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Scotton WJ, Shand C, Todd EG, Bocchetta M, Cash DM, VandeVrede L, Heuer HW, Young AL, Oxtoby N, Alexander DC, Rowe JB, Morris HR, Boxer AL, Rohrer JD, Wijeratne PA. Distinct spatiotemporal atrophy patterns in corticobasal syndrome are associated with different underlying pathologies. medRxiv 2024:2024.03.14.24304298. [PMID: 38562801 PMCID: PMC10984071 DOI: 10.1101/2024.03.14.24304298] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Objective To identify imaging subtypes of the cortico-basal syndrome (CBS) based solely on a data-driven assessment of MRI atrophy patterns, and investigate whether these subtypes provide information on the underlying pathology. Methods We applied Subtype and Stage Inference (SuStaIn), a machine learning algorithm that identifies groups of individuals with distinct biomarker progression patterns, to a large cohort of 135 CBS cases (52 had a pathological or biomarker defined diagnosis) and 252 controls. The model was fit using volumetric features extracted from baseline T1-weighted MRI scans and validated using follow-up MRI. We compared the clinical phenotypes of each subtype and investigated whether there were differences in associated pathology between the subtypes. Results SuStaIn identified two subtypes with distinct sequences of atrophy progression; four-repeat-tauopathy confirmed cases were most commonly assigned to the Subcortical subtype (83% of CBS-PSP and 75% of CBS-CBD), while CBS-AD was most commonly assigned to the Fronto-parieto-occipital subtype (81% of CBS-AD). Subtype assignment was stable at follow-up (98% of cases), and individuals consistently progressed to higher stages (100% stayed at the same stage or progressed), supporting the model's ability to stage progression. Interpretation By jointly modelling disease stage and subtype, we provide data-driven evidence for at least two distinct and longitudinally stable spatiotemporal subtypes of atrophy in CBS that are associated with different underlying pathologies. In the absence of sensitive and specific biomarkers, accurately subtyping and staging individuals with CBS at baseline has important implications for screening on entry into clinical trials, as well as for tracking disease progression.
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Affiliation(s)
- W J Scotton
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - C Shand
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - E G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - M Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - D M Cash
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - L VandeVrede
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - H W Heuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - A L Young
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - N Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - D C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - J B Rowe
- Cambridge University Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge UK
| | - H R Morris
- Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK
- Movement Disorders Centre, University College London Queen Square Institute of Neurology, London, UK
| | - A L Boxer
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - J D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - P A Wijeratne
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Department of Informatics, University of Sussex, Brighton, BN1 9RH, UK
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2
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Iu LPL, Yip WWK, Lok JYC, Ho M, Cheung LTY, Wu THM, Young AL. Comparison of United Kingdom and United States screening criteria for detecting retinopathy of prematurity in Hong Kong. Hong Kong Med J 2023; 29:330-336. [PMID: 37474485 DOI: 10.12809/hkmj219378] [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] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION We examined whether the United Kingdom (UK) or the United States (US) screening criteria are more appropriate for retinopathy of prematurity (ROP) screening in Hong Kong, in terms of sensitivity for detecting type 1 ROP and the number of infants requiring screening. METHODS In this retrospective cohort study, we reviewed the medical records of all infants who underwent ROP screening from 2009 to 2018 at a tertiary hospital in Hong Kong. During this period, all infants born at gestational age (GA) ≤31 weeks and 6 days or birth weight (BW) <1501 g (ie, the UK screening criteria) underwent ROP screening. We determined the number of infants requiring screening and the number of type 1 ROP cases that would have been missed if the US screening criteria (GA ≤30 weeks & 0 days or BW ≤1500 g) had been used. RESULTS Overall, 796 infants were screened using the UK screening criteria. If the US screening criteria had been used, the number of infants requiring screening would have decreased by 21.1%; all type 1 ROP cases would have been detected (38/38, 100% sensitivity). Of the 168 infants who would not have been screened using the US screening criteria, only four of them (2.4%) had developed ROP (all maximum stage 1 only). CONCLUSION In our population, the use of the US screening criteria could reduce the number of infants screened without compromising sensitivity for the detection of type 1 ROP requiring treatment. We suggest narrowing the GA criterion for consistency with the US screening criteria during ROP screening in Hong Kong.
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Affiliation(s)
- L P L Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - W W K Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - J Y C Lok
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - M Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - L T Y Cheung
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong SAR, China
| | - T H M Wu
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - A L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
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3
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Kam KW, Wong VWY, Chow VWS, Yiu EPF, Young AL. Celebrating 60 years of corneal transplant in Hong Kong. Hong Kong Med J 2021; 27:458-460. [PMID: 34764229 DOI: 10.12809/hkmj219671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- K W Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - V W Y Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,HKU Health System, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Ophthalmology, Queen Mary Hospital and Grantham Hospital, Hong Kong
| | - V W S Chow
- Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong Kong
| | | | - A L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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Abstract
Abstract
Introduction
Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.
Method
The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.
Result
9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9–34.9%] (N = 655) and 62.4% [56.3–70.2%] (N = 1419) of first authors, 20.6% [11.8–27.1%] (N = 453) and 74.2% [65.6–84.1%] (N = 1706) of last authors, 23.9% [14.9–29.6%] (N = 510) and 69.9% [60.5–79.3%] (N = 2341) of corresponding authors and in total 27% [19.4–31.6%] (N = 4298) and 65.5% [58.6–73.4%] (N = 9982) of all authors. The wide range in these results could be a result of various factors.
Conclusion
This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.
Take-home Message
This study identified a gender imbalance in authorship positions of major surgical journals, which has implications for women who choose to pursue a career in academic surgery.
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Affiliation(s)
| | | | | | | | - A L Young
- Department of Pancreatic Surgery, St James University Hospital
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5
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Mak CY, Ho M, Chan AZ, Iu LPL, Cheung CMT, Brelen ME, Choi PCL, Young AL. Tattoo-associated uveitis. Hong Kong Med J 2021; 27:222.e1-222.e2. [PMID: 34168090 DOI: 10.12809/hkmj208638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- C Y Mak
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - M Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - A Z Chan
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - L P L Iu
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - C M T Cheung
- Division of Dermatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - M E Brelen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - P C L Choi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong
| | - A L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
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To N, Bekker HL, Henry K, Melling P, Turley J, Lodge JPA, Young AL. COVID-19 restrictions on multidisciplinary team meeting decision-making: service evaluation in a major UK cancer centre. Br J Surg 2021; 108:e162-e163. [PMID: 33778851 PMCID: PMC8083657 DOI: 10.1093/bjs/znab009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/03/2020] [Accepted: 12/27/2020] [Indexed: 11/12/2022]
Affiliation(s)
- N To
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
| | - H L Bekker
- Department of Medical Decision-making, University of Leeds, UK
| | - K Henry
- Cancer Team, St James's University Hospital, Leeds, UK
| | - P Melling
- Cancer Team, St James's University Hospital, Leeds, UK
| | - J Turley
- Cancer Team, St James's University Hospital, Leeds, UK
| | - J P A Lodge
- Cancer Team, St James's University Hospital, Leeds, UK.,Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK
| | - A L Young
- Department of Pancreatic Surgery, St James's University Hospital, Leeds, UK
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7
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Gallivan ER, Arshad SR, Skinner H, Burke JR, Young AL. O54: GENDER REPRESENTATION IN EDITORIAL BOARDS OF INTERNATIONAL GENERAL SURGERY JOURNALS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Despite women constituting over half of new UK doctors, and a similar proportion worldwide, gender disparity remains an issue throughout academic medicine. Surgery has shown particularly slow progress towards gender parity. This study aims to quantify gender representation within editorial boards of the top 25 general surgical journals.
