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Stirrup O, Boshier F, Venturini C, Guerra-Assunção JA, Alcolea-Medina A, Beckett A, Charalampous T, da Silva Filipe A, Glaysher S, Khan T, Kulasegaran Shylini R, Kele B, Monahan I, Mollett G, Parker M, Pelosi E, Randell P, Roy S, Taylor J, Weller S, Wilson-Davies E, Wade P, Williams R, Copas A, Cutino-Moguel MT, Freemantle N, Hayward AC, Holmes A, Hughes J, Mahungu T, Nebbia G, Partridge D, Pope C, Price J, Robson S, Saeed K, de Silva T, Snell L, Thomson E, Witney AA, Breuer J. SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: multicentre cohort study. BMJ Open Respir Res 2021; 8:e001029. [PMID: 34544733 PMCID: PMC8453594 DOI: 10.1136/bmjresp-2021-001029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND SARS-CoV-2 lineage B.1.1.7 has been associated with an increased rate of transmission and disease severity among subjects testing positive in the community. Its impact on hospitalised patients is less well documented. METHODS We collected viral sequences and clinical data of patients admitted with SARS-CoV-2 and hospital-onset COVID-19 infections (HOCIs), sampled 16 November 2020 to 10 January 2021, from eight hospitals participating in the COG-UK-HOCI study. Associations between the variant and the outcomes of all-cause mortality and intensive therapy unit (ITU) admission were evaluated using mixed effects Cox models adjusted by age, sex, comorbidities, care home residence, pregnancy and ethnicity. FINDINGS Sequences were obtained from 2341 inpatients (HOCI cases=786) and analysis of clinical outcomes was carried out in 2147 inpatients with all data available. The HR for mortality of B.1.1.7 compared with other lineages was 1.01 (95% CI 0.79 to 1.28, p=0.94) and for ITU admission was 1.01 (95% CI 0.75 to 1.37, p=0.96). Analysis of sex-specific effects of B.1.1.7 identified increased risk of mortality (HR 1.30, 95% CI 0.95 to 1.78, p=0.096) and ITU admission (HR 1.82, 95% CI 1.15 to 2.90, p=0.011) in females infected with the variant but not males (mortality HR 0.82, 95% CI 0.61 to 1.10, p=0.177; ITU HR 0.74, 95% CI 0.52 to 1.04, p=0.086). INTERPRETATION In common with smaller studies of patients hospitalised with SARS-CoV-2, we did not find an overall increase in mortality or ITU admission associated with B.1.1.7 compared with other lineages. However, women with B.1.1.7 may be at an increased risk of admission to intensive care and at modestly increased risk of mortality.
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Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Florencia Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Cristina Venturini
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - José Afonso Guerra-Assunção
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Infection Sciences, Viapath, London, UK
| | - Angela Beckett
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Biological Sciences, University of Portsmouth, Portsmouth, UK
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
| | | | - Sharon Glaysher
- Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Tabassum Khan
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Beatrix Kele
- Division of Infection, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Irene Monahan
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Guy Mollett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Matthew Parker
- Sheffield Bioinformatics Core, The University of Sheffield, Sheffield, UK
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
- Sheffield Biomedical Research Centre, The University of Sheffield, Sheffield, UK
| | - Emanuela Pelosi
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, UK
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joshua Taylor
- Department of Microbiology, South West London Pathology, St. George's Hospital, London, UK
| | - Sophie Weller
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Eleri Wilson-Davies
- Southampton Specialist Virology Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Rachel Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | | | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Tabitha Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - David Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Cassie Pope
- Institute for Infection and Immunity, St George's University of London, London, UK
- Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - James Price
- Imperial College Healthcare NHS Trust, London, UK
| | - Samuel Robson
- Centre for Enzyme Innovation, University of Portsmouth, Portsmouth, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Kordo Saeed
- Microbiology Innovation and Research Unit (MIRU), Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Thushan de Silva
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The Florey Institute for Host-Pathogen Interactions & Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, UK
| | - Luke Snell
- Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King's College London, London, UK
- Department of Infectious Diseases, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Adam A Witney
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Adams J, Rauw J, Weller S, Campbell KL, Pollock P, Goulart J. Physical activity recommendations for cancer survivors living with bony metastases: views of oncologic healthcare providers. J Cancer Surviv 2021; 15:414-417. [PMID: 33604871 DOI: 10.1007/s11764-021-00999-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The potential of physical activity to improve function and quality of life of an individual with advanced cancer is now established. The purpose of this survey of oncologic healthcare providers (OHPs) is to understand their attitude towards physical activity for individuals living with bony metastases and to assess requirements to confidently provide physical activity recommendations. METHODS A web-based survey administered through Qualtrics™ included questions on participant demographics and attitude questions ranked on a Likert scale. Eligibility was a physician or nurse practitioner currently providing care in the cancer care system of a public healthcare system in Canada. 338 participants were identified and invited to participate in this survey. RESULTS The response rate was 34.6%. The majority of OHPs believed physical activity is important (89%) and safe (82%) in individuals living with bony metastases. OHPs agreed that these individuals looked to them for physical activity recommendations (74%) and that these recommendations would be followed (58%). Yet, 86% of OHPs felt they required more information before they could recommend physical activity to individuals living with bony metastases, and less than half (43%) of OHPs felt confident enough to prescribe physical activity. CONCLUSIONS OHPs agree that physical activity for individuals living with bony metastatic cancer is beneficial and safe. However, OHPs are not confident in their ability to recommend physical activity to this population. IMPLICATIONS FOR CANCER SURVIVORS There is a need to create physical activity guidelines for individuals living with bony metastases and improve access to rehabilitation services.
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Affiliation(s)
- J Adams
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - J Rauw
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - S Weller
- BC Cancer Vancouver, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada
| | - P Pollock
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada
| | - J Goulart
- BC Cancer, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada.
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Crickx E, Sokal A, Chappert P, Weller S, Azzaoui I, Vandenberghe A, Bonnard G, Geoffrey R, Fadeev T, Storck S, Fadlallah J, Meignin V, Riviere E, Godeau B, Michel M, Weill J, Reynaud C, Mahevas M. Un réservoir de lymphocytes B mémoires ayant résisté au rituximab participe aux rechutes à distance du traitement au cours de la thrombopénie immunologique de l’adulte. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Seit 2018 ist es nach einer Novellierung des SGB V psychiatrischen Kliniken möglich, stationäre aufsuchende Behandlung im Lebensumfeld psychiatrisch Erkrankter zu realisieren. Dabei sind besondere Strukturmerkmale und Dokumentationspflichten zu beachten. So muss dem Behandlungsteam neben einem Mitglied der ärztlichen und der pflegerischen Berufsgruppe auch mindestens ein Mitglied einer dritten Berufsgruppe angehören (z. B. Ergotherapie, Sozialarbeit, Physiotherapie). Die Leistungsvergütung wird zwischen der jeweiligen Klinik und den Krankenkassen verhandelt und schließt, regional divergent, Abrechnungen nach Pauschalen, nach geleisteten Minuten oder gemischte Modelle ein. Aus psychiatrisch-psychotherapeutischer Sicht bietet die Behandlung gerontopsychiatrischer Patienten in ihrem Wohnumfeld und damit in ihren sozialen Kontexten viele Vorteile. Voraussetzung für ein Gelingen dieses Ansatzes ist ein auch in somatischen Erkrankungen erfahrenes und logistisch hochflexibles multiprofessionelles Behandlungsteam. Unter den Bedingungen der Coronapandemie stellen sich besondere Herausforderungen aufgrund der Besuchsverbote in Pflegeheimen und der mit aufsuchender Arbeit verbundenen Infektionsgefahr für Patienten und Mitglieder des Behandlungsteams.
