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Jovic TH, Nicholson T, Arora H, Nelson K, Doak SH, Whitaker IS. A comparative analysis of pulp-derived nanocelluloses for 3D bioprinting facial cartilages. Carbohydr Polym 2023; 321:121261. [PMID: 37739492 DOI: 10.1016/j.carbpol.2023.121261] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 09/24/2023]
Abstract
Nanocelluloses have attracted significant interest in the field of bioprinting, with previous research outlining the value of nanocellulose fibrils and bacterial nanocelluloses for 3D bioprinting tissues such as cartilage. We have recently characterised three distinct structural formulations of pulp-derived nanocelluloses: fibrillar (NFC), crystalline (NCC) and blend (NCB), exhibiting variation in pore geometry and mechanical properties. In light of the characterisation of these three distinct entities, this study investigated whether these structural differences translated to differences in printability, chondrogenicity or biocompatibility for 3D bioprinting anatomical structures with human nasoseptal chondrocytes. Composite nanocellulose-alginate bioinks (75:25 v/v) of NFC, NCC and NCB were produced and tested for print resolution and fidelity. NFC offered superior print resolution whereas NCB demonstrated the best post-printing shape fidelity. Biologically, chondrogenicity was assessed using real time quantitative PCR, dimethylmethylene blue assays and histology. All biomaterials showed an increase in chondrogenic gene expression and extracellular matrix production over 21 days, but this was superior in the NCC bioink. Biocompatibility assessments revealed an increase in cell number and metabolism over 21 days in the NCC and NCB formulations. Nanocellulose augments printability and chondrogenicity of bioinks, of which the NCC and NCB formulations offer the best biological promise for bioprinting cartilage.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences 1, Swansea University, SA2 8PP, UK; Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK.
| | | | | | | | | | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences 1, Swansea University, SA2 8PP, UK; Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea SA6 6NL, UK
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Kennedy L, Nicholson T, MacDonald B, Jago E, Mah C. Healthy Eating Policy for a provincial health authority in Atlantic Canada. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Issue
Poor diets, the global leading cause of death and disability, are influenced by individual and community factors. Community health care settings have the potential to shape dietary behavior through food and beverage environments, and a healthy eating culture that supports the healthier choice as the easier choice.
Description of the Problem
The Nova Scotia Health Authority (NSHA) is a provincial government health authority in Atlantic Canada, responsible for delivering services to nearly 1 million people in 10 hospitals, 8 ERs, and 135 community locations. The NSHA employs over 23,400 health workers. In 2015, the NSHA centralized its governance, merging 9 regional health districts into one. Policies and procedures were re-written with a provincial focus, including a new Healthy Eating Policy (HEP) adopted in 2018. In this paper, we discuss the implementation of the HEP as a case study for how healthy eating can be fostered through continuous quality improvement.
Results
The policy upholds NSHA as a community leader working collaboratively with internal and external partners. To be a credible leader in changing the landscape around healthy eating, NSHA agrees to “walk the talk” and model an evidence-based healthy eating policy. A hospital in Halifax piloted pricing, placement and promotion interventions to further support healthier eating. These have been expanded to other sites across NS.
Lessons
1) Internal Capacity Building - A Healthy Eating Steering Committee promotes healthy eating across the health system, including initiatives in partnership with auxiliaries, foundations and staff. 2) Improving Evaluation Infrastructure- The interventions led to strategic thinking of future point of sale systems and ways to improve data collection for evaluation 3) Academic Partnerships - NSHA and Dalhousie University formed a collaborative partnership to strengthen evaluation capacity making use of the latest evidence and methods from food environments research.
Key messages
The Nova Scotia Health Authority’s Health Eating Policy supports healthy eating across the province, and promotes supportive environments where the healthier choice is the easier choice. A hospital site in Halifax, NS, implemented a variety of pricing, placement and promotion interventions to promote a healthy workplace environment for employees and community members.
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Affiliation(s)
- L Kennedy
- School of Health Administration, Dalhousie University, Halifax, Canada
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - T Nicholson
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - B MacDonald
- Food & Nutrition Services, Nova Scotia Health Authority, Halifax, Canada
| | - E Jago
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - C Mah
- School of Health Administration, Dalhousie University, Halifax, Canada
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Gibson LL, Harborow L, Nicholson T, Bell D, David AS. Is scan-negative cauda equina syndrome a functional neurological disorder? A pilot study. Eur J Neurol 2020; 27:1336-1342. [PMID: 32073712 DOI: 10.1111/ene.14182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Cauda equina syndrome (CES) is a neurosurgical emergency which warrants lumbar magnetic resonance imaging (MRI). Many patients with suggestive symptoms of CES have no radiological correlate. A functional (non-organic) aetiology has been proposed in some, but currently little is known about this patient group and their clinical outcomes. METHODS At a tertiary referral centre, 155 adult patients underwent urgent lumbar MRI for suspected CES in 1 year from December 2014. Data regarding clinical symptoms and follow-up were obtained from records. Patients were divided into CES (n = 25), radiculopathy (n = 68) and scan-negative (SN) groups (n = 62) from scans. Up to 3 years post-discharge, postal questionnaires were sent to patients with Oswestry Disability Index, Pain Catastrophizing score, Patient Health Questionnaire (PHQ) 9, Generalized Anxiety Disorder (GAD) 7, PHQ 15 and Work and Social Adjustment Scale measures. RESULTS No clinical symptoms were found to differentiate CES from SN patients. Functional comorbidities were significantly more common in SN patients but mental health diagnosis frequency did not differ. Follow-up was variable with no consistent referral pathways, particularly for the SN group. 33% (n = 47) responded to the postal questionnaires; high levels of pain, symptom chronicity and disability were ubiquitous but self-reported mental health diagnoses and PHQ 15 were higher for SN patients. CONCLUSIONS Conflicting data suggest further research is needed to investigate the prevalence of mental illness and somatic symptoms in SN cases. SN patients have higher rates of comorbid functional disorders and inconsistent referral pathways. Self-report measures indicate impaired quality of life across all groups. The low response rate limits the generalizability of findings but neuropsychiatric assessment and care pathway optimization should be considered.