Method
All surgical journals were collated using the SCImago Journal Rank (SJR) and Journal Impact Factor (JIF). Non general surgery journals were excluded. Journals were contacted requesting gender editorial team demographics. Editorial board data was collected via journal websites on 20th November 2019.
Result
The top 25 surgical journals were determined through SJR and JIF ranking methods. Editorial board data was publicly available for 31 of these 32 different surgical journals. This data was then examined. Women accounted for 18.4% (576/3135) of total editorial board positions. Women constituted 12.5% (5/40) of Editors-in-Chief positions, 31.6% (31/98) of Deputy Editors and 17.2% (416/2415) of general editorial board positions.
Conclusion
For the first time, gender disparity has been demonstrated within editorial boards of the most prominent general surgery journals. The implications of such significant gender disparity are wide reaching. Action should be taken to champion fair female representation, eliminate risk of bias and provide more visible female role models in academic surgery.
Take-home message
For the first time, this study demonstrates gender disparity in Editorial boards of major general surgery journals. Action should be taken to champion fair female representation, eliminate risk of bias and provide more visible female role models in academic surgery.
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Gallivan E, Arshad S, Skinner H, Burke JR, Young AL. Gender representation in editorial boards of international general surgery journals. BJS Open 2021; 5:6220244. [PMID: 33839744 PMCID: PMC8036998 DOI: 10.1093/bjsopen/zraa064] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background Despite women constituting over half of new doctors, gender disparity remains an issue. Surgery has shown particularly slow progress towards gender parity. This study aimed to quantify gender representation within editorial boards of the highest ranking international general surgery journals. Methods Surgical journals were collated using two indices: SCImago Journal Rank (SJR) and Journal Impact Factor (JIF). Non-general surgery journals were excluded. Journals were contacted, requesting gender editorial team demographics. Editorial board data were collected via journal websites on 28 November 2019. Results The top 25 general surgery journals according to SJR and JIF ranking methods were determined, identifying 28 unique journals. Editorial board data were publicly available for 27 of these 28 surgical journals, and were examined. Women accounted for 20.2 per cent (568 of 2816) of total editorial board positions. Women constituted 11 per cent (4 of 36) of editor-in-chief positions, 32 per cent (29 of 92) of deputy editors, and 19.1 per cent (369 of 1935) of general editorial board positions. Conclusion The findings demonstrate gender disparity within editorial boards of the most prominent general surgery journals.
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Affiliation(s)
- E Gallivan
- School of Medicine, University of Leeds, Leeds, UK
| | - S Arshad
- School of Medicine, University of Leeds, Leeds, UK
| | - H Skinner
- St James’ University Hospital, Leeds, UK
| | - J R Burke
- St James’ University Hospital, Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, St James’s University Hospital, Leeds, UK
| | - A L Young
- Correspondence to: Department of Pancreatic Surgery, St James’s University Hospital, Leeds LS9 7TF, UK (e-mail: )
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9
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Mak CY, Yam JC, Chen LJ, Lee SM, Young AL. Epidemiology of myopia and prevention of myopia progression in children in East Asia: a review. Hong Kong Med J 2018; 24:602-609. [PMID: 30530867 DOI: 10.12809/hkmj187513] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Myopia (short-sightedness) exhibits high prevalence in East Asia. Methods to mitigate myopia progression are important in preventing the vision-threatening complications associated with high myopia. In this review, we examine the regional epidemiology of myopia and provide updated evidence regarding interventions to slow myopia progression in children. METHODS We performed a literature search using PubMed from the date of inception through 25 June 2018. Studies involving myopia epidemiology and control of myopia progression were selected; only studies published in English were reviewed. Preference was given to prospective studies, as well as those conducted in Hong Kong or East Asia. RESULTS Atropine eye drops and pirenzepine eye gel are highly effective for controlling myopia progression in children. Orthokeratology, peripheral defocus contact lenses, bifocal or progressive addition spectacles, and increased involvement in outdoor activities are also effective for controlling myopia progression; however, myopia undercorrection and single vision contact lenses are ineffective. CONCLUSION Although various methods are effective for controlling myopia progression in children, no curative remedy exists for myopia. Health care professionals should be aware of the available methods, as well as their risks and benefits. Treatment should be individualised and based on the preferences of the patient's family, after full discussion of the risks and benefits of each modality.
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Affiliation(s)
- C Y Mak
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - J Cs Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - L J Chen
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - A L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
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10
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Young AL, Lee E, Absolom K, Baxter H, Christophi C, Lodge JPA, Glaser AG, Toogood GJ. Expectations of outcomes in patients with colorectal cancer. BJS Open 2018; 2:285-292. [PMID: 30263979 PMCID: PMC6156162 DOI: 10.1002/bjs5.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background Understanding patients' expectations of their treatment is critical to ensure appropriate treatment decisions, and to explore how expectations influence coping, quality of life and well‐being. This study aimed to examine these issues related to treatment in patients with colorectal cancer. Methods A literature search from January 1946 to September 2016 was performed to identify available data regarding patients' expectations of outcomes following colorectal cancer treatment. A narrative synthesis of the evidence was planned. Results Of 4337 items initially identified, 20 articles were included in the review. In studies presenting data on overall and short‐term survival, patients considerably overestimated prognosis. Patients also had unrealistic expectations of the negative aspects of chemotherapy and stomas. There was marked discordance between patients' and clinicians' expectations regarding chemotherapy, end‐of‐life care, bowel function and psychosocial outcomes. Level of education was the most consistent factor influencing the accuracy of patients' expectations. Conclusion Patients with colorectal cancer frequently have unrealistic expectations of treatment. Marked disparities exist between patients' and clinicians' expectations of outcomes.