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Affiliation(s)
- S Spannhorst
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - S Weller
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - C Thomas
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
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5
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Gil E, Weller S, Rokadiya S, Mirfenderesky M, Ahmed A, Schwenk A. Letter in response to 'Modelling SARS-COV2 spread in London: Approaches to lift the lockdown' local experience, national questions. How local is local enough? J Infect 2020; 82:e1-e3. [PMID: 32712205 PMCID: PMC7376350 DOI: 10.1016/j.jinf.2020.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Eliza Gil
- Department of Microbiology and Infection, North Middlesex University Hospital NHS Trust, United Kingdom.
| | - Sophie Weller
- Department of Microbiology and Infection, North Middlesex University Hospital NHS Trust, United Kingdom
| | - Sakib Rokadiya
- Department of Microbiology and Infection, North Middlesex University Hospital NHS Trust, United Kingdom
| | - Mariyam Mirfenderesky
- Department of Microbiology and Infection, North Middlesex University Hospital NHS Trust, United Kingdom
| | - Aliko Ahmed
- Cambridge Institute of Public Health, University of Cambridge, United Kingdom
| | - Achim Schwenk
- COVID-19 Incident Team, North Middlesex University Hospital NHS Trust, United Kingdom
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6
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Weller S, Plewnia C. P111. Exploring the effects of transcranial direct current stimulation on cognitive control training. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.728] [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: 10/28/2022]
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8
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Pappadis M, Krishnan S, Weller S, Tan A, Jaramillo E, Sheffield K, Goodwin J. CONTINUE OR STOP: A QUALITATIVE ANALYSIS OF MAMMOGRAPHY SCREENING DECISION FOR OLDER WOMEN. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M.R. Pappadis
- University of Texas Medical Branch, Galveston, Texas,
| | - S. Krishnan
- University of Texas Medical Branch, Galveston, Texas,
| | - S. Weller
- University of Texas Medical Branch, Galveston, Texas,
| | - A. Tan
- The Ohio State University, Colombus, Ohio
| | - E. Jaramillo
- University of Texas Medical Branch, Galveston, Texas,
| | | | - J.S. Goodwin
- University of Texas Medical Branch, Galveston, Texas,
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9
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Weller S, Varrier M, Ostermann M. Lymphocyte Function in Human Acute Kidney Injury. Nephron Clin Pract 2017; 137:287-293. [PMID: 28662513 DOI: 10.1159/000478538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/09/2017] [Indexed: 11/19/2022] Open
Abstract
Acute kidney injury (AKI) has been recognised as an inflammatory condition with serious short- and long-term complications. Animal studies primarily using models of ischaemia reperfusion injury or caecal ligation and perforation have clearly demonstrated that inflammatory cells contribute to the initiation, propagation and recovery phase of AKI and that lymphocytes have a key role in these processes. Less is known about their involvement in common types of human AKI. This paper summarises the key findings of experimental AKI studies and limited human data with particular focus on the role of T-lymphocytes.
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Affiliation(s)
- Sophie Weller
- Department of Critical Care, King's College London School of Medical Education, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kirkham AA, Neil-Sztramko SE, Morgan J, Hodson S, Weller S, McRae T, Campbell KL. Fee-for-service cancer rehabilitation programs improve health-related quality of life. ACTA ACUST UNITED AC 2016; 23:233-40. [PMID: 27536173 DOI: 10.3747/co.23.3038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. METHODS After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. RESULTS Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). CONCLUSIONS Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.
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Affiliation(s)
- A A Kirkham
- Rehabilitation Sciences, University of British Columbia
| | - S E Neil-Sztramko
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - J Morgan
- Back on Track Fitness, Vancouver, BC
| | - S Hodson
- Live Well Exercise Clinic, White Rock, BC
| | - S Weller
- Back on Track Fitness, Vancouver, BC
| | - T McRae
- Live Well Exercise Clinic, White Rock, BC
| | - K L Campbell
- Rehabilitation Sciences, University of British Columbia; Physical Therapy, University of British Columbia, Vancouver, BC
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Brinza L, Schofield PF, Hodson ME, Weller S, Ignatyev K, Geraki K, Quinn PD, Mosselmans JFW. Combining µXANES and µXRD mapping to analyse the heterogeneity in calcium carbonate granules excreted by the earthworm Lumbricus terrestris. J Synchrotron Radiat 2014; 21:235-41. [PMID: 24365942 PMCID: PMC3874023 DOI: 10.1107/s160057751303083x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/09/2013] [Indexed: 05/28/2023]
Abstract
The use of fluorescence full spectral micro-X-ray absorption near-edge structure (µXANES) mapping is becoming more widespread in the hard energy regime. This experimental method using the Ca K-edge combined with micro-X-ray diffraction (µXRD) mapping of the same sample has been enabled on beamline I18 at Diamond Light Source. This combined approach has been used to probe both long- and short-range order in calcium carbonate granules produced by the earthworm Lumbricus terrestris. In granules produced by earthworms cultured in a control artificial soil, calcite and vaterite are observed in the granules. However, granules produced by earthworms cultivated in the same artificial soil amended with 500 p.p.m. Mg also contain an aragonite. The two techniques, µXRD and µXANES, probe different sample volumes but there is good agreement in the phase maps produced.
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Affiliation(s)
- Loredana Brinza
- Science Division, Diamond Light Source, Harwell Campus, Didcot, Oxon OX11 0DE, UK
| | - Paul F. Schofield
- Mineral and Planetary Sciences Division, Natural History Museum, Cromwell Road, London SW7 5BD, UK
| | - Mark E. Hodson
- Environment Department, University of York, York YO10 5DD, UK
| | - Sophie Weller
- Department of Chemistry, University of Oxford, South Parks Road, Oxford OX1 3QR, UK
| | - Konstantin Ignatyev
- Science Division, Diamond Light Source, Harwell Campus, Didcot, Oxon OX11 0DE, UK
| | - Kalotina Geraki
- Science Division, Diamond Light Source, Harwell Campus, Didcot, Oxon OX11 0DE, UK
| | - Paul D. Quinn
- Science Division, Diamond Light Source, Harwell Campus, Didcot, Oxon OX11 0DE, UK
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12
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Víctor D, Burek C, Corbetta JP, Sentagne A, Sager C, Weller S, Paz E, Bortagaray JI, Lopez JC. Augmentation cystoplasty in children without preoperative mechanical bowel preparation. J Pediatr Urol 2012; 8:201-4. [PMID: 21831716 DOI: 10.1016/j.jpurol.2011.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Received: 08/30/2010] [Accepted: 01/31/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To retrospectively assess early postoperative complications in augmentation cystoplasty without preoperative mechanical bowel preparation (MBP). MATERIAL AND METHODS Between May 1987 and May 2006, 162 cystoplasties were performed in 158 children. The segments used were: sigmoid colon (81.5%), ileum (13%), and ileocecum (5.5%). The mean age was 8.65 years (range 2.1-22.7 years). No preoperative MBP of any kind was used in any of the patients and all of them received antibiotics preoperatively and postoperatively. RESULTS No intraoperative complications related to the procedure were reported. The mean hospital stay was 9.48 days (range 4-30 days). The mean time to intake of oral fluids was 94.77 h (range 48-288 h). Postoperative complications occurred in 9.87%: urinary fistula was the most common (2.4%); only 3 patients presented wound infection (1.85%); 5 patients required reoperative surgery (hemoperitoneum, patch necrosis and 3 cases of urinary peritonitis); 1 patient presented an intra-abdominal abscess that resolved with antibiotic treatment. CONCLUSIONS Preoperative MBP can be omitted in children that require augmentation cystoplasty without an increased risk of infectious or anastomotic complications. Further prospective, randomized clinical trials should be carried out in order to validate our findings in the pediatric population.