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Affiliation(s)
- L L Gibson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - L Harborow
- South London and Maudsley NHS Foundation Trust, London, UK
| | - T Nicholson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - D Bell
- Kings College Hospital NHS Foundation Trust, London, UK
| | - A S David
- Institute of Mental Health, University College London, London, UK
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Hassan M, Nicholson T, Taylor L, Howell T, Hadden R, Syred K, Riordan R, Corcoran J, Daneshvar C. Focused neck ultrasound and lymph node sampling by respiratory physicians can provide a rapid diagnosis in a poor prognostic patient group with suspected lung cancer. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30060-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: 10/25/2022]
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Snook S, Gunaratne H, Probyn B, Nicholson T, Corcoran J, Waine D, Howell T, Riordan R, Roy A, Daneshvar C. Early experience from the Plymouth National Optimal Lung Cancer Pathway. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uygun DS, McNally JM, Yang L, Imaizumi K, Katsuki F, Brown RE, Mao X, Nicholson T, Sidor M, Zhang Q, Strecker RE, McCarley RW, Feng G, Pan JQ. 0017 ABNORMAL SLEEP SPINDLE RHYTHMOGENESIS IN MICE BEARING A SCHIZOPHRENIA ASSOCIATED CODING VARIANT IN THE CACNA1I GENE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.016] [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: 11/14/2022] Open
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Cranstone K, Briggs J, Park J, Nicholson T, Unstead M. P283 An elevated PEF/FVC ratio is a marker for ILD and is associated with traction bronchiectasis on ct scan imaging. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.426] [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: 11/03/2022]
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Nicholson T, Woods A, David J, Hoyles R. P274 Anti-synthetase Syndrome: Validity Of Ana As A Screening Tool - The Oxford Ild Service Experience. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.392] [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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Robbins T, Linney L, Nicholson T, Stein A. Characterising the acute medical take: foundation for planning future care. Future Hosp J 2014; 1:28-32. [DOI: 10.7861/futurehosp.14.009] [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: 11/27/2022]
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Nicholson T. AUTOIMMUNITY AND NEUROPSYCHIATRY. Journal of Neurology, Neurosurgery & Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nicholson T. Interventional radiology on-call services in the UK. Clin Radiol 2013; 68:e438-9. [PMID: 23714234 DOI: 10.1016/j.crad.2013.05.001] [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] [Received: 09/26/2012] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 11/24/2022]
Affiliation(s)
- T Nicholson
- Department of Vascular and Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Great George St, Leeds LS13EX, UK.
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Marques IB, Silva RDM, Moraes CE, Azevedo LS, Nahas WC, David-Neto E, Furmanczyk-Zawiska A, Baczkowska T, Chmura A, Szmidt J, Durlik M, Joslin J, Blaker P, White B, Marinaki A, Sanderson J, Goldsmith DJ, Medani S, Traynor C, Mohan P, Little D, Conlon P, Molina M, Gonzalez E, Gutierrez E, Sevillano A, Polanco N, Morales E, Hernandez A, Praga M, Morales JM, Andres A, Park SJ, Kim TH, Kim YW, Kim YH, Kang SW, Kujawa-Szewieczek A, Szotowska M, Kuczera P, Chudek J, Wiecek A, Kolonko A, Mahrova A, Svagrova K, Bunc V, Stollova M, Teplan V, Hundt F, van Heteren P, Woitas R, Cavallo MC, Sepe V, Conte F, Albrizio P, Bottazzi A, Geraci PM, Alpay N, Gumber MR, Kute VB, Vanikar AV, Patel HV, Shah PR, Engineer DP, Trivedi HL, Golebiewska JE, Debska-Slizien A, Rutkowski B, Matias P, Martins AR, Raposo L, Jorge C, Weigert A, Birne R, Bruges M, Adragao T, Almeida M, Mendes M, Machado D, Masin-Spasovska J, Dohcev S, Stankov O, Stavridis S, Saidi S, Dejanova B, Rambabova-Busletic I, Dejanov P, Spasovski G, Nho KW, Kim YH, Han DJ, Park SK, Kim SB, Fenoglio R, Lazzarich EE, Cagna D, Cena T, Conti N, Quaglia M, Radin E, Izzo C, Stratta P, Oh IH, Park JS, Lee CH, Kang CM, Kim GH, Leone F, Lofaro D, Gigliotti P, Lupinacci S, Toteda P, Vizza D, Perri A, Papalia T, Bonofiglio R, di Loreto P, de Silvestro L, Montanaro D, Martino F, Sandrini S, Minetti E, Cabiddu G, Yildirim T, Yilmaz R, Turkmen E, Abudalal A, Altindal M, Ertoy-Baydar D, Erdem Y, Panuccio V, Tripepi R, Parlongo G, Versace MC, Politi R, Zoccali C, Mallamaci F, Porrini E, Silva I, Diaz J, Ibernon M, Moreso F, Benitez R, Delgado Mallen P, Osorio J, Lauzurica R, Torres A, Ersoy A, Koca N, Gullu Koca T, Kirhan E, Sarandol E, Ersoy C, Dirican M, Milne J, Suter V, Mikhail