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Affiliation(s)
- A L Young
- Department of Hepatobiliary and Transplant Surgery St James's University Hospital Leeds UK.,Department of Hepatobiliary and Transplant Surgery Austin Health Melbourne, Victoria Australia
| | - E Lee
- Department of Hepatobiliary and Transplant Surgery Austin Health Melbourne, Victoria Australia
| | - K Absolom
- Leeds Institute of Cancer and Pathology University of Leeds Leeds UK
| | - H Baxter
- Austin Health Sciences Library Austin Health Melbourne, Victoria Australia
| | - C Christophi
- Department of Hepatobiliary and Transplant Surgery Austin Health Melbourne, Victoria Australia
| | - J P A Lodge
- Department of Hepatobiliary and Transplant Surgery St James's University Hospital Leeds UK
| | - A G Glaser
- Leeds Institute of Cancer and Pathology University of Leeds Leeds UK
| | - G J Toogood
- Department of Hepatobiliary and Transplant Surgery St James's University Hospital Leeds UK
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11
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Hodgson R, Young AL, Attia MA, Lodge JPA. Impact of a National Controlled Donation After Circulatory Death (DCD) Program on Organ Donation in the United Kingdom: A 10-Year Study. Am J Transplant 2017; 17:3172-3182. [PMID: 28556608 DOI: 10.1111/ajt.14374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/09/2017] [Accepted: 05/15/2017] [Indexed: 01/25/2023]
Abstract
Organ transplantation is the most successful treatment for some forms of organ failure, yet a lack of organs means many die on the waiting list. In the United Kingdom, the Organ Donation Taskforce was set up to identify barriers to organ donation and in 2008 released its first report (Organ Donation Taskforce Report; ODTR). This study assesses the success since the ODTR and examines the impact of the United Kingdom's controlled donation after circulatory death (DCD) program and the controversies surrounding it. There were 12 864 intended donation after brain death (DBD) or DCD donors from April 2004 to March 2014. When the 5 years preceding the ODTR was compared to the 5 years following, intended DCD donors increased 292% (1187 to 4652), and intended DBD donors increased 11% (3327 to 3698). Organs retrieved per intended DBD donor remained static (3.30 to 3.26), whereas there was a decrease in DCD (1.54 to 0.99) due to a large rise in donors who did not proceed to donation (325 to 2464). The majority of DCD donors who proceeded did so within 30 min from time of withdrawal. Our study suggests further work on converting eligible referrals to organ donation and exploring methods of converting DCD to DBD donors.
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Affiliation(s)
- R Hodgson
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - A L Young
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - M A Attia
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
| | - J P A Lodge
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, West Yorkshire, UK
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12
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Wakefield CE, Fardell JE, Doolan EL, Drew D, De Abreu Lourenco R, Young AL, Cohn RJ. Grandparents of children with cancer: Quality of life, medication and hospitalizations. Pediatr Blood Cancer 2017; 64:163-171. [PMID: 27442621 DOI: 10.1002/pbc.26153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/16/2016] [Accepted: 06/26/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Grandparents can play a crucial role of providing emotional and practical support for families facing childhood cancer. Yet, many have their own healthcare needs. This controlled study systematically assesses the impact of childhood cancer on grandparents' quality of life (QOL). Our objective was to compare QOL in grandparents of children with and without cancer and to identify factors associated with grandparents' QOL. PROCEDURE Grandparents (N = 222) completed two patient-reported outcome (PRO) measures assessing QOL: EQ-5D-5L and WHOQOL-BREF. Secondary endpoints included sleep, medications and hospitalizations. We used independent samples t-tests and multivariate linear regression to assess between-group differences and identify predictors. RESULTS Grandparents of children with cancer (n = 89) reported significantly worse QOL than controls (n = 133) [mean WHOQOL-BREF score: 75.6 (SD = 17.6) vs. 81.5 (15.6), P = 0.007; mean EQ-5D-5L index value: 0.777 (0.20) vs. 0.874 (0.14), P < 0.001)]. They also reported more problems with anxiety and depression (47.2 vs. 21.8%, P < 0.001) and pain (64.8 vs. 49.6%, P = 0.031). Grandparents of children with cancer reported taking longer to fall asleep [mean: 30.4 min (55.6) vs. 18.2 (20.2), P = 0.011] and taking more medications in the last 4 weeks [mean: 2.9 (SD = 3.8) vs. 1.8 (SD = 2.3), P = 0.012]. Hospitalizations were comparable across groups. Grandmothers, those living in urban locations, and retired/unemployed grandparents experienced reduced QOL. CONCLUSIONS Grandparents are significantly affected by childhood cancer. The impact appears across many domains of life and results in meaningful QOL differences. Given that four or more individuals may be affected per child, and that grandparent well-being can influence the whole family, interventions targeting at-risk grandparents are needed.
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Affiliation(s)
- C E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - J E Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - E L Doolan
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - D Drew
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - R De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia
| | - A L Young
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - R J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Ho M, Lo EC, Young AL, Liu DTL. Reply to ‘Factors influencing the outcome of polypoidal choroidal vasculopathy following combined treatment with photodynamic therapy and intravitreal ranibizumab’. Eye (Lond) 2015; 29:1239. [DOI: 10.1038/eye.2015.102] [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: 11/09/2022] Open
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Abstract
INTRODUCTION Complications from HELLP (Haemolysis, Elevated Liver enzymes and Low Platelet) syndrome may present as an emergency to any surgeon. We review the ten-year experience of a tertiary hepatobiliary centre managing HELLP patients. Three selected cases are described to highlight our management strategy and a systematic review of the recent literature is presented. METHODS All patients with HELLP syndrome were identified from a prospectively maintained database and their details collated. Subsequently, a detailed search of PubMed was carried out to identify all case series of HELLP syndrome in the literature in the English language since 1999. RESULTS On review of 1,002 cases, 10 patients were identified with surgical complications of HELLP syndrome. Seven of these patients had a significant liver injury. Only three of these required surgical intervention for liver injury although four other patients required surgical intervention for other complications. There was no maternal mortality in this series. Review of the literature identified 49 cases in 31 publications. The management approaches of these patients were compared with ours. CONCLUSIONS We have presented a large series of patients with surgical complications resulting from HELLP syndrome managed without maternal mortality. This review has confirmed that haemodynamically stable patients with HELLP syndrome associated hepatic rupture can be conservatively treated successfully. However, in unstable patients, perihepatic packing and transfer to a specialist liver unit is recommended.