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Affiliation(s)
- Durán Víctor
- Urology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina.
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13
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Corbetta JP, Durán V, Burek C, Weller S, Sager C, Dingevan R, Lopez JC. Renal autotransplantation for the treatment of renovascular hypertension in the pediatric population. J Pediatr Urol 2011; 7:378-82. [PMID: 21527221 DOI: 10.1016/j.jpurol.2011.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [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: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of renal autotransplantation (RA) for the treatment of renovascular hypertension (RVH) in a selected group of children in whom medical care, a percutaneous transluminal angioplasty or vascular reconstruction failed or was technically impossible, in addition to the short-term and long-term morbidity. MATERIALS AND METHODS A retrospective case review of 13 pediatric patients with severe or complicated RVH who underwent RA between May 1993 and August 2008 was conducted. We defined blood pressure (BP) response as follows: Cured: normal BP values with no need of antihypertensive medication (AM); Improved: normal BP values with AM requirements; Failed: abnormal BP values despite treatment with AM. RESULTS 16 RA were performed in 7 female and 6 male patients. Bilateral RA were performed in 2 females and in 1 male. The average age at consultation for hypertension was 8.5 years (range 4-12 years) and the time of transplantation was 9.12 years (range 6-13 years). Etiological diagnoses were: Takayasu disease (n = 5); renal artery fibrodysplasia (n = 3); mid-aortic syndrome (n = 3) and neurofibromatosis type I (n = 2). Results after RA were: Cured: 61.5%; Improved: 38.5%. No patient presented therapeutic failure during follow up time (median = 53.4 months). Only 1 case presented a postoperative complication. CONCLUSIONS RA is a procedure with no mortality and low morbidity rates that renders very satisfactory therapeutic results in the pediatric population.
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Affiliation(s)
- Juan Pablo Corbetta
- Urology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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14
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Sager C, Burek C, Durán V, Corbetta JP, Weller S, Paz E, Bortagaray J, López JC. [Botulinic toxin type A in the treatment of children with neurogenic bladder]. Cir Pediatr 2011; 24:38-43. [PMID: 23155649] [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: 06/01/2023]
Abstract
UNLABELLED INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder refractory to anticholinergics. OBJECTIVE. To evaluate the initial effects of BoNTA in neurogenic bladders. PATIENTS AND METHODS 12 patients (9 myelomeningoceles, 1 tethered cord, 1 medullary astrocytoma, 1 Ewing's sarcoma) were studied. The pretreatment evaluation included: voiding diary, incontinence score, renovesical ultrasound, cystourethrography and urodynamic parameters. Patients received 300 UI of BoNTA via detrusor injections. They were re-evaluated at months 1, 3 and 6. After the third control, if improvement was confirmed, patients were injected again. Otherwise, surgery was indicated. RESULTS After the initial injection, 50% of patients achieved complete continence and 20% remained with minimal leaks. The mean maximum bladder capacity increased from 264 +/- 117 ml to 324 +/- 170 ml (P = 0.322). The mean detrusor pressure decreased from 46 +/- 17 cm H2O to 42 +/- 14 cm H2O (P=0.596). The mean bladder compliance increased from 7.6 +/- 5.9 ml/cm H2O to 10.4 +/- 6.4 ml/cm H2O (P = 0.290). The reflex voiding contractions disappeared in 2 patients; 8 presented trabeculae. Ten patients were reinjected and two underwent surgery. CONCLUSION 70% urinary continence was achieved after the initial injection. No significant urodynamic changes were observed. A longer follow-up with subsequent injections is needed.
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Affiliation(s)
- C Sager
- Servicio de Urología, Hospital Nacional de Pediatría Profesor Dr. Juan P. Garrahan. Buenos Aires, Argentina.
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Klümper A, Lohmann V, Uehlinger E, Weller S, Strey M. Aseptische Knochennekrosen des Oberschenkelkopfes nach Glucocorticoidbehandlung. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1228191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klümper A, Strey M, Weller S, Roth U, Bildstein P. Neurogene Osteolysen*Defekte an Fußknochen nach traumatischer Schädigung peripherer Nerven. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1228305] [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: 10/20/2022]
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Weller S, Rosewich H, Gärtner J. Cerebral MRI as a valuable diagnostic tool in Zellweger spectrum patients. J Inherit Metab Dis 2008; 31:270-80. [PMID: 18415699 DOI: 10.1007/s10545-008-0856-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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: 12/26/2007] [Revised: 02/08/2008] [Accepted: 02/11/2008] [Indexed: 12/21/2022]
Abstract
Patients with defects in the biogenesis of peroxisomes include those with Zellweger syndrome spectrum (ZSS), a developmental and progressive metabolic disease with a distinct dysmorphic phenotype and varying severity. The diagnosis of ZSS relies on the clinical presentation and the biochemical evaluation of peroxisomal metabolites. Mutation detection in one out of twelve genes coding for proteins involved in the biogenesis of peroxisomes confirms the diagnosis. In the absence of pronounced clinical features of ZSS, neuroradiological findings may lead the way to the diagnosis. Cerebral magnetic resonance imaging (cMRI) pathology in ZSS consists of abnormal gyration pattern including polymicrogyria and pachygyria, leukencephalopathy, germinolytic cysts and heterotopias as reported by previous systematic studies including cMRI of a total of 34 ZSS patients, only five of whom had a severe phenotype. The present study evaluated the cMRI results of additional 18 patients, 6 with a severe and 12 with a milder ZSS phenotype. It confirms and extends knowledge of the characteristic cMRI pattern in ZSS patients. Besides an abnormal gyration pattern and delayed myelination or leukencephalopathy, brain atrophy was a common finding. Polymicrogyria and pachygyria were more common in patients with severe ZSS, while leukencephalopathy increases with age in patients with longer survival. Nevertheless, an abnormal gyration pattern might be more frequent in patients with a mild ZSS than deduced from previous studies. In addition, we discuss the differential diagnosis of the ZSS cMRI pattern and review investigations on the pathogenesis of the ZSS cerebral phenotype in mouse models of the disease.
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Affiliation(s)
- S Weller
- Department of Pediatrics and Pediatric Neurology, Georg August University, Göttingen, Germany.
