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Lee SH, Moorthy R, Nagala S. Author response to: Comment on: Evolution of transoral endoscopic thyroidectomy vestibular approach according to the IDEAL framework. Br J Surg 2022; 109:e118. [PMID: 35891610 PMCID: PMC10364675 DOI: 10.1093/bjs/znac236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 08/02/2023]
Affiliation(s)
- Shen Han Lee
- Correspondence to: Shen-Han Lee, Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, KM6 Jalan Langgar, Alor Setar 05460, Kedah, Malaysia (e-mail: )
| | - Ram Moorthy
- Department of Otolaryngology—Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
- Department of Otolaryngology—Head and Neck Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, UK
| | - Sidhartha Nagala
- Department of Otolaryngology—Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
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Dhar P, Maweni R, Kucheria A, Nair D, Nagala S, Corbridge R. 672 Endoscopic Laser Pharyngeal Pouch Surgery: Is It Safe? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.194] [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: 11/06/2022]
Abstract
Abstract
Aim
Zenker diverticulum can cause significant dysphagia and surgery is the definitive management. NICE guidelines describe inadequate evidence on laser cricopharyngeal myotomy (CPM). This study aimed to assess the safety and efficacy of carbon dioxide laser and stapling CPM to treat Zenker diverticulum.
Method
Retrospective data was collected from patients who underwent endoscopic CPM at the Royal Berkshire Hospital between 2011 and 2021. Two cohorts were assigned: endoscopic laser (EL) or endoscopic stapling (ES). Primary outcomes evaluated safety. These were surgical complication rates, duration of inpatient stay, readmissions, barium swallow leak and considered case complexity (revision cases). The secondary outcomes, persistence or recurrence of symptoms evaluated efficacy.
Results
One-hundred and eight patients (mean [range] age 75 [38 – 95] yr, 71 (66%) men, 23 (21%) revision surgeries) underwent CPM. The EL (n = 76) cohort had two (2.63%) surgical complications (mucosal tear requiring no repair, mediastinitis from an oesophageal leak). The ES (n = 32) cohort had one (3.13%) surgical complication (mucosal tear requiring suture repair). The average duration of inpatient stay was 3.61 and 1.53 days for the EL and ES cohorts respectively. 65 patients (60%) underwent a post-operative barium swallow of which 2 (0.03%) patients, both from the EL cohort, had a leak. There were no readmissions. A chi-square test of independence showed no significant association between type of surgery and persistence [X2 (1) = 0.169, p = .681] or recurrence of symptoms [X2 (1) = 0.443, p = .506]
Conclusions
Treatment of pharyngeal pouches with endoscopic laser CPM is safe and efficacious.
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Affiliation(s)
- P Dhar
- Royal Berkshire NHS Trust , Reading , United Kingdom
| | - R Maweni
- Royal Berkshire NHS Trust , Reading , United Kingdom
| | - A Kucheria
- Royal Berkshire NHS Trust , Reading , United Kingdom
| | - D Nair
- Royal Berkshire NHS Trust , Reading , United Kingdom
| | - S Nagala
- Royal Berkshire NHS Trust , Reading , United Kingdom
| | - R Corbridge
- Royal Berkshire NHS Trust , Reading , United Kingdom
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Maweni R, Nair D, Constatinou C, Kandiah S, Aung T, Nagala S. Clinical Efficacy And Cure Rate Of Fixed Dose Radioactive Iodine For The Treatment Of Hyperthyroidism: A Single Centre Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac056.028] [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]
Abstract
Abstract
Introduction
Iodine-131 is an effective treatment for thyrotoxicosis. In 2019, the National Institute for Clinical Excellence (NICE) guidelines suggested offering radioactive iodine as first-line definitive treatment for adults with Graves’ disease, toxic nodular and multinodular goitre unless it is unsuitable or anti-thyroid drugs are likely to achieve remission. The aim of this study was to evaluate the clinical outcome one year after using fixed dose Iodine-131 for hyperthyroidism and to identify any associated factors.
Methods
Electronic patient records were studied retrospectively for all patients who were treated with radioiodine therapy for hyperthyroidism between July 2017 and March 2020 at a district general hospital in the UK. Response to radioiodine therapy was assessed at 6 and 12 months by a dedicated thyroid nurse-led virtual follow-up.