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Young AL, Adair R, Culverwell A, Guthrie JA, Botterill ID, Toogood GJ, Lodge JPA, Prasad KR. Variation in referral practice for patients with colorectal cancer liver metastases. Br J Surg 2014; 100:1627-32. [PMID: 24264786 DOI: 10.1002/bjs.9285] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Half of patients with colorectal cancer develop liver metastases. There remains great variability between hospitals in rates of liver resection for colorectal cancer liver metastases (CLM). This study aimed to determine how many patients with potentially resectable CLM are not seen by specialist liver surgeons. METHODS Patients presenting with new CLM in a cancer network consisting of a tertiary centre and seven attached hospitals were studied prospectively over 12 months. Data were collected retrospectively for patients who did not have a complete data set. Outcomes for patients referred to the liver tertiary centre were collated. The radiology of tumours deemed inoperable by the local colorectal specialist teams was reviewed by specialist liver surgeons and radiologists. RESULTS In total, 631 patients with CLM were assessed. Prospective data were complete for 241 patients, and 64 (26.6 per cent) of these were referred to the specialist liver team for consideration of resection. No decision was documented for 16 patients (6.6 per cent). Of those not referred, 30 (18.6 per cent) were deemed unfit or refused and 131 (81.4 per cent) were thought inoperable. Referral rates varied between hospitals (13-43.6 per cent). Of 131 patients deemed fit but inoperable by the colorectal specialist teams, 38 (29.0 per cent) were deemed operable and 20 (15.3 per cent) had equivocal imaging when assessed retrospectively by liver specialists. In total, 142 of the 631 patients were referred to liver specialists for consideration of treatments, and 107 (75.4 per cent) treated with curative intent. CONCLUSION A considerable number of patients with potentially resectable CLM are not assessed by specialist liver teams. Improved referral rates could greatly improve resection rates for CLM, which may improve outcomes for patients with colorectal cancer.
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Affiliation(s)
- A L Young
- Departments of Hepatobiliary and Transplant Surgery
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16
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Abstract
We present a case of accessory gallbladder demonstrating an anatomical variation not previously reported. While rare, accessory gallbladders are an important consideration if a cholecystectomy is to be performed. We also present a brief literature review of accessory gallbladders.
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Affiliation(s)
- S Hassan
- Department of General Surgery, Scunthorpe General Hospital, Scunthorpe DN15 7BH, UK
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17
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Abstract
BACKGROUND Some 75-80 per cent of patients undergoing liver resection for colorectal liver metastases develop intrahepatic recurrence. A significant number of these can be considered for repeat liver surgery. This study examined the outcomes of repeat liver resection for the treatment of recurrent colorectal metastases confined to the liver. METHODS Patients who underwent repeat liver resection in a single tertiary referral hepatobiliary centre were identified from a database. Clinicopathological variables were analysed to assess factors predictive of survival. RESULTS A total of 195 patients underwent repeat resection between 1993 and 2010. Median age was 63 years, and the median interval between first and repeat resection was 13·8 months. Thirty-three patients (16·9 per cent) underwent completion hemihepatectomy or extended hemihepatectomy and the remainder had non-anatomical or segmental resection. The 30-day mortality rate was 1·5 per cent, and the overall 30-day morbidity rate was 20·0 per cent. Overall 1-, 3- and 5-year survival rates were 91·2, 44·3 and 29·4 per cent respectively. Tumour size 5 cm or greater was the only independent predictor of overall survival (relative risk 1·71, 95 per cent confidence interval 1·08 to 2·70; P = 0·021). Neoadjuvant chemotherapy before resection, perioperative blood transfusion, bilobar disease, R1 resection margin and multiple metastases were among factors that did not significantly influence survival. CONCLUSION Repeat hepatic resection remains the only curative option for patients presenting with recurrent colorectal liver metastases.
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Affiliation(s)
- R A Adair
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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Whipple CA, Young AL, Korc M. A KrasG12D-driven genetic mouse model of pancreatic cancer requires glypican-1 for efficient proliferation and angiogenesis. Oncogene 2012; 31:2535-44. [PMID: 21996748 PMCID: PMC3262079 DOI: 10.1038/onc.2011.430] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 07/30/2011] [Accepted: 08/18/2011] [Indexed: 12/20/2022]
Abstract
Pancreatic ductal adenocarcinomas (PDACs) exhibit multiple molecular alterations and overexpress heparin-binding growth factors (HBGFs) and glypican-1 (GPC1), a heparan sulfate proteoglycan that promotes efficient signaling by HBGFs. It is not known, however, whether GPC1 has a role in genetic mouse models of PDAC. Therefore, we generated a GPC1 null mouse that combines pancreas-specific Cre-mediated activation of oncogenic Kras (Kras(G12D)) with deletion of a conditional INK4A/Arf allele (Pdx1-Cre;LSL-Kras(G12D);INK4A/Arf(lox/lox);GPC1(-/-) mice). By comparison with Pdx1-Cre;LSL-Kras(G12D);INK4A/Arf(lox/lox) mice that were wild type for GPC1, the Pdx1-Cre;LSL-Kras(G12D);INK4A/Arf(lox/lox);GPC1(-/-) mice exhibited attenuated pancreatic tumor growth and invasiveness, decreased cancer cell proliferation and mitogen-activated protein kinase activation. These mice also exhibited suppressed angiogenesis in conjunction with decreased expression of messenger RNAs encoding several pro-angiogenic factors and molecules, including vascular endothelial growth factor-A (VEGF-A), SRY-box containing gene (SOX17), chemokine C-X3-C motif ligand 1 (CX3CL1) and integrin β3 (ITGB3). Moreover, pancreatic cancer cells isolated from the tumors of GPC1(-/-) mice were not as invasive in response to fibroblast growth factor-2 (FGF-2) as cancer cells isolated from wild-type mice, and formed smaller tumors that exhibited an attenuated metastatic potential. Similarly, VEGF-A and FGF-2 did not enhance the migration of hepatic endothelial cells and immortalized murine embryonic fibroblasts isolated from GPC1 null mice. These data demonstrate in an oncogenic Kras-driven genetic mouse model of PDAC that tumor growth, angiogenesis and invasion are enhanced by GPC1, and suggest that suppression of GPC1 may be an important component of therapeutic strategies in PDAC.
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Affiliation(s)
- C A Whipple
- Department of Medicine, Dartmouth Medical School, Hanover, NH, USA
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Abstract
We report a case of a parastomal hernia in which the stomach became incarcerated. This is an unusual yet serious complication of parastomal hernias.