A, Akalin H, Dizdar O, Ersoy A, Pascual J, Torio A, Garcia C, Hernandez J, Perez-Saez MJ, Mir M, Anna F, Crespo M, Carta P, Zanazzi M, Antognoli G, Di Maria L, Caroti L, Minetti E, Dizdar O, Ersoy A, Akalin H, Ray DS, Mukherjee K, Bohidar NP, Pattanaik A, Das P, Thukral S, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Fujiwara T, Nukui A, Gavela EE, Sancho AA, Kanter JJ, Avila AA, Beltran SS, Pallardo LL, Dawoud FG, Aithal V, Mikhail A, Majernikova M, Rosenberger J, Prihodova L, Nagyova I, Jarcuskova M, Roland R, Groothoff JW, van Dijk JP, van Agteren M, de Weerd A, van de Wetering J, IJzermans J, Betjes M, Weimar W, Popoola J, Reed A, Tavarro R, Chryssanthopoulou C, MacPhee I, Mayor M, Franco S, Jara P, Ayala R, Orue MG, Martinez A, Martinez M, Wasmouth N, Arik G, Yasar A, Turkmen E, Yildirim T, Altindal M, Abudalal A, Yilmaz S, Arici M, Bihari Bansal S, Pokhariyal S, Jain S, Sethi S, Ahlawat R, Kher V, Martins LS, Aguiar P, Dias L, Fonseca I, Henriques AC, Cabrita A, Davide J, Sparkes TM, Trofe-Clark J, Reese PP, Jakobowski D, Goral S, Doll SL, Abt PL, Sawinski D, MBloom RD, Knap B, Lukac J, Lukin M, Majcen I, Pavlovec F, Kandus A, Bren AF, Kong JM, Jeong JH, Ahn J, Lee DR, Son SH, Kim BC, Choi WY, Whang EJ, Czajka B, Malgorzewicz S, Debska-Slizien A, Rutkowski B, Panizo N, Rengel MA, Vega A, Abad S, Tana L, Arroyo D, Rodriguez-Ferrero M, Perez de Jose A, Lopez-Gomez JM, Koutroutsos K, Sackey J, Paolini L, Ramkhelawon R, Tavarro R, Chowrimootoo M, Whelan D, Popoola J, Szotowska M, Kuczera P, Chudek J, Wiecek A, Kolonko A, Slatinska J, Honsova E, Wohlfahrtova M, Slimackova E, Rajnochova SB, Viklicky O, Yankovoy A, Smith ISJ, Wylie E, Ruiz-Esteban P, Lopez V, Garcia-Frias P, Cabello M, Gonzalez-Molina M, Vozmediano C, Hernandez D, Pavlovic J, Radivojevic D, Lezaic V, Simic-Ogrizovic S, Lausevic M, Naumovic R, Ersoy A, Koca N, Kirhan E, Gullu Koca T, Ersoy C, Sarandol E, Dirican M, Sakhuja V, Gundlapalli S, Rathi M, Jha V, Kohli HS, Sharma A, Minz M, Nimgirova A, Esayan A, Kayukov I, Zuyeva E, Bilen Y, Cankaya E, Keles M, Gulcan E, Turkeli M, Albayrak B, Uyanik A, Yildirim R, Molitor N, Praktiknjo M, Woitas R, Abeygunaratne TN, Balasubramanian S, Baker R, Nicholson T, Toprak O, Sari Y, Keceli S, Kurt H, Rocha A, Malheiro J, Martins LS, Fonseca I, Dias L, Pedroso S, Almeida M, Henriques A, Nihei C, Bacelar Marques I, Seguro CA, David-Neto E, Mate G, Martin N, Colon L, Casellas L, Garangou D, de la Torre M, Torguet P, Garcia I, Calabia J, Valles M, Pruthi R, Calestani M, Leydon G, Ravanan R, Roderick P, Korkmaz S, Ersoy A, Gulten S, Koca N. Transplantation - clinical studies II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft155] [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: 11/14/2022] Open
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Nicholson T, Aybek S, Kempton M, David A, Kanaan R. P15 A structural MRI study of motor conversion disorder: evidence of bilateral reduction in thalamic volume. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303538.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Du X, Zhao Z, Le K, Nicholson T, Goh C, Bohonis S, Moghadasian M, Jassal D. 393 Does Fish Oil Consumption Reduce Cardiovascular Complications in ApoE Deficient Mice? Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.370] [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: 10/27/2022] Open
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Simon AF, Chou MT, Salazar ED, Nicholson T, Saini N, Metchev S, Krantz DE. A simple assay to study social behavior in Drosophila: measurement of social space within a group. Genes Brain Behav 2011; 11:243-52. [PMID: 22010812 DOI: 10.1111/j.1601-183x.2011.00740.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We have established a new simple behavioral paradigm in Drosophila melanogaster to determine how genes and the environment influence the behavior of flies within a social group. Specifically, we measure social space as the distance between two flies. The majority of Canton-s flies, regardless of their gender, are within two body lengths from each other. Their social experience affects this behavior, with social isolation reducing and mating enhancing social space respectively, in both males and females. Unlike several other social behaviors in the fly, including the formation of social groups themselves (a well-described behavior), social space does not require the perception of the previously identified aggregation pheromone cis-vaccenyl acetate. Conversely, performance of the assay in darkness or mutations in the eye pigmentation gene white increased social space. Our results establish a new assay for the genetic dissection of a fundamental mode of social interaction.
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Affiliation(s)
- A F Simon
- Department of Biology, York College, City University of New York, 94-20 Guy R. Brewer Blvd., Jamaica, NY 11451, USA.
