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O'Sullivan R, Cosgrave M, Butler A, Lyne JP. Characteristics of a later life population in a general adult community mental health service setting. Ir J Psychol Med 2023; 40:450-456. [PMID: 34130771 DOI: 10.1017/ipm.2021.46] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Globally, increasing life expectancy has escalated demands on psychiatric services caring for a later life population. It is recognised that those with enduring mental illness may have specific needs with advancing age. In this study, we describe the characteristics of a population aged over 60 years attending a general adult community psychiatric service and compare demographic and clinical features across age and diagnostic categories. The study aims to gather preliminary information which may guide future local mental health service planning. METHODS We conducted a cross-sectional observational study using retrospective chart review of all patients aged over 60 years attending four community mental health teams in North Dublin. Cohorts of attenders were stratified by age comparing 60-64 year age group with the population aged 65 years and over. Attenders were also stratified by diagnosis and regression analysis was used to determine predictors of psychotic disorder diagnosis. RESULTS The study included 127 patients. There was a higher prevalence of psychotic disorders among those aged 65 years and over (n = 73), while those aged 60-64 years (n = 54) were more likely to have depression and non-affective, non-psychotic disorders. Among the population aged 65 years and over 78% (n = 57) were long-term psychiatric service attenders. CONCLUSIONS The majority of the sample aged 65 years and over were long-term service attenders with a diagnosis of severe mental illness. Further research is warranted to determine optimal service delivery for later life psychiatric service attenders.
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Affiliation(s)
- R O'Sullivan
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
| | - M Cosgrave
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
| | - A Butler
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
| | - J P Lyne
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
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Marron A, O'Sullivan R, Leonard J, Kiernan D. The medium-term effects of selective dorsal rhizotomy on gait compared to a matched cerebral palsy non-SDR group: A follow-up study. Gait Posture 2023; 99:124-132. [PMID: 36413875 DOI: 10.1016/j.gaitpost.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) has been shown to improve gait in the short-term in children with cerebral palsy (CP). Further study is needed to look at the trajectory of outcomes over the longer-term. RESEARCH QUESTION What are the medium-term effects of SDR on gait compared to a matched CP non-SDR group? METHODS Participants underwent SDR at mean age 6.3 years and completed baseline, 1-year and 5-year follow-up gait analyses. Non-SDR participants were matched at baseline. Differences were assessed within and between groups. Kinematic variables were analysed using Statistical non-Parametric Mapping (SnPM). Other gait and clinical data were analysed using Friedman's one-way repeated measure analysis of variance and a Mann-Whitney U-test. RESULTS The initial SDR group consisted of 29 participants, reducing to 22 at 5-year follow-up. Of these, 15 (68 %) had orthopaedic surgeries either concurrent with or in the intervening period since the SDR, mean 3.3 procedures per participant. The initial non- SDR group had 18 participants, reducing to 17 at 5-year follow-up. Of these, 13 (76 %) had orthopaedic surgeries, mean 5.7 procedures. At 1-year follow-up the SDR group had significantly improved knee extension, ankle dorsiflexion, foot progression, Gait Deviation Index, and normalised step length compared to baseline, p < 0.05, and outcomes were maintained at 5-years. At 1-year follow-up the non-SDR group kinematic patterns were unchanged, but at 5-year follow-up this group demonstrated significantly improved knee extension, ankle dorsiflexion and foot progression. There were no significant kinematic differences between the SDR and the non-SDR group at medium-term follow-up. SIGNIFICANCE We have documented the trajectory of gait outcomes post-SDR over 3 assessments and found that short-term gait changes endured in the medium-term. However, kinematic changes were similar to a non-SDR group undergoing routine and orthopaedic care. These outcomes are important to guide surgical decision making and to manage treatment goals and expectations.