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Affiliation(s)
- C Ilyas
- Scarborough and North East Yorkshire Healthcare NHS Trust, UK
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20
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White AD, Young AL, Verbeke C, Brannan R, Smith A, Prasad KR. Biliary papillomatosis in three Caucasian patients in a Western centre. Eur J Surg Oncol 2011; 38:181-4. [PMID: 22154963 DOI: 10.1016/j.ejso.2011.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 09/19/2011] [Accepted: 11/15/2011] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Biliary papillomatosis (BP) is a rare condition with a strong potential for malignant transformation and cases from Western centres are sparse.(1) We discuss the presentation, investigation and management of this condition in three Caucasian patients and present a review of the existing literature on BP. PATIENTS AND METHODS The case notes of three Caucasian patients with BP who presented to our tertiary referral centre were reviewed. Their case histories, investigations and managements are presented. A search of MEDLINE, PubMed and Cochrane databases was performed to review relevant literature around BP. DISCUSSION BP is a rare condition characterised by multiple papillary adenomas involving the biliary tree which lead to recurrent attacks of cholangitis. It is a low-grade neoplasm with high malignant potential and should be regarded as a pre-malignant lesion.
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Affiliation(s)
- A D White
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, United Kingdom.
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Cockbain AJ, Young AL, Toogood GJ. Randomized clinical trial of routine on-table cholangiography during laparoscopic cholecystectomy (Br J Surg 2011; 98: 362–367). Br J Surg 2011; 98:744; author reply 744. [DOI: 10.1002/bjs.7510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Affiliation(s)
- A J Cockbain
- Department of Hepatobiliary Surgery, St James' University Hospital, Leeds, UK
| | - A L Young
- Department of Hepatobiliary Surgery, St James' University Hospital, Leeds, UK
| | - G J Toogood
- Department of Hepatobiliary Surgery, St James' University Hospital, Leeds, UK
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Lau TTY, Young AL, Lam PTH. Cardinal sutures revisited: position modification in corneal transplantation. Eye (Lond) 2009; 24:1291. [PMID: 20010794 DOI: 10.1038/eye.2009.298] [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: 11/09/2022] Open
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Pine JK, Aldouri A, Young AL, Davies MH, Attia M, Toogood GJ, Pollard SG, Lodge JPA, Prasad KR. Liver transplantation following donation after cardiac death: an analysis using matched pairs. Liver Transpl 2009; 15:1072-82. [PMID: 19718634 DOI: 10.1002/lt.21853] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Grafts from donation after cardiac death (DCD) donors are used to increase the number of organs available for liver transplantation. There is concern that warm ischemia may impair graft function. We compared our DCD recipients with a case-matched group of donation after brain death (DBD) recipients. Between January 2002 and April 2008, 39 DCD grafts were transplanted. These were matched with 39 DBD recipients on the basis of identified variables that had a significant impact on mortality. These were used to individually match DCD and DBD patients with similar predictive mortality. We compared patient/graft survival, primary non-function (PNF), and rates of complications. Of all liver transplants, 6.1% were DCD grafts. PNF occurred twice in the DCD group. The incidence of nonanastomotic biliary strictures (NABS; 20.5% versus 0%, P = 0.005) and hepatic artery stenosis (HAS; 12.8% versus 0%, P = 0.027) in the DCD group was higher. One-year (79.5% versus 97.4%, P = 0.029) and 3-year (63.6% versus 97.4%, P = 0.001) graft survival was lower in the DCD group. Three-year patient survival was also lower (68.2% versus 100%, P < 0.0001). Our study is the first to use case-matched patients and compare groups with similar predictive mortality. There was a higher incidence of NABS and HAS in the DCD group. NABS were likely a result of warm ischemia. HAS may have been due to ischemia or arterial injury during retrieval. The DCD group had significantly poorer outcomes, but DCD grafts remain a valuable resource. With careful donor/recipient selection, minimization of ischemia, and good postoperative care, acceptable results can be achieved.
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Affiliation(s)
- James K Pine
- Department of Hepatobiliary/Transplant Surgery, St. James's University Hospital, Beckett Street, United Kingdom
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Young AL, Lodge JPA. Needle-track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut 2009; 58:887-8. [PMID: 19433605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Young AL, Kellermayer R, Szigeti R, Tészás A, Azmi S, Celebi JT. CYLD mutations underlie Brooke-Spiegler, familial cylindromatosis, and multiple familial trichoepithelioma syndromes. Clin Genet 2006; 70:246-9. [PMID: 16922728 DOI: 10.1111/j.1399-0004.2006.00667.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Brooke-Spiegler syndrome (BSS), familial cylindromatosis (FC), and multiple familial trichoepithelioma (MFT), originally described as distinct inherited disorders, are characterized by a variety of skin appendage neoplasms. Mutations in the CYLD gene are found in individuals with these syndromes. We describe a single family with affected members exhibiting either the FC or the MFT phenotypes associated with a mutation in the CYLD gene. These findings support the notion that BSS, FC, and MFT represent phenotypic variation of a single defect. Of interest, one of the affected individuals described in this report exhibits a severe phenotype illustrating the morbidity of the disorder.
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Affiliation(s)
- A L Young
- Department of Dermatology, Columbia University, New York, NY 10032, USA
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Young AL, Peters CJ, Toogood GJ, Davies MH, Millson CE, Lodge JPA, Pollard SG, Prasad KR. A combined liver-pancreas en-bloc transplant in a patient with cystic fibrosis. Transplantation 2005; 80:605-7. [PMID: 16177633 DOI: 10.1097/01.tp.0000167007.58199.9b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alistair L Young
- Transplant and Hepatobiliary Unit, St. James' University Hospital, Leeds, UK
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Abstract
OBJECTIVE Automobile head restraints, when used properly, have been shown to decrease the incidence and severity of whiplash injuries to the neck. Before the development of a public campaign on proper head restraint positioning, the authors assessed head restraint positioning and public understanding. DESIGN Over a one month period, the position of the vehicle head restraint of drivers was observed in moving cars in the city of Portland, Oregon (population 530,000). Optimal position was defined as having the head restraint above the ears with the back of the head touching the head restraint. A questionnaire on head restraint understanding was administered to people during jury service. RESULTS Of the 4287 drivers observed, 1% (n = 30) had no head restraint on their seat, 4% (n = 158) had a fixed head restraint, and 95% (n = 4099) had an adjustable head restraint. Among the fixed head restraints, 21% (33/158) were positioned optimally with no horizontal gap. Among the adjustable head restraints, only 7% (280/4099) had optimal head restraint positioning. Overall, 93% (3974/4287) of all head restraints observed were suboptimally positioned. Seventy five percent (38/51) of polled Portland residents identified safety as the primary head restraint function. CONCLUSION Ninety three percent of all head restraints observed were suboptimally positioned. Fixed head restraints were three times more likely to be in optimal position than adjustable head restraints (21% v 7%). Most polled Portland residents understood the proper function and positioning of head restraints. This discrepancy between actual practice and understanding should be addressed with public education and manufacturer design changes.