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Nicholson T, Mahmood A, Limpa-Amara N, Salvarese N, Takase MK, Müller P, Jones AG. Reactions of the Tridentate and Tetradentate Amine Ligands di-(2-picolyl)(N-ethyl)amine and 2,5-Bis-(2-pyridylmethyl)-2,5 diazohexane with Technetium Nitrosyl Complexes. Inorganica Chim Acta 2011; 373:301-305. [PMID: 21836726 DOI: 10.1016/j.ica.2011.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The reaction of the Tc(II) nitrosyl complex (Bu(4)N)[Tc(NO)Cl(4)] with Di-(2-picolyl)(NEt)amine in methanol yields the neutral complex [Tc(NO)Cl(py-N(Et)-py)]. The reaction of the Tc(I) nitrosyl complex [Tc(NO)Cl(2)(HOMe)(PPh(3))(2)] with this tridentate ligand yields cationic [Tc(NO)Cl(py-N(Et)-py)(PPh(3))]Cl. These two complexes have been structurally characterized. The reaction of [Tc(NO)Cl(2)(HOMe)(PPh(3))(2)] with the tetradentate ligand 1,4-Bis(2-pyridylmethyl)-1,4-diazobutane yields a mixture of products including cationic [Tc(NO)Cl(py-NH-NH-py)]Cl and cationic [Tc(NO)Cl(PPh(3))(py-NH-NH~py)]Cl, with a pyridyl terminus left dangling.
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Affiliation(s)
- T Nicholson
- Dept. of Radiology, Harvard Medical School, Boston, MA 02115, USA
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Aybek S, Nicholson T, Craig T, David A, Kanaan R. 019 Life events in the year preceding the onset of conversion disorder: the role of the type and timing of events. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.217554.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The human brain can be subdivided many ways depending upon the criteria used. One of the most basic approaches is to subdivide the cortical regions into functional units composed of the frontal, occipital, parietal, and temporal lobes. To date, the process of reliably extracting measurements of the human brain from MR images has been mostly dependent on subjective decisions made by operators tracing regions. We present a technique for the identification of the cortical lobes of the brain based upon an interactive extraction program. It requires an operator to identify a fixed set of neuroanatomical guides which are used along with segmentation information to map automatically in three dimensions the full extent of each lobe without further editing by the operator. The definitions of the lobes are based upon standard, fully accepted, neuroanatomical criteria which can readily be found in the stack of images obtained from each subject. We have used this technique in this report on a subset of images from both healthy control subjects and patients with clinically confirmed memory disorders in order to establish its interoperator and intraoperator reliability.
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Affiliation(s)
- R J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Dunne N, Ormsby R, McNally T, Mitchell C, Martin D, Halley P, Nicholson T, Schiller T, Gahan L, Musumeci A, Smith S. M-3 Nanocomposite Bone Cements for Orthopaedic Applications. J Biomech 2010. [DOI: 10.1016/s0021-9290(10)70112-3] [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: 11/16/2022]
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Nicholson T. The effect of antidiuretic hormone on faecal water excretion in sheep. Zentralbl Veterinarmed A 2010; 28:547-51. [PMID: 6805166 DOI: 10.1111/j.1439-0442.1981.tb01225.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Girn HRS, McPherson S, Nicholson T, Mavor AID, Homer-Vanniasinkam S, Gough MJ. Short series of emergency stent-graft repair of symptomatic penetrating thoracic aortic ulcers (PTAU). Vasc Med 2009; 14:123-8. [DOI: 10.1177/1358863x08098951] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract Acute penetrating thoracic aortic ulcers (PTAU) are associated with vessel rupture, particularly when intramural haematoma (IMH) is present. Although surgical repair is the treatment of choice for PTAU in the aortic arch, definitive treatment of PTAU in other locations of the thoracic aorta remains controversial, particularly in this frail cohort of patients. Recent series of elective and semi-elective endovascular stent-graft repair of PTAU of the descending thoracic aorta show comparable results with the previously advocated best medical management. We report our results from a retrospective, observational study of acute stent-graft repair of symptomatic PTAU. Between 2000 and 2005, 11 patients (seven male, four female; median age 71 years) presented with acute PTAU. CT scans demonstrated an associated IMH in six, a contained leak in three or rupture in four unstable patients. All were covered by a single endovascular stent [Gore (5), Talent (5), Zenith (1); 10 inserted via the groin and one via iliac conduit within 1 week of presentation (five < 24 h). Technical success was 90.90% (10/11) and 3/11 (27%) died within 30 days (two ARDS, one a persistent leak and rupture at 48 h). One patient developed transient paraplegia; three haemothoraces required chest drains, one of which subsequently required empyema drainage. In survivors, CT scans were satisfactory, with no further intervention required at 32.5 (6–66) months of median follow-up. In conclusion, endovascular management of acute PTAU appears effective and durable with mortality rates that are likely to be better than for open surgery. However, haemodynamic compromise at presentation remains a robust denominator of over-all survival.
