammation may in part be due to patient immunosuppression or to possible transient nature of any host response, compartmentalization of viral antigen to the luminal region of epithelial cells may sequester WNV from immune recognition. Comparison of our findings with previous reports suggests that patients with WNV encephalitis can have widespread systemic infection.
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Affiliation(s)
- Henry B Armah
- Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA 15213, USA.
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Baas T, Baskin CR, Diamond DL, García-Sastre A, Bielefeldt-Ohmann H, Tumpey TM, Thomas MJ, Carter VS, Teal TH, Van Hoeven N, Proll S, Jacobs JM, Caldwell ZR, Gritsenko MA, Hukkanen RR, Camp DG, Smith RD, Katze MG. Integrated molecular signature of disease: analysis of influenza virus-infected macaques through functional genomics and proteomics. J Virol 2006; 80:10813-28. [PMID: 16928763 PMCID: PMC1641753 DOI: 10.1128/jvi.00851-06] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [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: 11/20/2022] Open
Abstract
Recent outbreaks of avian influenza in humans have stressed the need for an improved nonhuman primate model of influenza pathogenesis. In order to further develop a macaque model, we expanded our previous in vivo genomics experiments with influenza virus-infected macaques by focusing on the innate immune response at day 2 postinoculation and on gene expression in affected lung tissue with viral genetic material present. Finally, we sought to identify signature genes for early infection in whole blood. For these purposes, we infected six pigtailed macaques (Macaca nemestrina) with reconstructed influenza A/Texas/36/91 virus and three control animals with a sham inoculate. We sacrificed one control and two experimental animals at days 2, 4, and 7 postinfection. Lung tissue was harvested for pathology, gene expression profiling, and proteomics. Blood was collected for genomics every other day from each animal until the experimental endpoint. Gross and microscopic pathology, immunohistochemistry, viral gene expression by arrays, and/or quantitative real-time reverse transcription-PCR confirmed successful yet mild infections in all experimental animals. Genomic experiments were performed using macaque-specific oligonucleotide arrays, and high-throughput proteomics revealed the host response to infection at the mRNA and protein levels. Our data showed dramatic differences in gene expression within regions in influenza virus-induced lesions based on the presence or absence of viral mRNA. We also identified genes tightly coregulated in peripheral white blood cells and in lung tissue at day 2 postinoculation. This latter finding opens the possibility of using gene expression arrays on whole blood to detect infection after exposure but prior to onset of symptoms or shedding.
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Affiliation(s)
- T Baas
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA.
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Abstract
A large number of microvascular anastomoses, involving both arteriovenous and artery-artery end-to-side and end-to-end anastomoses, were carried out in the rat to develop a temporal and morphologic profile of thrombogenesis. While excellent patency rates were obtained in purely arterial preparations, significant thrombus formation occurred in the arteriovenous preparations, both at the suture line and more distally in the vein. Factors contributing to thrombogenesis in these microvascular anastomoses are discussed.
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Affiliation(s)
- Y Shimizu
- Neurochirurgische Universitätsklinik, Kantonsspital Zürich, Switzerland
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Abstract
OBJECTIVE We report the incidence, distribution, aetiology and outcome of urological trauma in a unique national database to provide an insight into its contemporary management. PATIENTS AND METHODS The Scottish Trauma Audit Group prospectively collected data from severe trauma presenting to all major Scottish hospitals. We examined data from 24,666 trauma admissions from 1999 to 2002. Patients who sustained urological injuries were identified and studied in detail. RESULTS 362 patients had urological injuries, comprising 1.5% of the trauma population, and an incidence of 1 per 45,000 head of adult population per year. Blunt injury (n = 285, 79%) was the main cause of urological trauma. Road traffic accidents were most frequent (197 patients, 54%), followed by assaults (76, 21%) and high falls (45, 12%). Renal injuries were the most common (n = 241, 67%), followed by injuries to the external genitalia (71, 20%), bladder (65, 18%), urethra (16, 4%) and ureter (3, 1%). Only 52 patients (14%) had isolated urological trauma. One hundred and fifty nine out of 310 (51%) urological patients with associated injuries were physiologically compromised on arrival in A&E, compared with only 4/52 (8%) patients with isolated urological trauma. All patients with isolated urological trauma survived, whereas 110/310 (35%) of those with associated injuries died. CONCLUSION Urological injuries in Scotland mostly result from blunt trauma due to high-energy impacts. Isolated urological injuries are uncommon and all such patients survived. The majority of patients with urological trauma have multiple injuries and require a multi-disciplinary approach. Current urological services appear adequately distributed to cope with contemporary demands of urological trauma.