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Affiliation(s)
- A L Young
- Department of Neurosurgery, Oregon Health Sciences University, Portland, OR 97201, USA
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Monaghan KG, Highsmith WE, Amos J, Pratt VM, Roa B, Friez M, Pike-Buchanan LL, Buyse IM, Redman JB, Strom CM, Young AL, Sun W. Genotype-phenotype correlation and frequency of the 3199del6 cystic fibrosis mutation among I148T carriers: results from a collaborative study. Genet Med 2005; 6:421-5. [PMID: 15371907 DOI: 10.1097/01.gim.0000139507.20179.3a] [Citation(s) in RCA: 27] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We expect that the mutation panel currently recommended for preconception/prenatal CF carrier screening will be modified as new information is learned regarding the phenotype associated with specific mutations and allele frequencies in various populations. One such example is the I148T mutation, originally described as a severe CF mutation. After implementation of CF population-based carrier screening, we learned that I148T exists as a complex allele with 3199del6 in patients with clinical CF, whereas asymptomatic compound heterozygotes for I148T and a second severe CF mutation were negative for 3199del6. METHODS We performed reflex testing for 3199del6 on 663 unrelated specimens, including I148T heterozygotes, compound heterozygotes, and a homozygous individual. RESULTS Less than 1% of I148T carriers were also positive for 3199del6. Excluding subjects tested because of a suspected or known CF diagnosis or positive family history, 0.6% of I148T-positive individuals were also positive for 3199del6. We identified 1 I148T homozygote and 6 unrelated compound heterozygous individuals with I148T and a second CF variant (2 of whom also carried 3199del6). In addition, one fetus with echogenic bowel and one infertile male were heterozygous for I148T (3199del6 negative). CONCLUSIONS Reflex testing for 3199del6 should be considered whenever I148T is identified. Reflex testing is of particular importance for any symptomatic patient or whenever one member of a couple carries a deleterious CF mutation and the other member is an I148T heterozygote. Further population data are required to determine if I148T, in the absence of 3199del6, is associated with mild or atypical CF or male infertility.
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Affiliation(s)
- K G Monaghan
- Department of Medical Genetics, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Young AL, Leung GYS, Wong AKK, Cheng LL, Lam DSC. A randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary pterygium. Br J Ophthalmol 2004; 88:995-7. [PMID: 15258011 PMCID: PMC1772290 DOI: 10.1136/bjo.2003.036830] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [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: 11/04/2022]
Abstract
BACKGROUND Mitomycin C (MMC) and limbal conjunctival autograft (LCAU) are two known useful adjuvants in the prevention of pterygial recurrence. This study was conducted to compare the outcome of these two treatments. METHODS Prospective study on consecutive cases of primary pterygium (February 2001 to March 2002) randomised into two adjuvant groups: (1) intraoperative 0.02% MMC for 5 minutes or (2) LCAU. Patients were followed for recurrence (defined as fibrovascular tissue invading the cornea >1.5mm) and complications for a period of one year. RESULTS 115 eyes in 114 patients who completed the study were randomised to receive MMC (n = 63) and LCAU (n = 52). There were 10 recurrences (15.9%) in the MMC group and only one recurrence (1.9%) in the LCAU group. There was a statistically significant difference in the recurrence rate between the two groups (p = 0.04). There were a total of three conjunctival cysts, three symblephara, one granuloma, and one dellen. No other visually significant complications were encountered in either group. CONCLUSION Although LCAU resulted in better one year success rates, it is technically more difficult and inapplicable in cases with previous limbal disturbance. Simple excision followed by MMC or LCAU are both safe and acceptable adjuvants for pterygium excision. Choice of adjuvant should be carefully made based on assessment of recurrence risk, local practices, and surgeon's expertise.
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Affiliation(s)
- A L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Abstract
PURPOSE Persistent corneal epithelial defects (PED) present a very challenging problem to anterior segment surgeons. Autologous serum tears had been demonstrated to be beneficial in the treatment of PED. The current study was conducted to review the local spectrum of indications and to examine the outcome of autologous serum tear usage. METHODS All cases of PED treated with autologous serum tears at a tertiary referral centre for the period August 1999 - July 2001 were identified and reviewed. RESULTS A total of 10 eyes from 10 patients were identified (5OD : 5OS). The gender ratio was 7M : 3F and the mean age was 36.8 (range 17-73) years old. The mean duration of PED before the usage of autologous serum tears was 22.4+/-69.6 days. Six eyes healed within 2 weeks, but two eyes failed to heal after 1 month of treatment and two patients defaulted follow-up. No adverse effects were observed with the addition of autoserum tears. CONCLUSIONS The results of the current study correlated well with previous reported studies. Autologous serum tears may be considered as a valuable adjunct in the management of recalcitrant cases of PED.
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Affiliation(s)
- A L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.
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Abstract
PURPOSE To examine the safety and efficacy of a modified scleral fixated intraocular lens (SFIOL) technique combining a scleral tunnel for intraocular lens (IOL) insertion, horizontal passage of sutures, and performing anterior vitrectomy through self-sealing pars plana sclerostomies. METHODS Retrospective review of all patients who underwent SFIOL for aphakic correction at the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (a tertiary referral centre) between October 2000 and December 2001 with either the modified or conventional techniques. RESULTS A total of 20 eyes were identified. Eight modified (Group 1) and 12 conventional (Group 2) with a mean follow-up of 18.3 months. Postoperatively, all the eyes improved on unaided preoperative acuity and they all had a stable and well-positioned IOL. In all, 85% (7/8) of eyes in Group 1 maintained or improved best-corrected visual acuity. CONCLUSIONS The modified SFIOL technique was found to be as safe and effective as conventional techniques. The main advantages of this technique include easy intraoperative suture management and superior globe maintenance.
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Affiliation(s)
- A L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong, People's Republic of China.
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Abstract
BACKGROUND Pseudoexfoliation syndrome (PXS) is regarded as rare in people of Chinese ethnicity but the prevalence of this condition is not known. This epidemiology study was conducted to assess the prevalence of PXS in cataract patients and to report the clinical features present. METHODS Prospective descriptive study conducted in the period from March 1999 to May 2001 in ophthalmology departments in cluster hospitals serving a population of about 1.2 million. 500 consecutive patients aged 60 or above attending the general ophthalmic clinics with a presumed diagnosis of cataract were recruited. A detailed examination including biomicroscopy, intraocular measurement, and gonioscopy were performed on all patients. All positive PXS cases were documented photographically. RESULTS 500 patients were examined. They ranged from the ages of 60 to 91 years old, with a male to female ratio of 1:2. 40% suffered from hypertension while 24% were known diabetics. Only two positive cases (0.4%) of PXS were identified in the study population. 18% of all eyes were found to have narrow angles (defined as grade 0 to 2 by Shaffer grading). Nuclear sclerosis was the single most common type of lens opacity. CONCLUSION PXS is a rare condition in Chinese people. A prevalence rate of 0.4% in patients aged 60 or above was identified in this hospital based epidemiology study. To the best of our knowledge, this was the first study conducted in a Chinese population to examine the prevalence of PXS.