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Affiliation(s)
- HRS Girn
- Leeds Vascular Institute, Leeds General Infirmary
| | - S McPherson
- Department of Interventional Radiology, Leeds General Infirmary
| | - T Nicholson
- Department of Interventional Radiology, Leeds General Infirmary
| | - AID Mavor
- Leeds Vascular Institute, Leeds General Infirmary
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- Leeds Vascular Institute, Leeds General Infirmary
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Dutton S, Hirst A, McPherson K, Nicholson T, Maresh M. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG 2007; 114:1340-51. [DOI: 10.1111/j.1471-0528.2007.01526.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [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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Jakob F, Marín F, Martín-Mola E, Torgerson D, Fardellone P, Adami S, Thalassinos NC, Sykes D, Melo-Gomes J, Chinn C, Nicholson T, Cooper C. Characterization of patients with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). QJM 2006; 99:531-43. [PMID: 16861718 DOI: 10.1093/qjmed/hcl073] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/13/2022] Open
Abstract
BACKGROUND Osteoporotic fractures remain a major public health problem. Currently available osteoporosis therapies significantly reduce the risk of fractures, but up to 50% of patients have an inadequate clinical outcome to therapy. AIM To describe the clinical and quality of life (QOL) of a study population meeting a proposed definition of inadequate clinical outcome to osteoporosis therapy, recruited for the Observational Study of Severe Osteoporosis (OSSO). DESIGN Cross-sectional, observational study. METHODS Post-menopausal women with osteoporosis (n = 2314) were divided into Group 1 (those who had previously experienced a fragility fracture despite osteoporosis drug therapy for at least 12 months) (n = 1309, 57%), or Group 2 (those who had previously discontinued osteoporosis drug therapy due to non-compliance or side-effects) (n = 1005; 43%). Baseline clinical characteristics, quality of life (QOL) and osteoporosis/falls risk factors were analysed. RESULTS The overall population had low BMD (mean +/- SD T-score at lumbar spine -3.1 +/- 1.1), and risk factors for fracture such as previous fractures (67.8%), family history (15.1%), and prolonged glucocorticoid use (17.5%). QOL was poor: total QUALEFFO and EQ-5D scores were 46.8 +/- 18.7, and 0.50 +/- 0.33, respectively. Patients in Group 1 had higher age and body mass index, fewer hours of exercise, more previous fragility fractures and falls, and poorer QOL scores. DISCUSSION Our definition of inadequate clinical outcome from osteoporosis drug therapy identifies a severe osteoporosis cohort with poor QOL and increased fracture risk. Using such a definition may lead to earlier recognition of inadequate clinical outcome to osteoporosis therapy, and improved interventions and results.
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Affiliation(s)
- F Jakob
- Orthopaedic Department, Julius-Maximilians-Universität, Wurzburg, Germany
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Seidel J, Reynolds S, Nicholson T. Crit Care 2006; 10:P281. [DOI: 10.1186/cc4628] [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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Shellenbarger-Jones A, Nicholson T, Davis W, Davison A, Jones A. Tris-mercaptophenylphosphine complexes of rhenium: Synthesis, reactivity and structural characterization. Inorganica Chim Acta 2005. [DOI: 10.1016/j.ica.2004.09.065] [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: 10/25/2022]
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Nicholson T. In response to ?Anaesthetists and sedation in the Radiology Department: involved or left behind?? Anaesthesia 2005; 60:946. [PMID: 16115280 DOI: 10.1111/j.1365-2044.2005.04363.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roderick P, Nicholson T, Armitage A, Mehta R, Mullee M, Gerard K, Drey N, Feest T, Greenwood R, Lamping D, Townsend J. An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales. Health Technol Assess 2005; 9:1-178. [PMID: 15985188 DOI: 10.3310/hta9240] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To survey of the structure, processes and organisation of renal satellite units (RSUs) in England and Wales (Phase 1), and to compare the effectiveness, acceptability, accessibility and economic impact of chronic haemodialysis performed in RSUs compared to main renal units (MRUs) (Phase 2). DATA SOURCES Phase 1: all renal satellite units in England and Wales. Phase 2: haemodialysis patients in a representative sample (based on geography, site, private--public ownership, medical input) of 12 RSUs and their MRUs. REVIEW METHODS Phase 1 consisted of a questionnaire survey. Semi-structured interviews were held in a representative sample of 24 RSUs with the senior clinician, senior nurse and manager. Phase 2 consisted of a cross-sectional comparison of patients in these RSUs and patients in the parent MRUs deemed suitable for satellite care by senior staff. Clinical information was obtained from medical notes and unit computer systems. Generic and disease specific health-related quality of life (HRQoL) measures were used. Co-morbidity was assessed by the Wright/Khan Index, the Lister/Chandna score, the Modified Charlson Index, and the Karnofsky Performance Score. Statistical analyses compared RSU versus MRU patients and took account of the paired and clustered nature of the data. RESULTS In Phase 1, responses were received from 74/80 (93%) of RSUs; 2600 patients were being treated in these RSUs. The interviews were generally positive about the impact of RSUs in terms of improved accessibility and a better environment for chronic haemodialysis (HD) patients, and in expanding renal replacement therapy patients (RRT) capacity. In Phase 2, some 82% of eligible patients took part, 394 patients in the 12 RSUs and 342 in the parent MRUs. The response rate was similar in both groups. There were no significant differences in clinical processes of care. Most clinical outcomes were similar, especially after pooled analysis, although a few parameters were statistically significantly different -- notably the proportion achieving Renal Association Standards for adequacy of dialysis as measured by the urea reduction ratio (URR) was higher in the RSU patients. Patient-specific quality of life did not differ except on the patient satisfaction questions from the KDQOL, which were scored higher by the RSU sample. Strength of preference for health status on and off dialysis was very similar between the groups, as were EQ-5D utilities. Major adverse events were not common in the RSU patients, although there were many hypotensive episodes on HD, a proportion of which affected the duration of the HD session. Of the costs measured, the only difference that was statistically significant was for District Nurse visits. Of particular note was that despite the MRU group having a higher proportion of patients hospitalised, this did not translate into a statistically significant budgetary impact in terms of the total cost per patient of hospitalisations or mean cost per patient per hospitalisation. CONCLUSIONS This study has shown that RSUs are an effective alternative to MRU HD for a wide spectrum of patients. They improve geographic access for more dispersed areas and reduce patients' travel time, and are generally more acceptable to patients on several criteria. There does not seem to be an adverse impact of care in the RSUs although comparative long-term prospective data are lacking. The evidence suggests that satellite development could be successfully expanded; not all MRUs have any satellites and many have only a few. No single RSU model can be recommended but key factors would include local geography, the likely catchment population and the type of patients to be treated. There is a need for more basic budgetary information linking activity and expenditure to be available and more transparent, to perform at least an insightful top-down costing of the two care settings. Other areas suggested for further research include: a comparison of adverse events occurring in MRUs and RSUs with longer duration and larger numbers to identify more severe events, along with the more research into the scope for preventing such events, and a study into the patients deemed ineligible for satellite care. International comparisons of satellite care would also be useful.