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Ochs U, Eingartner C, Volkmann R, Ochs B, Huber C, Weller S, Weise K. Prospective Long-Term Follow-Up of the Cementless Bicontact Hip Stem with Plasmapore Coating. ACTA ACUST UNITED AC 2007; 145 Suppl 1:S3-8. [PMID: 17939096 DOI: 10.1055/s-2007-965652] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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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Ochs B, Volkmann R, Eingartner C, Ludolph I, Weller S, Weise K, Ochs U. Treatment of Large Femoral Bone Defects - 15-Year Experiences with the Cementless Bicontact Revision Stem with Distal Interlocking. ACTA ACUST UNITED AC 2007; 145 Suppl 1:S34-9. [DOI: 10.1055/s-2007-965658] [Citation(s) in RCA: 9] [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] [Indexed: 10/22/2022]
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Volkmann R, Bretschneider K, Erlekampf E, Weller S. Revision Surgery in High Grade Acetabular Defects with Thermodisinfected Allografts. ACTA ACUST UNITED AC 2007; 145 Suppl 1:S44-8. [DOI: 10.1055/s-2007-965660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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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Schrock J, Reznikova S, Weller S. 62: Does the Addition of an Observation Unit Change the Rate of Admission For Pyelonephritis? Ann Emerg Med 2007. [DOI: 10.1016/j.annemergmed.2007.06.093] [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: 11/28/2022]
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Zaidi A, Tripuraneni G, Weller S, Ward B, Sinnett HD, Coombes RC, Slade MJ. Minimal residue disease (MRD). Breast Cancer Res 2007. [DOI: 10.1186/bcr1724] [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: 11/10/2022] Open
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Liu A, Dunbar J, Fayard D, Lee S, Leng C, Leng J, Lim P, Niemeyer M, Weller S, Vyhmeister N, Fayard E. 247 RECOMBINANT HUMAN ERYTHROPOIETIN TREATMENT AND INCIDENCE OF RETINOPATHY OF PREMATURITY. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Eingartner C, Volkmann R, Ilchmann T, Weise K, Weller S. A modular system for cemented and cementless implantation of femoral stem prostheses. Surg Technol Int 2003; 7:353-61. [PMID: 12722002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A femoral stem [BiContact, Aesculap, Germany) has been developed which is suitable for both cemented
and uncemented implantation. Thus a highly standardized procedure and a standard implant for any
iritraoperative finding is available. While the cemented stems have a smooth surface, the cementless
implants are proximally coated with a microporous titanium plasmaspray [Plasmapore]. The strategy based on
the intraoperative choice of the surgeon to use either cemented or cementless implants after bone preparation
turned out to be very successful in our institution. A consecutive series of 250 cases with cemented implantation
and 250 cases with uncemented implantation was analyzed in a prospective follow-up study, Pollow-up time
averaged 7 years for cemented and 6.5 years for uncemented THRs. The follow-up rate was 88.7% in cases treated
with cemented stems and 93.1% in cases treated with uncemented stems. The rate of aseptic loosening was 1.2%
for the cemented version and 0.4-% for the uncemented stem. Radiological loosening could be observed in
another 1.2% of the cemented stems and was not to be found in the uncemented cases. Our data suggest an
excellent midterm stability of both the cemented and the uncemented version of the BiContact hip system. The
long-term results for both the cemented and uncemented prostheses of our series are still to be evaluated.
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Eingartner C, Ihm A, Maurer F, Volkmann R, Weise K, Weller S. [Good long term results with a cemented straight femoral shaft prosthesis made of titanium]. Unfallchirurg 2002; 105:804-10. [PMID: 12232740 DOI: 10.1007/s00113-002-0425-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A higher-than-average rate of aseptic loosening has been postulated to be associated with the combination of a titanium stem and bone cement. In this prospective follow-up study we therefore investigated our first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (BiCONTACT((R)), Aesculap, Tuttlingen, Germany). Average time of follow-up evaluation was 9.7 years (range 8.7-10.3 years). At follow-up, mean patient age was 81 years; 89 patients with 93 hips have deceased and two could not be located. Follow-up rate was 98.7% for the patients still alive at time of follow-up evaluation. Five patients have been revised, two for infection and one for aseptic loosening of a varus-malaligned stem; two radiologically well-fixed stems had been revised during acetabular revision. Survival estimate showed a calculated cumulative survival rate of 97.5% after 11 years [confidence limits: 99.0% (upper) and 94.1% (lower)]. The average Harris hip score at time of follow-up was 82.25 points.Radiologically, signs of loosening could be detected in 3 stems: in one case varus malalignement deteriorated with time and in 2 cases osteolyses developed together with significant polyethylene wear. All 3 patients experienced only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated to the combination of titanium and cement in this specific stem. Design parameters seem to play an important role in the development of aseptic loosening in cemented titanium stems.
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Affiliation(s)
- C Eingartner
- Berufsgenossenschaftliche Unfallklinik, Eberhard-Karls-Universität Tübingen, Germany.
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Golumbic C, Orchin M, Weller S. Partition Studies on Phenols. I. Relation between Partition Coefficient and Ionization Constant. J Am Chem Soc 2002. [DOI: 10.1021/ja01176a006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
L1 disease is a group of overlapping clinical phenotypes including X-linked hydrocephalus, MASA syndrome, spastic paraparesis type 1, and X-linked agenesis of corpus callosum. The patients are characterized by hydrocephalus, agenesis or hypoplasia of corpus callosum and corticospinal tracts, mental retardation, spastic paraplegia, and adducted thumbs. The responsible gene, L1CAM, encodes the L1 protein which is a member of the immunoglobulin superfamily of neuronal cell adhesion molecules. The L1 protein is expressed in neurons and Schwann cells and seems to be essential for nervous system development and function. The patients' gene mutations are distributed over the functional protein domains. The exact mechanisms by which these mutations cause a loss of L1 protein function are unknown. There appears to be a relationship between the patients' clinical phenotype and the genotype. Missense mutations in extracellular domains or mutations in cytoplasmic regions cause milder phenotypes than those leading to truncation in extracellular domains or to non-detectable L1 protein. Diagnosis of patients and carriers, including prenatal testing, is based on the characteristic clinical picture and DNA mutation analyses. At present, there is no therapy for the prevention or cure of patients' neurological disabilities.