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Affiliation(s)
- S V Bariol
- The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, Scotland
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Smith RD, Babiychuk EB, Noble K, Draeger A, Wray S. Increased cholesterol decreases uterine activity: functional effects of cholesterol alteration in pregnant rat myometrium. Am J Physiol Cell Physiol 2005; 288:C982-8. [PMID: 15613497 DOI: 10.1152/ajpcell.00120.2004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [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: 11/22/2022]
Abstract
Uterine quiescence is essential for successful pregnancy. Cholesterol and triglycerides are markedly increased in pregnancy. Cholesterol is enriched in microdomains of the plasma membrane known as rafts and caveolae. Both lipid rafts and caveolae have been implicated in cellular signaling cascades. The purpose of this work was to investigate whether manipulation of cholesterol content alters uterine contractility. Late pregnancy (19–21 days) rats were humanely euthanized and strips of longitudinal myometrium were then dissected. Force and Ca2+ measurements were simultaneously recorded and cholesterol increased by the addition of 5 mg/ml cholesterol or 0.25 mg/ml low-density lipoproteins (LDLs) or reduced by 2% methyl-β-cyclodextrin (MCD) or 2 U/ml cholesterol oxidase addition to the perfusate. Both LDLs and cholesterol profoundly inhibited spontaneous uterine force production and associated Ca2+ transients; frequency, amplitude, and duration of contraction were all significantly reduced compared with preceding control contractions. Force and Ca2+ were also reduced by cholesterol when 1 nM oxytocin was used to stimulate the myometrium. Uterine activity was significantly increased by cholesterol extraction with MCD or cholesterol oxidase treatment. Electron microscopy confirmed the lipid raft disrupting effect of MCD, as formerly electron microscopy-visible caveolae in the myometrial cell membrane all but disappeared after MCD treatment. These data show that uterine smooth muscle cell cholesterol content is critically important for functional activity. A novel finding of our study is that cholesterol is inhibitory for force generation. It may be one of the mechanisms operating to maintain uterine quiescence throughout gestation and may also contribute to difficulties in labor suffered by obese women.
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Affiliation(s)
- R D Smith
- Dept. of Physiology, The University of Liverpool, Crown St., Liverpool, L69 3BX, UK.
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Tender GC, Smith RD. Pineal ganglioglioma in a young girl: a case report and review of the literature. J La State Med Soc 2004; 156:316-8. [PMID: 15688672] [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: 05/01/2023]
Abstract
Gangliogliomas are exceedingly rare in the pineal region. We present the case of a 16-year-old girl diagnosed with a pineal-region mass, initially diagnosed as a germ-cell tumor on the frozen section examination. The tumor was resected completely despite the frozen section results. The final pathological diagnosis was that of a ganglioglioma. This diagnosis obviated the need for postoperative adjuvant therapy. Gangliogliomas, although rare, should be considered in the differential diagnosis of the pineal region tumors. Frozen section results can be misleading since the large neuronal cells can mimic germ cells. Gangliogliomas are not sensitive to adjuvant therapy. Initial gross total resection should be attempted if the anatomy is favorable.
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Affiliation(s)
- Gabriel C Tender
- Department of Neurosurgery, Louisiana State University, New Orleans, USA
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Wray S, Smith RD. Mechanisms of action of pH-induced effects on vascular smooth muscle. Mol Cell Biochem 2004; 263:163-72. [PMID: 15524177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
It is clear that pH has many effects on vascular smooth muscle and the overall action of pH on force will depend on the type of vascular smooth muscle in question and the combined effects on all the potential modulatory mechanisms. The major effects of pH on force appear to be mediated via modulation of [Ca]i rather than changes in the sensitivity of the contractile machinery to Ca2+. There are still numerous gaps in our understanding of the actions of pH and as more data become available, we will be able to better understand the major mechanisms involved.
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Affiliation(s)
- Susan Wray
- The Physiological Laboratory, The University of Liverpool, Liverpool, UK.
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