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Affiliation(s)
- P Roderick
- Health Care Research Unit, University of Southampton, UK
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Abstract
AIMS To evaluate patients undergoing uterine artery embolization for symptomatic fibroids who, for technical reasons, underwent unilateral rather than bilateral embolization. PATIENTS Prospective data were collected on 109 patients undergoing uterine artery embolization for symptomatic fibroids. Of these, six underwent unilateral embolization. They were followed with ultrasound or magnetic resonance imaging (MRI) at 3, 6 and 12 months. Patients' histories were reviewed and patients were asked to evaluate their symptoms at 3, 6 and 12 months on a scoring system, which scored their pre-embolization symptoms as 10. RESULTS In one case the patient's symptoms did not change in the first 3 months. This patient underwent a second embolization procedure to occlude the non-embolized uterine artery. In four cases the patients' symptoms had begun to resolve at 3 months and by 12 months the patients no longer required any further treatment. In one case the patient passed a 10 cm fibroid per vagina 2 months post uterine artery embolization. After this the patient had a normal uterus on MRI and no further symptoms. CONCLUSION Where planned bilateral uterine artery embolization is not possible for technical reasons and a unilateral embolization only is performed a conservative approach is indicated.
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Affiliation(s)
- T Nicholson
- Radiology Department, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
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Nicholson T. The causes of early deterioration in renal function following successful renal interventions. Acta Chir Belg 2003; 103:463-9. [PMID: 14653029 DOI: 10.1080/00015458.2003.11679468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The available evidence suggests that endovascular intervention in renovascular renal failure is a safe and efficacious procedure. However there is a significant incidence of early renal deterioration following angioplasty or stenting. Complications are limited by training and experience but inevitably still occur. Cholesterol embolization and contrast nephrotoxicity may be more important. This review describes the complications and considers whether the kidney should be protected from the effects of cholesterol and contrast and, if so, whether this can be done safely and economically?
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Affiliation(s)
- T Nicholson
- Leeds Teaching Hospitals NHS Trust, Great George St., Leeds LS13EX, Yorkshire, UK.
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Abstract
It is common when treating patients with respiratory exacerbations of cystic fibrosis to use both nebulised and intravenous antibiotics. Aminoglycoside drug levels are often measured from finger-prick blood samples. We describe a case of a 14-year-old girl treated simultaneously with IV and nebulised tobramycin in whom drug levels, measured from finger prick blood samples, were erroneously high due to finger contamination by the nebulised drug. Special precautions or direct venepuncture is essential when assessing antibiotic levels in such patients.
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Affiliation(s)
- S L Struthers
- Cystic Fibrosis Team, Department of Paediatrics, Southampton General Hospital, Tremona Rd, Southampton, SO16 6YD, UK.
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Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N. Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease: a rapid and systematic review. Health Technol Assess 2001; 5:1-137. [PMID: 11262420 DOI: 10.3310/hta5010] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alzheimer's disease is the most common cause of dementia and is characterised by an insidious onset and slow deterioration. The estimated prevalence of Alzheimer's disease for a standard health authority (500,000 people) is about 3330. Current service involves a wide range of agencies, and drug therapy for some patients. OBJECTIVES To provide a rapid and systematic review of the clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine in the symptomatic treatment of people suffering from Alzheimer's disease. METHODS A systematic review of the literature was undertaken. METHODS - DATA SOURCES: Searches were made of electronic databases, including MEDLINE, EMBASE, The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, NHS Economic Evaluation Database, National Research Register, Science Citation Index, BIOSIS, EconLit, MRC Trials database, Early Warning System, Current Controlled Trials, TOXLINE, Index of Scientific and Technical Proceedings, and Getting Easier Access to Reviews. All sources were searched over the period covered by the databases up to March/July 2000. Bibliographies of related papers were assessed for relevant studies and experts were contacted for advice and peer review, and to identify additional published and unpublished references. Manufacturer submissions to the National Institute for Clinical Excellence (NICE) were reviewed. METHODS - STUDY SELECTION Studies were included if they fulfilled the following criteria: (1) INTERVENTION: donepezil, rivastigmine or galantamine used to treat Alzheimer's disease. (2) PARTICIPANTS: people diagnosed with Alzheimer's disease who meet the criteria for treatment with donepezil, rivastigmine and galantamine. (3) OUTCOMES: measures assessing changes in cognition, function, behaviour and mood, quality of life (including studies assessing carer well-being and carer-input), and time to institutionalisation. (4) DESIGN: systematic reviews of randomised controlled trials (RCTs) and RCTs comparing donepezil, rivastigmine or galantamine with placebo or each other or non-drug comparators were included in the review of effectiveness. Economic studies of donepezil, rivastigmine or galantamine used to treat Alzheimer's disease that included a comparator (or placebo) and both the costs and consequence (outcomes) of treatment were included in the review of cost-effectiveness. Studies in non-English language, and abstracts and conference poster presentations of systematic reviews, RCTs and economic evaluations were excluded. Two reviewers identified studies by independently screening study titles and abstracts, and then by examining the full text of selected studies to decide inclusion. METHODS - DATA EXTRACTION AND QUALITY ASSESSMENT: Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer, with any disagreements resolved through discussion. The quality of RCTs was assessed using the Jadad scale and the quality of systematic reviews was assessed using criteria developed by the NHS Centre for Reviews and Dissemination. The quality of economic evaluation studies was assessed by their internal validity (i.e. the methods used) using a standard checklist, and external validity (i.e. the generalisability of the economic study to the population of interest) using a series of relevant questions. METHODS - DATA SYNTHESIS: The clinical effectiveness and cost-effectiveness of donepezil, rivastigmine and galantamine were synthesised through a narrative review with full tabulation of results of all included studies. In