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Affiliation(s)
- S Weller
- Department of Pediatrics, Heinrich Heine University, Düsseldorf, Germany
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Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Corey L, Gruber WC, Rathore M, Bradley JS, Diaz PS, Kumar M, Arvin AM, Gutierrez K, Shelton M, Weiner LB, Sleasman JW, de Sierra TM, Weller S, Soong SJ, Kiell J, Lakeman FD, Whitley RJ. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics 2001; 108:230-8. [PMID: 11483782 DOI: 10.1542/peds.108.2.230] [Citation(s) in RCA: 306] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this investigation was to establish the safety of high-dose (HD) acyclovir for the treatment of neonatal herpes simplex virus (HSV) disease. In addition, an estimate of therapeutic efficacy was sought, both with respect to mortality and to morbidity. Virologic efficacy of HD acyclovir was also assessed. PARTICIPANTS Infants who were </=28 days old and whose disease was considered to be caused by HSV were enrolled in this study. Patients with central nervous system (CNS; N = 28) or disseminated (N = 41) HSV infection were offered participation in the trial. A small number of patients with HSV disease limited to the skin, eyes, or mouth (SEM; N = 10) or whose disease was clinically consistent with HSV but who did not have virologic confirmation of infection (N = 9) also were enrolled on a compassionate basis. Only patients with virologically confirmed HSV disease were included in efficacy analyses. All enrolled patients were included in safety analyses. METHODS The study was an open-label evaluation of intravenous acyclovir at dosages higher than the 30 mg/kg/d standard dosage approved by the US Food and Drug Administration. The first 16 patients enrolled received intermediate-dose (ID) acyclovir (45 mg/kg/d), and the next 72 patients received HD acyclovir (60 mg/kg/d). Acyclovir was administered in 3 divided daily doses for 21 days. Neonates were assessed prospectively throughout treatment and at scheduled follow-up visits for the first 4 years of life. Data were compared with those of a previous National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group trial in which patients received standard-dose (SD) acyclovir for 10 days and in which identical methods (with the exception of acyclovir dosage and duration of therapy) were used. RESULTS Six (21%) of 29 HD acyclovir recipients whose HSV disease remained localized to the SEM or CNS experienced neutropenia. One of the 6 had an absolute neutrophil count <500/mm(3), and 5 patients had an absolute neutrophil count (ANC) between 500/mm(3) and 1000/mm(3). In all 6 cases, the ANC recovered during continuation of acyclovir at the same dosage or after completion of acyclovir therapy, and there were no apparent adverse sequelae of the transient neutropenia. No other drug-related adverse events were reported among ID or HD recipients, and no other laboratory aberrations could be correlated specifically with antiviral therapy. The survival rate for the patients with disseminated HSV disease treated with HD acyclovir was significantly higher than for those in the previous study treated with SD acyclovir, with an odds ratio (OR) of 3.3 (95% confidence interval [CI]: 1.4-7.9). For patients with CNS disease, however, survival rates were similar for the HD and SD groups. To assess the effect of HD acyclovir on survival for the entire population with neonatal HSV disease, the Cox proportional hazards regression analysis was performed with stratification for disease category (CNS versus disseminated). In performing this analysis, differences in mortality for each disease category were weighted to allow statistical comparison of the treatment dosage groups (HD, ID, and SD). This analysis indicated that the survival rate for patients treated with HD acyclovir was statistically significantly higher than for patients treated with SD acyclovir (OR: 3.3; 95% CI: 1.5-7.3). Recipients of HD acyclovir had a borderline significant decrease in morbidity compared with SD recipients, after stratification for the extent of disease (SEM vs CNS vs disseminated) and controlling for the potential confounding factors of HSV type (HSV-1 vs. HSV-2), prematurity, and disease severity (seizures). Patients treated with HD acyclovir were 6.6 times (adjusted OR; 95% CI: 0.8-113.6) as likely to be developmentally normal at 12 months of age as patients treated with SD therapy. CONCLUSION These data support the use of a 21-day course of HD (60 mg/kg/d) intravenous acyclovir to treat neonatal CNS and disseminated HSV disease. Throughout the course of HD acyclovir therapy, serial ANC determination should be made at least twice weekly. Decreasing the acyclovir dosage or administering granulocyte colony-stimulating factor should be considered if the ANC remains below 500/mm(3) for a prolonged period.
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Affiliation(s)
- D W Kimberlin
- Department of Pediatrics, University of Alabama at Birmingham, Alabama 35233, USA.
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Bönig H, Silbermann S, Weller S, Kirschke R, Körholz D, Janssen G, Göbel U, Nürnberger W. Glycosylated vs non-glycosylated granulocyte colony-stimulating factor (G-CSF)--results of a prospective randomised monocentre study. Bone Marrow Transplant 2001; 28:259-64. [PMID: 11535993 DOI: 10.1038/sj.bmt.1703136] [Citation(s) in RCA: 39] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2001] [Accepted: 06/03/2001] [Indexed: 12/12/2022]
Abstract
The discovery of the haematopoietic growth factor granulocyte colony-stimulating factor (G-CSF) has reduced infection-related morbidity in cancer patients by alleviating post-chemotherapy neutropenia. Two formulations of recombinant human (rh) G-CSF, one glycosylated and one non-glycosylated, are available. The glycosylated form, lenograstim, possesses at least 25% greater bioactivity in vitro. Some comparative studies into the preparation's potential to mobilise haematopoietic stem cells suggest a similar advantage. In the light of the great clinical importance of G-CSF, we have performed the first prospective, randomised, crossover study on children with chemotherapy-induced neutropenia. G-CSF (250 microg/m(2)) was started 1 day after the chemotherapy block, and was administered until a WBC >1500/microl was achieved on 3 successive days. Thirty-three G-CSF cycles from 11 patients (16 lenograstim, 17 filgrastim) were studied. They were investigated for duration of very severe (WBC <500/microl, 9 vs 9.5 days, lenograstim vs filgrastim, median) and severe leukopenia (WBC <1000/microl, 11 vs 11 days), infections (CRP >5 mg/dl, 5 vs 5.5 days), infection-related hospital stay (11 vs 9 days) and antibiotic treatment (9 vs 9 days). Statistical evaluation by paired analysis could not detect any difference between treatment groups; the median difference for all end-points was zero. In summary, at least at 250 microg/m(2), in terms of their clinical effect on neutropenia, the two G-CSF preparations appear to have identical activity.
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Affiliation(s)
- H Bönig
- Department of Paediatric Haematology and Oncology, Center of Child Health, Heinrich-Heine University Medical Center, Düsseldorf, Germany
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Höglund M, Ljungman P, Weller S. Comparable aciclovir exposures produced by oral valaciclovir and intravenous aciclovir in immunocompromised cancer patients. J Antimicrob Chemother 2001; 47:855-61. [PMID: 11389118 DOI: 10.1093/jac/47.6.855] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [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: 11/14/2022] Open
Abstract
The objective of this study was to evaluate the comparability of systemic aciclovir exposure at steady state in immunocompromised patients following oral valaciclovir 1000 mg tds and intravenous (iv) aciclovir 5 mg/kg tds. A two-centre, randomized, open label, two-way crossover study was undertaken. Patients aged 18-65 years who had undergone high-dose chemotherapy for cancer and were neutropenic (neutrophil count <0.5 x 109/mL) with normal renal function were recruited. The pharmacokinetic parameters of aciclovir after oral valaciclovir 1000 mg or iv aciclovir 5 mg/kg given as 1 h infusion, each administered every 8 h for seven doses, were compared. Fifteen patients were enrolled and 13 completed both treatments. The mean (s.d.) values for aciclovir after oral valaciclovir and iv aciclovir were: AUC0-8 76.3 (29.7) and 64.2 (20.0) microM x h; peak plasma concentration (Cmax) 26.6 (10.5) and 34.0 (11.9) microM; time to maximal plasma concentration (tmax) 2.01 (0.65) and 0.95 (0.19); and plasma elimination half-life (t1/2) 2.83 (0.91) and 2.44 (0.62) h, respectively. The mean absolute bioavailability of aciclovir from oral valaciclovir was 60 +/- 21%. Equivalent systemic exposure to aciclovir after oral valaciclovir 1000 mg and iv aciclovir 5 mg/kg was observed with AUC0-8 (oral/iv ratio = 1.16; 90% CI 0.98-1.39), whilst significantly reduced peak aciclovir concentrations were obtained with oral valaciclovir (ratio = 0.75; 90% CI 0.60-0.94). Oral valaciclovir offers a convenient, and possibly safer, alternative to iv aciclovir, delivering comparable systemic exposures with reduced peak levels. This may contribute to shorter hospitalization, reduced costs for healthcare providers and improved quality of life for patients.