Results
We identified 67 patients with a mean age of 55.9 years (range 18–84); 48 (72%) females, 19 (28%) males. Of these, 57 (85%) patients were cured at 12 months (93.7% in non-Graves’, 82.3% in Graves’ group). Gender, diagnosis, and pre-treatment disease interval were not significantly associated with treatment success. Non-Graves’ patients had a significantly shorter time to discharge than Graves’ patients receiving Iodine-131 (8 vs 10.3 months, p=0.0174).
Conclusions
The results of the present study demonstrate that a single fixed dose of Iodine-131 therapy is highly effective and comparable to outcomes from calculated dose therapy in literature. We propose the routine use of scoring system to calculate risk of relapse for all newly diagnosed hyperthyroid patients to tailor treatment modality.
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Maweni R, Nair D, Kandiah S, Rourke T, Corbridge R, Nagala S. Malignancy rates and initial management of Thy3 thyroid nodules in a district general hospital: The ‘Reading’ experience. Br J Surg 2022. [DOI: 10.1093/bjs/znac056.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Ultrasound-guided fine-needle aspiration cytology is the gold standard for investigating thyroid nodules. Stratifying the Thy3 thyroid nodule risk of malignancy is essential for clinical decision-making. According to the Royal College of Pathologists Guidance (2016), the rate of malignancy for Thy3a is 5–15% and for Thy3f 15–30%. Our aim was to investigate the malignancy rate and the initial management of Thy3 nodules in our institution.
Methods
A retrospective review was undertaken of 115 patients with Thy3 cytology results from thyroid fine-needle aspirations performed between January 2015 and June 2020 at a single centre. A total of 90 out of 115 patients underwent surgery.
Results
Of the 90 patients, we had a 40% malignant rate (36/90). Specifically, 14 of 34 (41.1%) Thy3a and 22 of 56 (39.2%) Thy3f nodules were malignant. Of the malignant lesions, 52.7% (19/36) were follicular thyroid carcinoma. 58.8% (10/17) of male patients and 35.6% (26/73) of female patients had a malignant histology. Eighteen patients eventually needed a completion thyroidectomy.
Conclusion
Compared with national data, we showed a higher risk of malignancy in Thy3 nodules in our centre. Our study should encourage other centres to audit their own data. We propose setting up a national Thy3 registry as a basis to promote research in improving preoperative diagnosis of indeterminate thyroid nodules.
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Abstract
BACKGROUND The IDEAL Framework is a scheme for safe implementation and assessment of surgical innovation. The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a new innovation in thyroid surgery that eliminates the need for a cervical incision. Despite considerable interest and adoption worldwide, significant scepticism remains regarding the outcomes and cost-effectiveness for healthcare systems. The aim of this narrative review was to appraise the available literature and examine whether TOETVA has progressed in line with the IDEAL Framework. METHODS A literature review of PubMed with a focus on historical and landmark studies was undertaken to classify the evidence according to the different stages of the IDEAL Framework. RESULTS Several different transoral approaches were developed by a small of number of surgeon-innovators on animals and cadavers, and subsequently in first-in-human studies. The trivestibular approach emerged as the safest technique, with further refinements of this technique culminating in TOETVA. The basic steps and indications for this technique have been standardized and it is now being replicated by early adopters in many centres worldwide. The development of TOETVA has closely aligned with the IDEAL Framework, and is currently at stage 2B (Exploration). CONCLUSION There is need for multi-institutional collaborations and international registry studies to plan high-quality randomized trials comparing TOETVA with other remote-access approaches and collect long-term follow-up data. In countries where TOETVA has yet to be adopted, the IDEAL Framework will be a useful roadmap for government regulators and professional societies to evaluate, regulate, and provide best practice recommendations for the adoption of this technique.