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Affiliation(s)
- A L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People's Republic of China.
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Young AL, Rao SK, Cheng LL, Wong AKK, Leung ATS, Lam DSC. Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience. Eye (Lond) 2002; 16:304-8. [PMID: 12032722 DOI: 10.1038/sj.eye.6700144] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [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: 11/08/2022] Open
Abstract
PURPOSE To report the mid-term results of a treatment strategy using topical steroids, intravenous pulse methyl prednisolone and oral cyclosporine A (CSA) for the treatment of acute corneal graft rejection. METHODS Noncomparative, interventional case series. Treatment of corneal graft rejection included 1% prednisolone eye drops, intravenous infusion of 500 mg methyl prednisolone, and oral CSA in two regimens--standard dose was 15 mg/kg/day for 2 days, 7.5 mg/kg/day for 2 days, then adjusted to maintain trough blood levels of 100-200 microg/l; low dose was 2 mg/kg/day with no loading dose. RESULTS Outcome in 34 eyes of 34 patients (21 M;13 F) aged 60 +/- 17.7 years (range 9-83 years), who presented after an average duration of 6.6 +/- 6.3 days (range 0-30 days) following acute corneal graft rejection, are reported. Twenty-five patients received standard dose CSA while nine patients received the low dose regimen. Mean duration of treatment before reversal of graft rejection was 13.6 +/- 12.1 days (range 3-54 days). Treatment was successful in reversing the graft rejection in 32/34 (94%) eyes. Irreversible graft failure occurred in one eye in each group. During a mean follow-up period of 19.2 +/- 16.7 months (range 1-55 months), further episodes of graft rejection were seen in 1/32 (3%) eyes. Complications due to treatment included: duodenal ulcer in one patient that responded to medical treatment, and transient elevation in serum creatinine levels in three patients, which returned to normal after decrease in dosage or cessation of oral CSA. CONCLUSION Our 5-year experience with the use of oral CSA in the treatment of acute corneal graft rejection has shown this treatment approach to be safe and effective in reversing the rejection process. This approach may also protect the graft from subsequent episodes of allograft rejection. A randomised controlled trial to further delineate the role of CSA in reversing acute graft rejection seems warranted.
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Affiliation(s)
- A L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
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Young AL, Carter WG, Doyle HA, Mamula MJ, Aswad DW. Structural integrity of histone H2B in vivo requires the activity of protein L-isoaspartate O-methyltransferase, a putative protein repair enzyme. J Biol Chem 2001; 276:37161-5. [PMID: 11479322 DOI: 10.1074/jbc.m106682200] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Protein L-isoaspartate O-methyltransferase (PIMT) is postulated to repair beta-aspartyl linkages (isoaspartyl (isoAsp)) that accumulate at certain Asp-Xaa and Asn-Xaa sites in association with protein aging and deamidation. To identify major targets of PIMT action we cultured rat PC12 cells with adenosine dialdehyde (AdOx), a methyltransferase inhibitor that promotes accumulation of isoAsp in vivo. Subcellular fractionation of AdOx-treated cells revealed marked accumulation of isoAsp in a 14-kDa nuclear protein. Gel electrophoresis and chromatography of nuclei (3)H-methylated in vitro by PIMT revealed this protein to be histone H2B. The isoAsp content of H2B in AdOx-treated cells was approximately 18 times that in control cells, although no isoAsp was seen in other core histones, regardless of treatment. To confirm the relevance and specificity of this effect, we measured isoAsp levels in histones from brains of PIMT knockout mice. IsoAsp was found at near stoichiometric levels in H2B extracted from knockout brains and was at least 80 times greater than that in H2B from normal mice. Little or no isoAsp was detected in H2A, H3, or H4 from mice of either genotype. Accumulation of isoAsp in histone H2B may disrupt normal gene regulation and contribute to the reduced life span that characterizes PIMT knockouts. In addition to disrupting protein function, isoAsp has been shown to trigger immunity against self-proteins. The propensity of H2B to generate isoAsp in vivo may help explain why this histone in particular is found as a major antigen in autoimmune diseases such as lupus erythematosus.
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Affiliation(s)
- A L Young
- Department of Molecular Biology and Biochemistry, University of California, Irvine, California 92697, USA
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Abstract
PURPOSE To evaluate the efficacy and safety of topical 2% lignocaine gel in providing analgesia during outpatient transpupillary or trans-scleral laser treatment of inflamed eyes. METHODS A prospective study was carried out of consecutive eligible eyes undergoing laser treatment using 2% lignocaine gel as a topical anaesthetic and a coupling medium. At the conclusion of each procedure, patients were asked to grade a pain score (0 = no discomfort, 1 = mild discomfort, 2 = mild pain, 3 = moderate pain, 4 = severe pain). RESULTS Twenty eyes in 19 patients received laser treatment. No pain was reported in 95% of cases treated (no discomfort in 75%, mild discomfort in 20%) and only mild pain in 5% (one patient). No adverse reactions were encountered in any of the patients. There were no complications associated with the procedures. CONCLUSIONS Lignocaine 2% gel is safe and effective for outpatient transpupillary and trans-scleral laser treatment in inflamed eyes, providing adequate analgesia and serving as a coupling medium at the same time.
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Affiliation(s)
- A K Kwok
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital.
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Young AL, Langston CS, Schiffman RL, Shortsleeve MJ. Mitral valve regurgitation causing right upper lobe pulmonary edema. Tex Heart Inst J 2001; 28:53-6. [PMID: 11330743 PMCID: PMC101132] [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: 02/19/2023]
Abstract
When radiography is performed in patients with mitral regurgitation, cardiogenic pulmonary edema is a typical finding; however, asymmetric pulmonary edema has also been reported. We describe the case of a patient in whom mitral valve regurgitation caused isolated pulmonary edema in the right upper lung. We include a discussion of pulmonary edema in conjunction with mitral regurgitation.