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Affiliation(s)
- M Höglund
- Department of Internal Medicine, Haematology, University Hospital, S-751 85 Uppsala, Sweden.
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Winter E, Piert M, Volkmann R, Maurer F, Eingartner C, Weise K, Weller S. Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 2001; 83:862-7. [PMID: 11407794 DOI: 10.2106/00004623-200106000-00007] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is an ever-increasing number of failed hip arthroplasties associated with massive deficiency of acetabular bone stock consisting of a segmental or cavitary defect. This study was undertaken to evaluate the long-term results after use of morselized cryopreserved allogeneic bone graft and an antiprotrusio cage to treat such a deficiency. METHODS From January 1, 1988, to January 1, 1994, forty-one patients (forty-one hips) with an acetabular defect classified as type IIl or IV according to the American Academy of Orthopaedic Surgeons system were operated on with use of a Burch-Schneider ring and morselized cryopreserved allogeneic cancellous bone graft. Thirty-eight patients (thirty-eight hips) were available for clinical and radiographic follow-up examinations at an average of 7.3 years (range, 4.2 to 9.4 years) after surgery. RESULTS All measured clinical parameters had improved significantly by the time of the follow-up examination (p < 0.0001). Radiographs confirmed that none of the thirty-eight hips had any measurable migration or displacement of the acetabular component and that osseous consolidation occurred only within the grafted area in all patients. CONCLUSION Acetabular reconstruction with use of morselized cryopreserved allogeneic cancellous bone graft and the Burch-Schneider ring can be highly successful in managing massive acetabular deficiencies in revision hip arthroplasty.
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Affiliation(s)
- E Winter
- Berufsgenossenschaftliche Unfallklinik, Trauma Center, University of Tuebingen, Germany
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Gandhi V, Plunkett W, Weller S, Du M, Ayres M, Rodriguez CO, Ramakrishna P, Rosner GL, Hodge JP, O'Brien S, Keating MJ. Evaluation of the combination of nelarabine and fludarabine in leukemias: clinical response, pharmacokinetics, and pharmacodynamics in leukemia cells. J Clin Oncol 2001; 19:2142-52. [PMID: 11304766 DOI: 10.1200/jco.2001.19.8.2142] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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
PURPOSE A pilot protocol was designed to evaluate the efficacy of fludarabine with nelarabine (the prodrug of arabinosylguanine [ara-G]) in patients with hematologic malignancies. The cellular pharmacokinetics was investigated to seek a relationship between response and accumulation of ara-G triphosphate (ara-GTP) in circulating leukemia cells and to evaluate biochemical modulation of cellular ara-GTP metabolism by fludarabine triphosphate. PATIENTS AND METHODS Nine of the 13 total patients had indolent leukemias, including six whose disease failed prior fludarabine therapy. Two patients had T-acute lymphoblastic leukemia, one had chronic myelogenous leukemia, and one had mycosis fungoides. Nelarabine (1.2 g/m(2)) was infused on days 1, 3, and 5. On days 3 and 5, fludarabine (30 mg/m(2)) was administered 4 hours before the nelarabine infusion. Plasma and cellular pharmacokinetic measurements were conducted during the first 5 days. RESULTS Seven patients had a partial or complete response, six of whom had indolent leukemias. The disease in four responders had failed prior fludarabine therapy. The median peak intracellular concentrations of ara-GTP were significantly different (P =.001) in responders (890 micromol/L, n = 6) and nonresponders (30 micromol/L, n = 6). Also, there was a direct relationship between the peak fludarabine triphosphate and ara-GTP in each patient (r = 0.85). The cellular elimination of ara-GTP was slow (median, 35 hours; range, 18 to > 48 hours). The ratio of ara-GTP to its normal counterpart, deoxyguanosine triphosphate, was higher in each patient (median, 42; range, 14 to 1,092) than that of fludarabine triphosphate to its normal counterpart, deoxyadenosine triphosphate (median, 2.2; range, 0.2 to 27). CONCLUSION Fludarabine plus nelarabine is an effective, well-tolerated regimen against leukemias. Clinical responses suggest the need for further exploration of nelarabine against fludarabine-refractory diseases. Determination of ara-GTP levels in the target tumor population may provide a prognostic test for the activity of nelarabine.
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Affiliation(s)
- V Gandhi
- Departments of Experimental Therapeutics, Biostatistics, and Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Eingartner C, Volkmann R, Winter E, Maurer F, Ihm A, Weller S, Weise K. Results of a cemented titanium alloy straight femoral shaft prosthesis after 10 years of follow-up. Int Orthop 2001; 25:81-4. [PMID: 11409457 PMCID: PMC3620625 DOI: 10.1007/s002640100249] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two-hundred fifty implantations of a cemented femoral stem made of titanium alloy in 239 patients were followed for 9.7 years (range 8.7-10.3 years). Eighty-nine patients with 93 hips have died and two could not be located. Five hips have been revised, two for infection, one for aseptic loosening and two during revision of the cup. Three stems showed radiological loosening but have not been revised. The average hip score was 85. The results are encouraging and comparable to other cemented femoral stems.
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Affiliation(s)
- C Eingartner
- BG Trauma Center, University of Tübingen, Germany.
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Weller S, Faili A, Garcia C, Braun MC, Le Deist F F, de Saint Basile G G, Hermine O, Fischer A, Reynaud CA, Weill JC. CD40-CD40L independent Ig gene hypermutation suggests a second B cell diversification pathway in humans. Proc Natl Acad Sci U S A 2001; 98:1166-70. [PMID: 11158612 PMCID: PMC14726 DOI: 10.1073/pnas.98.3.1166] [Citation(s) in RCA: 299] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Somatically mutated IgM(+)-only and IgM(+)IgD(+)CD27(+) B lymphocytes comprise approximately 25% of the human peripheral B cell pool. These cells phenotypically resemble class-switched B cells and have therefore been classified as postgerminal center memory B cells. X-linked hyper IgM patients have a genetic defect characterized by a mutation of the CD40L gene. These patients, who do not express a functional CD40 ligand, cannot switch Ig isotypes and do not form germinal centers and memory B cells. We report here that an IgM(+)IgD(+)CD27(+) B cell subset with somatically mutated Ig receptors is generated in these patients, implying that these cells expand and diversify their Ig receptors in the absence of classical cognate T-B collaboration. The presence of this sole subset in the absence of IgM(+)-only and switched CD27(+) memory B cells suggests that it belongs to a separate diversification pathway.