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Affiliation(s)
- Shen-Han Lee
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Ram Moorthy
- Department of Otolaryngology-Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
- Department of Otolaryngology-Head and Neck Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - Sidhartha Nagala
- Department of Otolaryngology-Head and Neck Surgery, Royal Berkshire Hospital, Reading, UK
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Nair D, Maweni R, Constantinou C, Kandiah S, Nagala S, Aung T. Clinical efficacy of fixed-dose radioactive iodine for the treatment of hyperthyroidism at a single centre: our experience. Ir J Med Sci 2021; 191:1659-1665. [PMID: 34537910 DOI: 10.1007/s11845-021-02767-0] [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: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Iodine-131 is an effective treatment for thyrotoxicosis. In 2019, National Institute for Clinical Excellence guidelines (UK) suggested offering radioactive iodine as first-line definitive treatment for adults with Graves' disease, toxic nodular and multinodular goitre unless it is unsuitable or anti-thyroid drugs are likely to achieve remission. The aim of this study was to evaluate the clinical outcome 1 year after using fixed-dose Iodine-131 for hyperthyroidism and time (months) to response. METHODS Electronic patient records were studied retrospectively for all patients who were treated with radioiodine therapy for hyperthyroidism between July 2017 and March 2020 at a district general hospital in the UK. Response to radioiodine therapy was initially assessed at 6 weeks and then at 3, 6, and 12 months by a dedicated thyroid nurse-led virtual follow-up. RESULTS We identified 67 patients with a mean age of 55.9 years (range 18-84); 48 (72%) females, 19 (28%) males. Of these, 57 (85%) patients were cured at 12 months (93.7% in non-Graves', 82.3% in Graves' group). Gender, diagnosis and pre-treatment disease interval were not significantly associated with treatment success. Non-Graves' patients had a significantly shorter time to discharge than Graves' patients receiving Iodine-131 (8 versus 10.3 months, p = 0.0174). CONCLUSION The results of the present study demonstrate that a single fixed dose of Iodine-131 therapy is highly effective and comparable to outcomes from calculated dose therapy in literature. We propose the routine use of scoring system to calculate risk of relapse for all newly diagnosed hyperthyroid patients to tailor treatment modality.
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Affiliation(s)
- Dilip Nair
- Department of ENT, Royal Berkshire NHS Foundation Trust Hospital, Reading, Berkshire, RG1 5AN, UK.
| | - Robert Maweni
- Department of ENT, Royal Berkshire NHS Foundation Trust Hospital, Reading, Berkshire, RG1 5AN, UK
| | | | - Shivanthi Kandiah
- Department of Abdominal Medicine and Surgery, St James Hospital, LTH NHS Trust Beckett Street, Leeds, UK
| | - Sidhartha Nagala
- Department of ENT, Royal Berkshire NHS Foundation Trust Hospital, Reading, Berkshire, RG1 5AN, UK
| | - Theingi Aung
- Department of Endocrinology, Royal Berkshire NHS Foundation Trust Hospital, Reading, Berkshire, UK
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Nair D, Kandiah S, Rourke T, Corbridge R, Nagala S. Malignancy rates and initial management of Thy3 thyroid nodules in a district general hospital: The 'Reading' experience. Endocrinol Diabetes Metab 2021; 4:e00243. [PMID: 34277968 PMCID: PMC8279597 DOI: 10.1002/edm2.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 11/12/2022]
Abstract
Background Ultrasound-guided fine-needle aspiration cytology is the gold standard for investigating thyroid nodules. Stratifying the Thy3 thyroid nodule risk of malignancy is essential for clinical decision-making. According to the Royal College of Pathologists Guidance (2016), the rate of malignancy for Thy3a is 5-15% and for Thy3f 15-30%. Our aim was to investigate the malignancy rate and the initial management of Thy3 nodules in our institution. Methods A retrospective review was undertaken of 115 patients with Thy3 cytology results from thyroid fine-needle aspirations performed between January 2015 and June 2020 at a single centre. A total of 90 out of 115 patients underwent surgery. Results Of the 90 patients, we had a 40% malignant rate (36/90). Specifically, 14 of 34 (41.1%) Thy3a and 22 of 56 (39.2%) Thy3f nodules were malignant. Of the malignant lesions, 52.7% (19/36) were follicular thyroid carcinoma. 58.8% (10/17) of male patients and 35.6% (26/73) of female patients had a malignant histology. Eighteen patients eventually needed a completion thyroidectomy. Conclusion Compared with national data, we showed a higher risk of malignancy in Thy3 nodules in our centre. Our study should encourage other centres to audit their own data. We propose setting up a national Thy3 registry as a basis to promote research in improving preoperative diagnosis of indeterminate thyroid nodules.