the economic evaluation, the reviewers assessed whether adjustments could be made to existing models to reflect the current situation in England and Wales. RESULTS - CLINICAL EFFECTIVENESS: (1) Donepezil--three systematic reviews and five RCTs (plus four studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that donepezil is beneficial when assessed using global and cognitive outcome measures. (2) Rivastigmine--three systematic reviews and five RCTs (plus two studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that rivastigmine is beneficial in terms of global outcome measures. (3) Galantamine--one systematic review and three RCTs (plus three studies from industry (unpublished data, submitted as commercial in confidence)) were found. Results suggest that galantamine is beneficial in terms of global, cognitive and functional scales. RESULTS - SUMMARY OF BENEFITS: It is difficult to quantify benefits from the evidence available in the literature. Statistically significant improvements in tests such as ADAS-cog (Alzheimer's Disease Assessment Scale cognitive subscale) may not be reflected in changes in daily life. (ABSTRACT TRUNCATED)
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Affiliation(s)
- A Clegg
- Wessex Institute for Health Research and Development, University of Southampton, UK
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Nicholson T, Patel J, Sleigh JW. Sleep patterns in intensive care unit patients: a study using the bispectral index. CRIT CARE RESUSC 2001; 3:86-91. [PMID: 16610990] [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] [Received: 02/07/2001] [Accepted: 04/27/2001] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To objectively record sleep patterns in intensive care unit patients using the Bispectral Index as an electroencephalographic measure of sleep and to determine if the sleep pattern is correlated with various clinical factors. METHODS Adult intensive care patients were recruited who were in the recovery phase of their illness and on minimal sedation. The sleep pattern was examined using an overnight recording of the patient's Bispectral Index and submental electromyogram. RESULTS Twenty-seven adult patients in a tertiary level general intensive care unit were enrolled. The sleep pattern was examined using an overnight recording of the patient's Bispectral Index and submental electromyogram. No intensive care unit patients showed a completely normal sleep pattern, but about half showed 40-90 min cyclical periods of slow wave sleep that approached a normal sleep pattern. CONCLUSIONS Traditional classifications of EEG sleep staging are deficient when used to describe sleep in intensive care unit patients.
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Affiliation(s)
- T Nicholson
- Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand
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Abstract
In recent years, a national discussion has emerged concerning what parents should tell their children about their own past drug use. DRUGNET is an ongoing, on-line survey of successful, healthy, adults who occasionally use illicit drugs. This paper reviews data from a subset of this survey, namely, those respondents who were parents with self-reported use of at least one illicit drug. The sample (n = 325) was predominantly white men who reported having above average education and household incomes. Their mental health as measured by the General Well-being Schedule was similar to the national norm. Respondents reported using drugs to manage parental stress and expressed concerns over how to communicate with their children and legal risks related to their own drug use. The limitations and the implications of these data are discussed.
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Affiliation(s)
- T Nicholson
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA.
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Abstract
Stress related disorders in college students are widespread and largely preventable. Students do not have the preventative skills necessary to manage stress in their lives and, because of the inability to cope, students may turn to alcohol and drugs to alleviate the pressures they are experiencing. The purpose of this study was to describe the association between stress and alcohol and drug use. A total of 772 undergraduate and graduate students from a small, elite, private university were randomly selected from 4000 students to complete two anonymous questionnaires. The Core Alcohol and Drug Survey identified the frequency and consequences of alcohol and drug use, and the General-Well Being Schedule was used to assess subjective well being and mental health status. The results of this study revealed that, for this sample of students, health behaviors such as using drugs recreationally and drinking alcohol played an associative role with general well being. A significant relationship was also found between student participation in intramural or club sports and positive mental well being.
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Affiliation(s)
- C A Lanier
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843-4243, USA
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Nicholson T, Tiruchelvam V. Comparison of laparoscopic-assisted appendectomy with intracorporal laparoscopic appendectomy and open appendectomy. JSLS 2001; 5:47-51. [PMID: 11303994 PMCID: PMC3015413] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A laparoscopic appendectomy is associated with less postoperative pain and a shorter postoperative stay than the open technique. However, the open technique is faster and less expensive than the completely laparoscopic method. A laparoscopic-assisted appendectomy has the advantages of both the laparoscopic and open techniques. METHODS A retrospective study involving 83 patients was performed comparing the three different techniques. The comparison studied operating time, surgical expense, and postoperative stay. RESULTS The completely laparoscopic method was performed on 24 patients with an average surgical time of 88.9 minutes, average charges of $604, and average postoperative stay of 2.6 days. The open technique was performed on 26 patients with a surgical time of 77.1 minutes, charges of $42, and a postoperative stay of 2.4 days. The laparoscopic-assisted technique was performed on 33 patients with a surgical time of 70.3 minutes, charges of $208, and a postoperative stay of 1.8 days. CONCLUSION The laparoscopic-assisted method of appendix removal can be performed as efficiently as the open technique but at <67% of the cost of the complete laparoscopic method. The postoperative stay is shorter for the laparoscopic-assisted technique than for the open technique. Thus, the laparoscopic-assisted technique is a cost-effective method for removing the appendix.
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Affiliation(s)
- T Nicholson
- Department of General Surgery, York Hospital, York, PA 17405, USA
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Abstract
New generation metallic stents are making an impact on coronary, peripheral vascular and biliary diseases. However, their use is not limited to these: other areas include the oesophagus and upper gastrointestinal tract, the small bowel, large bowel and dacryocystic duct.