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Affiliation(s)
- S Weller
- Institut National de la Santé et de la Recherche Médicale U373, Faculté de Médecine Necker-Enfants Malades, 156, Rue de Vaugirard, 75730 Paris Cedex 15, France
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Abstract
BACKGROUND The amount of protection that condoms provide for HIV and other sexually transmitted diseases is unknown. Cohort studies of sexually active HIV serodiscordant couples with follow-up of the seronegative partner, provide a situation in which a seronegative partner has known exposure to the disease and disease incidence can be estimated. When some individuals use condoms and some do not, namely some individuals use condoms 100% of the time and some never use (0%) condoms, condom effectiveness can be estimated by comparing the two incidence rates. Condom effectiveness is the proportionate reduction in disease due to the use of condoms. OBJECTIVES The objective of this review is to estimate condom effectiveness in reducing heterosexual transmission of HIV. SEARCH STRATEGY Studies were located using electronic databases (AIDSLINE, CINAHL, Embase, and MEDLINE) and handsearched reference lists. SELECTION CRITERIA For inclusion, studies had to have: (1) data concerning sexually active HIV serodiscordant heterosexual couples, (2) a longitudinal study design, (3) HIV status determined by serology, and (4) contain condom usage information on a cohort of always (100%) or never (0%) condom users. DATA COLLECTION AND ANALYSIS Studies identified through the above search strategy that met the inclusion criteria were reviewed for inclusion in the analysis. Sample sizes, number of seroconversions, and the person-years of disease-free exposure time were recorded for each cohort. If available, the direction of transmission in the cohort (male-to-female, female-to-male), date of study enrollment, source of infection in the index case, and the presence of STDs was recorded. Duplicate reports on the same cohort and studies with incomplete or nonsepecific information were excluded. HIV incidence was estimated from the cohorts of "always" users and for the cohorts of "never" users. Effectiveness was estimated from these two incidence estimates. MAIN RESULTS Of the 4709 references that were initially identified, 14 were included in the final analysis. There were 13 cohorts of "always" users that yielded an homogeneous HIV incidence estimate of 1.14 [95% C.I.:.56, 2.04] per 100 person-years. There were 10 cohorts of "never" users that appeared to be heterogeneous. The studies with the longest follow-up time, consisting mainly of studies of partners of hemophiliac and transfusion patients, yielded an HIV incidence estimate of 5.75 [95% C.I.: 3.16, 9.66] per 100 person-years. Overall effectiveness, the proportionate reduction in HIV seroconversion with condom use, is approximately 80%. REVIEWER'S CONCLUSIONS This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse. Because the studies used in this review did not report on the "correctness" of use, namely whether condoms were used correctly and perfectly for each and every act of intercourse, effectiveness and not efficacy is estimated. Also, this estimate refers in general to the male condom and not specifically to the latex condom, since studies also tended not to specify the type of condom that was used. Thus, condom effectiveness is similar to, although lower than, that for contraception.
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Affiliation(s)
- S Weller
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas 77555 - 1153, USA.
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Weller S, Radomski KM, Lou Y, Stein DS. Population pharmacokinetics and pharmacodynamic modeling of abacavir (1592U89) from a dose-ranging, double-blind, randomized monotherapy trial with human immunodeficiency virus-infected subjects. Antimicrob Agents Chemother 2000; 44:2052-60. [PMID: 10898675 PMCID: PMC90013 DOI: 10.1128/aac.44.8.2052-2060.2000] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [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: 11/20/2022] Open
Abstract
Abacavir (formerly 1592U89) is a carbocyclic nucleoside analog with potent anti-human immunodeficiency virus (anti-HIV) activity when administered alone or in combination with other antiretroviral agents. The population pharmacokinetics and pharmacodynamics of abacavir were investigated in 41 HIV type 1 (HIV-1)-infected, antiretroviral naive adults with baseline CD4(+) cell counts of >/=100/mm(3) and plasma HIV-1 RNA levels of >30,000 copies/ml. Data for analysis were obtained from patients who received randomized, blinded monotherapy with abacavir at 100, 300, or 600 mg twice-daily (BID) for up to 12 weeks. Plasma abacavir concentrations from sparse sampling were analyzed by standard population pharmacokinetic methods, and the effects of dose, combination therapy, gender, weight, and age on parameter estimates were investigated. Bayesian pharmacokinetic parameter estimates were calculated to determine the peak concentration of abacavir in plasma (C(max)) and the area under the concentration-time curve from time zero to infinity (AUC(0-infinity)) for individual subjects. The pharmacokinetics of abacavir were dose proportional over the 100- to 600-mg dose range and were unaffected by any covariates. No significant correlations were observed between the incidence of the five most common adverse events (headache, nausea, diarrhea, vomiting, and malaise or fatigue) and AUC(0-infinity). A significant correlation was observed between C(max) and nausea by categorical analysis (P = 0.019), but this was of borderline significance by logistic regression (odds ratio, 1.45; 95% confidence interval, 0.95 to 2.32). The log(10) time-averaged AUC(0-infinity) minus baseline (AAUCMB) values for HIV-1 RNA and CD4(+) cell count correlated significantly with C(max) and AUC(0-infinity), but with better model fits for AUC(0-infinity). The increase in AAUCMB values for CD4(+) cell count plateaued early for drug exposures that were associated with little change in AAUCMB values for plasma HIV-1 RNA. There was less than a 0.4 log(10) difference over 12 weeks in the HIV-1 RNA levels with the doubling of the abacavir AUC(0-infinity) from 300 to 600 mg BID dosing. In conclusion, pharmacodynamic modeling supports the selection of abacavir 300 mg twice-daily dosing.
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Affiliation(s)
- S Weller
- Worldwide Clinical Pharmacology, Glaxo Wellcome Inc., Research Triangle Park, North Carolina 27709, USA.
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Eingartner C, Volkmann R, Winter E, Maurer F, Sauer G, Weller S, Weise K. Results of an uncemented straight femoral shaft prosthesis after 9 years of follow-up. J Arthroplasty 2000; 15:440-7. [PMID: 10884203 DOI: 10.1054/arth.2000.5265] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The first consecutive 250 implantations of an uncemented, proximally anchored straight femoral shaft prosthesis (BiCONTACT) in 236 patients are included in this prospective follow-up study. Average time of follow-up evaluation was 8.9 years (range, 7.4-10.7 years). At follow-up, 27 patients had died, and 2 could not be located. Seven patients underwent revision-2 for infection, 1 for recurrent dislocation, 2 for component undersizing with rapid subsidence, and 1 for aseptic loosening of a varus-malaligned stem; 1 radiologically well-fixed stem had been revised during acetabular revision. Overall survival was 97.1% after 11 years (confidence limits, 98.7% [upper] and 93.6% [lower]). The average Harris Hip score at time of follow-up was 84.3 points. Radiologically, tiny reactive lines (<2 mm) were present in the distal zones of the femoral shaft, but no radiolucencies could be found in the proximal anchoring zone. The midterm to long-term follow-up results with the evaluated femoral component are encouraging and are comparable to those of modern techniques of cementing in primary total hip arthroplasty.
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Affiliation(s)
- C Eingartner
- BG Trauma Center, University of Tübingen, Germany
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Eingartner C, Volkmann R, Winter E, Weise K, Weller S. A Long Straight Stem with Distal Interlocking for Uncemented Stem Revision in THR. Surg Technol Int 2000; 9:273-279. [PMID: 21136416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Femoral revision in total hip replacement (THR) is often demanding due to severe bone defects of the proximal femur. The surgical technique must provide sufficient stability in the distal femur. However, long-term stability depends on preserving or even rebuilding proximal bone stock.