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Affiliation(s)
- Dilip Nair
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Shivanthi Kandiah
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Thomas Rourke
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Rogan Corbridge
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
| | - Sidhartha Nagala
- Department of ENT Royal Berkshire NHS Foundation Trust Hospital Reading Berkshire UK
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Abstract
Immunoglobulin G4-related disease (IgG4-RD) is becoming increasingly documented. It was first described in relation to autoimmune pancreatitis. Features of the disease include tissue infiltration by IgG4 plasma cells with associated fibrosis and the growth of pseudotumours. A 71-year-old woman presented with increasing right cheek swelling and mild proptosis. Ten years earlier, she had a similar presentation and was diagnosed with an inflammatory pseudotumour. Examination revealed a lesion in the right nasal cavity. CT and MRI confirmed a mass within the right maxillary antrum extending into the nasal cavity. Endoscopic biopsies showed florid plasma cell infiltrate with marked increase in IgG+ plasma cells. Immunostaining expressed IgG4 (70%). She was started on a course of prednisolone and her symptoms resolved. IgG4-RD is becoming an emerging disease entity. Its involvement in the paranasal sinuses can mimic nasal tumours. Major surgical resection should be avoided as patients can often be treated medically.
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Affiliation(s)
- Anthony Bashyam
- ENT Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Sidhartha Nagala
- ENT Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Fawzia Tahir
- Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Showkat Mirza
- ENT Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
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Brown AM, Nagala S, McLean MA, Lu Y, Scoffings D, Apte A, Gonen M, Stambuk HE, Shaha AR, Tuttle RM, Deasy JO, Priest AN, Jani P, Shukla‐Dave A, Griffiths J. Multi-institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion-weighted MRI. Magn Reson Med 2016; 75:1708-16. [PMID: 25995019 PMCID: PMC4654719 DOI: 10.1002/mrm.25743] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasound-guided fine needle aspirate cytology fails to diagnose many malignant thyroid nodules; consequently, patients may undergo diagnostic lobectomy. This study assessed whether textural analysis (TA) could noninvasively stratify thyroid nodules accurately using diffusion-weighted MRI (DW-MRI). METHODS This multi-institutional study examined 3T DW-MRI images obtained with spin echo echo planar imaging sequences. The training data set included 26 patients from Cambridge, United Kingdom, and the test data set included 18 thyroid cancer patients from Memorial Sloan Kettering Cancer Center (New York, New York, USA). Apparent diffusion coefficients (ADCs) were compared over regions of interest (ROIs) defined on thyroid nodules. TA, linear discriminant analysis (LDA), and feature reduction were performed using the 21 MaZda-generated texture parameters that best distinguished benign and malignant ROIs. RESULTS Training data set mean ADC values were significantly different for benign and malignant nodules (P = 0.02) with a sensitivity and specificity of 70% and 63%, respectively, and a receiver operator characteristic (ROC) area under the curve (AUC) of 0.73. The LDA model of the top 21 textural features correctly classified 89/94 DW-MRI ROIs with 92% sensitivity, 96% specificity, and an AUC of 0.97. This algorithm correctly classified 16/18 (89%) patients in the independently obtained test set of thyroid DW-MRI scans. CONCLUSION TA classifies thyroid nodules with high sensitivity and specificity on multi-institutional DW-MRI data sets. This method requires further validation in a larger prospective study. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance.
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Affiliation(s)
- Anna M. Brown
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
- Duke University School of MedicineDurhamNorth CarolinaUSA
| | - Sidhartha Nagala
- Addenbrooke's Hospital Department of OtolaryngologyCambridgeUnited Kingdom
| | - Mary A. McLean
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
| | - Yonggang Lu
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Daniel Scoffings
- Addenbrooke's Hospital Department of RadiologyCambridgeUnited Kingdom
| | - Aditya Apte
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Mithat Gonen
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Hilda E. Stambuk
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ashok R. Shaha
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - R. Michael Tuttle
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Joseph O. Deasy
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Andrew N. Priest
- Addenbrooke's Hospital Department of RadiologyCambridgeUnited Kingdom
| | - Piyush Jani
- Cambridge Teaching Hospitals ENT DepartmentCambridgeUnited Kingdom
| | - Amita Shukla‐Dave
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - John Griffiths
- Cancer Research UK Cambridge Institute, University of CambridgeLi Ka Shing CentreRobinson WayCambridgeUnited Kingdom