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Affiliation(s)
- A L Young
- Department of Radiology, Mount Auburn Hospital, A Harvard University Community Teaching Hospital, Cambridge, Massachusetts 02238, USA
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Ng JS, Fan DS, Young AL, Yip NK, Tam K, Kwok AK, Lam DS. Ocular hypertensive response to topical dexamethasone in children: a dose-dependent phenomenon. Ophthalmology 2000; 107:2097-100. [PMID: 11054340 DOI: 10.1016/s0161-6420(00)00357-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the ocular-hypertensive response to different dosages of topical dexamethasone eye drops in Chinese children. DESIGN Prospective, randomized clinical trial. PARTICIPANTS Thirty-one consecutive children undergoing bilateral strabismus surgery. INTERVENTION Topical dexamethasone (0.1%) was administered to children undergoing bilateral strabismus surgery. They were all less than 10 years of age. One eye was randomized to receive a regimen of four times daily, and another received a twice daily regimen. Intraocular pressure (IOP) was serially measured in the postoperative period for 4 weeks or more. Topical steroids were discontinued if IOP was 30 mmHg or more. MAIN OUTCOME MEASURES Intraocular pressure was measured on the day before the surgery, on postoperative days 1, 3, 5, 8, 12, 15, 22, 29, and 2 weeks thereafter until the IOP reached preoperative levels. Peak IOP, IOP net increase, and time to reach an IOP more than 20 mmHg in the two study groups were analyzed. RESULTS A total of 31 patients (20 male, 11 female) were examined. The mean age was 5.8 +/- 2.0 years (range, 2-10 years). Preoperative IOP in groups treated twice daily and four times daily were similar. After topical dexamethasone treatment, both groups showed a significant rise in peak IOP compared with preoperative values (twice daily, 25.2 +/- 6.8 mmHg vs. 14.3 +/- 2.4 mmHg, P < 0.001; four times daily, 28.7 +/- 6.9 mmHg vs. 14.3 +/- 2.9 mmHg, P < 0.001). The peak IOP was significantly higher in the four times daily group (P < 0.001), as was the net increase in IOP (twice daily, 10.9 +/- 5.8 mmHg vs. four times daily, 14.5 +/- 6.4 mmHg; P < 0.001). There was no difference in time for both groups to achieve the peak IOP, but the time to exceed its upper normal value (20 mmHg) was shorter in the four times daily group (twice daily, 12.3 +/- 9.1 days vs. four times daily, 10.0 +/- 7.4 days; P < 0.05). CONCLUSIONS In children treated with topical dexamethasone, ocular hypertension occurs in a dose-dependent manner. Children in the four times daily group had a quicker onset and more severe ocular hypertensive response than the twice daily group. Nevertheless, even the twice daily regimen produced significant IOP rise, suggesting that dexamethasone use in children should be avoided if possible, and it would be desirable to monitor the IOP twice weekly when it is administered to children.
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Affiliation(s)
- J S Ng
- Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong
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Abstract
A 38-year-old man sustained a left eye injury after being attacked by a mynah bird. Ocular examination revealed a beak-shaped, full-thickness corneal laceration with total aniridia in the left eye. No other ocular injury was observed, and the lens and posterior segment remained normal over the subsequent 3 months. A penetrating keratoplasty was planned for visual restoration.
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Affiliation(s)
- A L Young
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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Abstract
A 4-year-old boy with bilateral idiopathic and progressive ectopia lentis had phacoaspiration of the lens and capsular tension ring (CTR) insertion in his left eye. Postoperatively, lens capsule centration remained poor. Single-point scleral fixation of the CTR was performed and centration of the lens capsule achieved. In-the-capsule intraocular lens (IOL) implantation was tried, but excessive IOL manipulation sliced open the capsule at the equator. Anterior vitrectomy and scleral IOL fixation were required. A similar approach was adopted in the right eye with meticulous attention given to gentle maneuvers. The operation was uneventful, with good IOL centration. Three and 11 months after surgery in the right and left eye, respectively, best corrected visual acuity was 20/50 in both eyes. Scleral fixation of the CTR, accompanied by gentle IOL manipulation, is an option to improve IOL centration in patients with severe zonular deficiency.
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Affiliation(s)
- D S Lam
- Department of Ophthalmology & Visual Sciences, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Rao SK, Leung AT, Young AL, Fan DS, Lam DS. Is there a minimum endothelial cell count for a clear cornea after penetrating keratoplasty? Indian J Ophthalmol 2000; 48:71-2. [PMID: 11271943] [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: 02/19/2023] Open
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Lam DS, Young AL, Leung AT, Fan DS, Wong AK. Limbal stem cell allografting from related live donors for corneal surface reconstruction. Ophthalmology 2000; 107:411-2. [PMID: 10711872 DOI: 10.1016/s0161-6420(99)00110-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Lam DS, Young AL, Leung AT. Retinal detachment surgery in Marfan's syndrome. Retina 2000; 19:578-9. [PMID: 10606469 DOI: 10.1097/00006982-199919060-00025] [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: 11/26/2022]
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Abstract
PURPOSE To investigate a case of isolated pedunculated congenital corneal dermoid. METHODS Case report. RESULTS In a 14-day-old infant, the pedunculated portion of the dermoid was removed and confirmed by histopathologic examination. No surgical complication or recurrence was encountered, and the patient is waiting for a rotational autokeratoplasty. CONCLUSIONS Prompt treatment of such an unusual tumor is important to allow for visual rehabilitation and development.
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Affiliation(s)
- A T Leung
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
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Kwok AK, Young AL, Bhende P, Lam DS. Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia. Am J Ophthalmol 1999; 128:395-6. [PMID: 10511053 DOI: 10.1016/s0002-9394(99)00211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE This paper presents data on the efficacy of a diabetes day treatment program to modify the healthcare behavior of elderly African Americans with diabetes. METHODS African American patients with Type 1 or Type 2 diabetes who were referred by their certified diabetes educator were eligible to participate in the day treatment program. The program was designed to serve eight patients for 4 hours 1 day a week over 9 months. Participants engaged in informal discussions, low-impact armchair exercises, and discussions of various diabetes issues. A flow sheet was initiated and maintained by the investigators to record information pertaining to each participant's blood pressure, blood sugar, and weight at each session. Attendance and reasons for not attending sessions were recorded. To obtain more in-depth information, the group leaders used a technique known as participant observation. RESULTS Having CDEs administer a blood sugar test, take blood pressure, and weigh each patient at each clinic visit promotes patient adherence to the diabetes treatment regimen. Memory loss was observed to be especially prevalent among the subjects. CONCLUSIONS The Diabetes Day Treatment Program may be used as a model for working with elderly persons with diabetes from different ethnic groups.
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Affiliation(s)
- L E Hendricks
- LCHA's Diabetes Self-Management Skills Training Center, Wheaton, Maryland (Dr Hendricks and Ms Hendricks)
| | - R T Hendricks
- LCHA's Diabetes Self-Management Skills Training Center, Wheaton, Maryland (Dr Hendricks and Ms Hendricks)
| | - A L Young
- Ms Young is a dietitian from Manassas Park, Virginia
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