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Affiliation(s)
- C Eingartner
- Consultant, BG Trauma Center, University of Tübingen, Tübingen, Germany
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Abstract
A total of 299 acute, acute on chronic, and chronic slips were treated from 1975 to 1997. The patients were reviewed in three cohorts: 75 patients with slipped capital femoral epiphysis (SCFE) were treated between 1975 and 1982, 101 patients with 107 slips were treated from 1983 to 1991, and 110 patients with 117 slips were treated from 1992 to 1997. The authors have corrected 130 hips with chronic slips by intertrochanteric osteotomy. Of these 130 hips, 111 were moderate slips between 20 and 50 degrees, 19 hips with a slipping angle of more than 50 degrees were classified as severe chronic slips. During the same period, 92 chronic slips less than 20 degrees were treated by fixation in situ, and 77 acute or acute on chronic slips had an open and exceptionally a closed reduction followed by fixation. Eight postoperative fractures caused by inadequate plate fixation were observed after these 130 intertrochanteric osteotomies. They all necessitated plate replacement followed by uneventful healing. Three patients with major displacement developed chondrolysis after the corrective osteotomy, two were transient, and one patient developed avascular necrosis (AVN). The midterm clinical results showed a satisfactory outcome in all three cohorts. In 47 patients in the series from 1975 to 1982, the clinical outcome was measured using Imhäuser's score: 43 patients had good and very good results, 4 patients had a moderate or bad result. In the second and third series, the IOWA hip score was used to measure the clinical outcome. The 49 patients with osteotomies for chronic slips treated from 1983 to 1991 had an average score of 90.3 points, and 1 patient had AVN. In the latest series from 1992 to 1997 with 34 corrective osteomies, there was no chondrolysis or AVN and the average IOWA score was 93.9 points.
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Affiliation(s)
- K Parsch
- Department of Orthopedic Surgery, Pädiatrisches Zentrum, Olgahospital, Stuttgart, Germany
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Abstract
We report on the 6-month outcome of a retrospective analysis of additional treatment services for patients entering a methadone maintenance program who transferred from community methadone treatment programs (n = 83) or entered off the street (n = 83) not currently on methadone. Patients were participating in a clinical treatment trial examining the effectiveness of Community Reinforcement Approach and Relapse Prevention. Patients in the methadone transfer group were using less heroin at intake than patients newly initiated onto methadone and both groups improved from additional treatment services in the following problem areas specifically: drug, alcohol, legal, employment, social, and in some measures of psychiatric distress. Therefore, both groups of patients in this study benefited from additional treatment services.
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Affiliation(s)
- P J Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque 87106, USA
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Weller S. [Biological osteosynthesis]. Langenbecks Arch Chir Suppl Kongressbd 1999; 115:61-5. [PMID: 9931583] [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: 02/10/2023]
Abstract
A historic review distinguishes three periods in the treatment of fractures: The conservative period (approximate reduction and immobilization in traction or plaster cast), the mechanical and operative period (exact anatomical reduction and stable--even rigid--fracture fixation), and the biological and mechanical period (stability with strict attention to the biological environment of the bone circulation). Biological fracture fixation means: conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host-defense mechanism. For preoperative planning, the following points have to be considered: choice of fixation method, reduction technique (open, closed, additional aids), surgical tactics (approach), and intra- and postoperative adjuvant therapy.
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Conde C, Weller S, Gilfillan S, Marcellin L, Martin T, Pasquali JL. Terminal deoxynucleotidyl transferase deficiency reduces the incidence of autoimmune nephritis in (New Zealand Black x New Zealand White)F1 mice. J Immunol 1998; 161:7023-30. [PMID: 9862739] [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: 02/09/2023]
Abstract
Terminal deoxynucleotidyl transferase (TdT) enzyme activity in lymphocytes generates diversity in the Ag receptor repertoires by adding template-independent N nucleotides and disrupting homology-directed rearrangements. The importance of this diversity in vivo and the significance of the suppression of TdT during fetal life remain uncertain. Previous studies have shown that in TdT knockout mice (TdT(0)) 1) the T cell repertoire is less peptide oriented; and 2) natural autoantibody, particularly anti-DNA autoantibodies, are less polyreactive, and their mean affinities are reduced. Consequently, the suppression of TdT during early T/B cell ontogeny may participate in controlling autoimmunity. To study the impact of TdT suppression in autoimmune-prone mice, we introduced the TdT null mutation into the (NZB x NZW)F1 (B/W) mouse strain. We show that TdT deficiency significantly reduces the incidence of autoimmune nephritis and prolongs survival compared with those in control mice. Surprisingly, the long-term survivor TdT(0) mice produced amounts of anti-ADN and anti-histone autoantibodies similar to those of their TdT+ littermates. However, these TdT(0) mice showed no evidence of renal inflammation, and the immune deposits were restricted to the mesangium, whereas basal membrane deposits were clearly correlated with overt renal disease. The present study supports the idea that the absence of TdT enzyme activity in lymphocytes protects mice against autoimmunity and could offer a therapeutic approach to autoimmune diseases. Moreover, our results may help to unravel the mechanisms of lupus nephritis.
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Affiliation(s)
- C Conde
- Laboratory of Immunopathology, Institute of Immuno-Hematology, Central Hospital, Strasbourg, France
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Kimberlin DF, Weller S, Whitley RJ, Andrews WW, Hauth JC, Lakeman F, Miller G. Pharmacokinetics of oral valacyclovir and acyclovir in late pregnancy. Am J Obstet Gynecol 1998; 179:846-51. [PMID: 9790357 DOI: 10.1016/s0002-9378(98)70176-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [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: 11/19/2022]
Abstract
OBJECTIVE The objective was to obtain preliminary pharmacokinetic data for acyclovir from gravid women receiving herpes simplex virus suppressive therapy with the acyclovir prodrug valacyclovir. STUDY DESIGN In a prospective, double-blind trial, 20 women with a history of recurrent genital herpes simplex virus infection and positive herpes simplex virus 2 serologic results were randomly assigned at 36 weeks' gestation to receive oral valacyclovir (500 mg twice daily) or acyclovir (400 mg 3 times daily). Acyclovir pharmacokinetic profiles were obtained after the initial dose (36 weeks) and at steady state (38 weeks). Amniotic fluid samples were obtained during labor and simultaneous umbilical cord and maternal plasma samples were collected at delivery. Laboratory studies were performed to screen for laboratory evidence of toxicity in mothers and infants. RESULTS Peak acyclovir plasma concentrations (mean +/- standard deviation) were higher in valacyclovir recipients than in acyclovir recipients after the initial dose (3.14 +/- 0.7 microg/mL vs 0.74 +/- 0.6 microg/mL, P < .0001) and at steady state (3.03 +/- 1.0 microg/mL vs 0.94 +/- 0.7 microg/mL, P < .001). The daily area under the curve values were higher in valacyclovir recipients than acyclovir recipients after the initial dose (17.8 +/- 3.6 h x microg/mL vs 7.71 +/- 2.5 h x microg/mL, P < .001) and at steady state (19.65 +/- 6.4 h x microg/mL versus 11.0 +/- 4.5 h x microg/mL, P = .009). There was no significant difference in drug elimination half-life or in time to peak concentration between valacyclovir and acyclovir recipients at either sampling interval. Acyclovir was concentrated in the amniotic fluid; however, there was no evidence of preferential fetal drug accumulation (mean maternal/umbilical vein plasma ratios at delivery were 1.7 for valacyclovir and 1.3 for acyclovir). Valacyclovir was well tolerated, and no significant laboratory or clinical evidence of toxicity was detected. CONCLUSION In this phase I trial maternal valacyclovir therapy resulted in higher plasma acyclovir levels, with significantly higher peak concentrations and daily area under the curve values, than did acyclovir therapy. Additional trials are needed to further evaluate the safety and efficacy of suppressive valacyclovir therapy during late pregnancy.
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Affiliation(s)
- D F Kimberlin
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA
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