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Taviani V, Nagala S, Priest AN, McLean MA, Jani P, Graves MJ. 3T diffusion-weighted MRI of the thyroid gland with reduced distortion: preliminary results. Br J Radiol 2013; 86:20130022. [PMID: 23770539 PMCID: PMC3745056 DOI: 10.1259/bjr.20130022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Received: 01/08/2013] [Revised: 05/23/2013] [Accepted: 06/07/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Single-shot diffusion-weighted (DW) echo planar imaging (EPI), which is commonly used for imaging the thyroid, is characterised by severe blurring and distortion. The objectives of this work were: 1, to show that a reduced-field of view (r-FOV) DW EPI technique can improve image quality; and 2, to investigate the effect of different reconstruction strategies on the resulting apparent diffusion coefficients (ADCs). METHODS We implemented a single-shot, r-FOV DW EPI technique with a two-dimensional radiofrequency excitation pulse for DW imaging of the thyroid at 3T. Images were reconstructed using root sum of squares (SOS) and an optimal-B1 reconstruction (OBR). Phantom and in vivo experiments were performed to compare r-FOV and conventional full-FOV DW EPI with root SOS and OBR. RESULTS r-FOV with OBR substantially improved image quality at 3T. In phantoms, r-FOV gave more accurate ADCs than full-FOV. In vivo r-FOV always gave lower ADC values with respect to the full-FOV technique irrespective of the reconstruction used and whether only two or multiple b-values were used to compute the ADCs. CONCLUSION r-FOV DW EPI can reduce image blurring and distortion at the expense of a low signal-to-noise ratio. OBR is a promising reconstruction technique for accurate ADC measurements in lower signal-to-noise ratio regimes, although further studies are needed to characterise its performance. ADVANCES IN KNOWLEDGE DW imaging of the thyroid at 3T could potentially benefit from r-FOV acquisition strategies, such as the r-FOV DW EPI technique proposed in this paper.
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Affiliation(s)
- V Taviani
- Department of Radiology, University of Cambridge, Cambridge, UK.
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Nagala S, Wilson J. Chronic cough. Clin Otolaryngol 2008; 33:94-6. [DOI: 10.1111/j.1749-4486.2008.01686.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Mutations in the BRI gene are thought to cause dementias in members of families. The clinical symptoms are similar to those of Alzheimer's disease, but with additional ocular and hearing deficits, and spasticity. The mutations lead to the release of the 34-residue peptides, ABri and ADan, in the brains of afflicted individuals. We have synthesized the peptides in their straight-chain and oxidized cyclic forms and shown that the oxidized form of ABri and reduced form of ADan are toxic to human neuronal cell lines in culture. Neurotoxicity correlates with the extent of formation of SDS-stable non-fibrillar low-molecular-mass oligomers (SSNFOs).
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Affiliation(s)
- B Austen
- Neurodegeneration Unit, Surgery Department, St. George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK.
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El-Agnaf OM, Nagala S, Patel BP, Austen BM. Non-fibrillar oligomeric species of the amyloid ABri peptide, implicated in familial British dementia, are more potent at inducing apoptotic cell death than protofibrils or mature fibrils. J Mol Biol 2001; 310:157-68. [PMID: 11419943 DOI: 10.1006/jmbi.2001.4743] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Familial British dementia (FBD) is an autosomal dominant neurodegenerative disorder, with biochemical and pathological similarities to Alzheimer's disease. FBD is associated with a point mutation in the stop codon of the BRI gene. The mutation extends the length of the wild-type protein by 11 amino acids, and following proteolytic cleavage, results in the production of a cyclic peptide (ABri) 11 amino acids longer than the wild-type (WT) peptide produced from the normal gene BRI. ABri was found to be the main component of amyloid deposits in FBD brains. However, pathological examination of FBD brains has shown the presence of ABri as non-fibrillar deposits as well as amyloid fibrils. Taken together, the genetic, pathological and biochemical data support the hypothesis that ABri deposits play a central role in the pathogenesis of FBD. Here we report that ABri, but not WT peptide, can oligomerise and form amyloid-like fibrils. We show for the first time that ABri induces apoptotic cell death, whereas WT is not toxic to cells. Moreover, we report the novel findings that non-fibrillar oligomeric species of ABri are more toxic than protofibrils and mature fibrils. These findings provide evidence that non-fibrillar oligomeric species are likely to play a critical role in the pathogenesis of FBD and suggest that a similar process may also operate in other neurodegenerative diseases.
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Affiliation(s)
- O M El-Agnaf
- Department of Surgery, Neurodegeneration Unit, St. George's Hospital Medical School, Cranmer Terrace, London, Tooting, SW17 0RE, UK.
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