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Smithies A, Nicholson T, Stein K. Health technology assessment in primary and community care. Br J Gen Pract 2000; 50:3-4. [PMID: 10695057 PMCID: PMC1313600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Abstract
DRUGNET was a cross-sectional survey of adult recreational drug users (i.e., not abusers) via the World Wide Web of the Internet. The purpose of this survey was to provide a unique, broad description of nondeviant adult recreational drug users. The survey instrument had four divisions: demographic and lifestyle indices, drug use history, legal history and attitudes about drug issues, and the General Well-being Schedule (GWBS). Responses were received from 1,473 self-identified drug users. Of these, 567 completed only the first section, leaving 906 respondents who completed the entire survey. The typical respondent was a White male who was well educated, employed full-time, a participant in recreational and community activities, and who described his physical health status as good. Their mental health, as measured by the GWBS, was similar to the general adult U.S. population. Their drug-taking behavior appeared to be well-controlled, at mild to moderate levels in both frequency of use and degree of intoxication. These findings have major implications for drug policy and indicate the need for further research on the majority of drug users, who may be expected to resemble this sample more than they do clinical populations of drug abusers.
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Affiliation(s)
- T Nicholson
- Western Kentucky University, Bowling Green, 42101-3576, USA
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Stein K, Nicholson T. The end of the heparin pump? Low molecular weight heparins have practical advantages, but clinical advantages are small. BMJ 1999; 319:576. [PMID: 10523087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
Over the last 10 years the development of stent technology has had a major effect on the treatment of patients with cardiac vascular and non-vascular disease. However, no two abnormalities are ever alike and stents differ hugely in their properties.
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Abstract
The complication of cholecystocutaneous fistula secondary to calculus cholelithiasis is an extremely rare occurrence. The incidence has further decreased with the advent of broad-spectrum antibiotics, ultrasonography, and safe and early surgical treatment of biliary tract disease. We are reporting a rare cholecystocutaneous fistula presenting in the right-side gluteal region below the iliac crest.
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Affiliation(s)
- T Nicholson
- Department of Surgery, York Hospital, Pennsylvania 17405, USA
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Abstract
Data from the Rhode Island Behavioral Risk Factor Survey on self-reported alcohol consumption and drunk driving were examined. Driving while intoxicated was significantly associated with both binge drinking and chronic drinking, but the measures of drinking were not significantly associated.
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Affiliation(s)
- D F Duncan
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
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Nicholson T, Tiruchelvam V. Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repair. JSLS 1999; 3:39-43. [PMID: 10323168 PMCID: PMC3015338] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inguinal hernia repair has been a common procedure performed by general surgeons. Recently, a newly developed approach has been introduced using the pre-peritoneal laparoscopic repair. The laparoscopic approach allows patients to recover faster, with less pain, however, a disadvantage is the higher cost. We conducted a retrospective study of inguinal hernia repairs performed by one surgeon at the same institution, comparing the laparoscopic technique to the modified Shouldice procedure with regard to surgical time, postoperative recovery time, charge, and time to return to work and to activities. Patients undergoing laparoscopic hernia repairs were able to return to work and to activities sooner than patients undergoing the modified Shouldice procedure. The results obtained in this study showed a higher charge for the laparoscopic procedure, with longer surgical and recovery room time. The more rapid return to work and activities may outweigh the higher charge and longer surgical and recovery room time.
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Affiliation(s)
- T Nicholson
- Department of General Surgery, York Hospital, Pennsylvania 17401, USA
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Nicholson T, Travis S, Ettles D, Dyet J, Sedman P, Wedgewood K, Royston C. Hepatic artery angiography and embolization for hemobilia following laparoscopic cholecystectomy. Cardiovasc Intervent Radiol 1999; 22:20-4. [PMID: 9929540 DOI: 10.1007/s002709900323] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [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: 10/18/2022]
Abstract
PURPOSE The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. METHODS Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. RESULTS Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. CONCLUSION Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.
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Affiliation(s)
- T Nicholson
- Department of Vascular Radiology, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK
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Nicholson T. Percutaneous transluminal angioplasty and enclosed thrombolysis versus percutaneous transluminal angioplasty in the treatment of femoropopliteal occlusions: results of a prospective randomized trial. Cardiovasc Intervent Radiol 1998; 21:470-4. [PMID: 9853164 DOI: 10.1007/s002709900306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine whether percutaneous transluminal angioplasty (PTA) and enclosed thrombolysis (ET) is superior to PTA alone in the treatment of femoropopliteal occlusions. METHODS Twenty-five patients with 5-15-cm-long occlusions in the femoropopliteal segments, with otherwise normal run-in arteries and at least one normal tibioperoneal artery to the foot, were randomized to ET/PTA or PTA alone. Ankle brachial systolic index (ABI) was measured before the procedure and at 24 hr and 12 months after the procedure, when a duplex scan was also carried out. End points in the study were patency at, or repeat intervention before, 12 months. RESULTS Procedures were successful in 23 of 25 patients. There was one immediate occlusion of tibioperoneal arteries, and one early reocclusion of a reopened segment in the ET/PTA group. There was one early reocclusion in the PTA group. At 12 months patency was 70% and 69.2% in the ET/PTA and PTA groups respectively. Covariant analysis showed no significant difference in ABI between the two groups at any of the three measurement times. CONCLUSION This trial demonstrated no difference between ET/PTA and PTA alone in femoropopliteal occlusions associated with normal proximal arteries and at least one normal tibioperoneal artery.
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Affiliation(s)
- T Nicholson
- Department of Vascular and Interventional Radiology, Royal Hull Hospitals Trust, United Kingdom
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