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Affiliation(s)
- A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - J Leonard
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Lewis R, Walsh J, Maddison K, McArdle N, Barnes M, Campbell M, Mansfield D, Sigston E, Wheatley J, O'Sullivan R, Kitipornchai L, MacKay S. Bilateral Hypoglossal Nerve Stimulation Improves Moderate to Severe Obstructive Sleep Apnoea in Participants With and Without Complete Concentric Collapse (BETTER SLEEP). Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Power JM, Holton E, Warters A, Simons R, Pertl M, O'Sullivan R, O'Philbin L, Lawlor B. 264 FREEDOM AND LONELINESS: SPOUSAL DEMENTIA CARE-GIVERS AND THE NURSING HOME TRANSITION. Age Ageing 2022. [PMCID: PMC9620372 DOI: 10.1093/ageing/afac218.232] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Many persons with dementia transition to nursing home care, but little is known about the impact, positive and negative, that this may have on the social isolation and loneliness of their spouse. Methods Using our existing theoretical synthesis of loneliness to provide sensitising concepts, we conducted a deductive grounded theory study of loneliness during the nursing home transitions. We recruited 11 spousal participants to engage in semi-structured remote interviews during 2021. Results Participants provided their own definitions of loneliness, and spoke about their life history of loneliness, the loneliness associated with living with a spouse with dementia, and the loneliness, and alleviation of loneliness through re-engagement with social contacts, associated with their spouse moving to the nursing home. Participants agreed with the idea that loneliness has a physical feeling. More distal parts of the theoretical synthesis, such as the influence that culture and gender have on loneliness, were not corroborated by the findings. Conclusion We conclude that loneliness is a frequent experience among spousal caregivers whose spouse has moved to nursing home care, but that loneliness is also associated with living with a spouse with dementia. Loneliness in this population was aggravated by the COVID-19 pandemic and associated lockdowns. Further research steps will involve more targeted interviewing to focus on the link between transitions and loneliness in this and in other populations.
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Affiliation(s)
- JM Power
- Maynooth University , Maynooth, Ireland
| | - E Holton
- Maynooth University , Maynooth, Ireland
| | - A Warters
- Health Service Executive , Dublin, Ireland
| | - R Simons
- Department of Health , Dublin, Ireland
| | | | - R O'Sullivan
- Institute of Public Health , Belfast, United Kingdom
| | - L O'Philbin
- Alzheimer Society of Ireland , Dublin, Ireland
| | - B Lawlor
- Trinity College Dublin , Dublin, Ireland
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Hackeng WM, Brosens LAA, Kim JY, O'Sullivan R, Sung YN, Liu TC, Cao D, Heayn M, Brosnan-Cashman J, An S, Morsink FHM, Heidsma CM, Valk GD, Vriens MR, Nieveen van Dijkum E, Offerhaus GJA, Dreijerink KMA, Zeh H, Zureikat AH, Hogg M, Lee K, Geller D, Marsh JW, Paniccia A, Ongchin M, Pingpank JF, Bahary N, Aijazi M, Brand R, Chennat J, Das R, Fasanella KE, Khalid A, McGrath K, Sarkaria S, Singh H, Slivka A, Nalesnik M, Han X, Nikiforova MN, Lawlor RT, Mafficini A, Rusev B, Corbo V, Luchini C, Bersani S, Pea A, Cingarlini S, Landoni L, Salvia R, Milione M, Milella M, Scarpa A, Hong SM, Heaphy CM, Singhi AD. Non-functional pancreatic neuroendocrine tumours: ATRX/DAXX and alternative lengthening of telomeres (ALT) are prognostically independent from ARX/PDX1 expression and tumour size. Gut 2022; 71:961-973. [PMID: 33849943 PMCID: PMC8511349 DOI: 10.1136/gutjnl-2020-322595] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Recent studies have found aristaless-related homeobox gene (ARX)/pancreatic and duodenal homeobox 1 (PDX1), alpha-thalassemia/mental retardation X-linked (ATRX)/death domain-associated protein (DAXX) and alternative lengthening of telomeres (ALT) to be promising prognostic biomarkers for non-functional pancreatic neuroendocrine tumours (NF-PanNETs). However, they have not been comprehensively evaluated, especially among small NF-PanNETs (≤2.0 cm). Moreover, their status in neuroendocrine tumours (NETs) from other sites remains unknown. DESIGN An international cohort of 1322 NETs was evaluated by immunolabelling for ARX/PDX1 and ATRX/DAXX, and telomere-specific fluorescence in situ hybridisation for ALT. This cohort included 561 primary NF-PanNETs, 107 NF-PanNET metastases and 654 primary, non-pancreatic non-functional NETs and NET metastases. The results were correlated with numerous clinicopathological features including relapse-free survival (RFS). RESULTS ATRX/DAXX loss and ALT were associated with several adverse prognostic findings and distant metastasis/recurrence (p<0.001). The 5-year RFS rates for patients with ATRX/DAXX-negative and ALT-positive NF-PanNETs were 40% and 42% as compared with 85% and 86% for wild-type NF-PanNETs (p<0.001 and p<0.001). Shorter 5-year RFS rates for ≤2.0 cm NF-PanNETs patients were also seen with ATRX/DAXX loss (65% vs 92%, p=0.003) and ALT (60% vs 93%, p<0.001). By multivariate analysis, ATRX/DAXX and ALT status were independent prognostic factors for RFS. Conversely, classifying NF-PanNETs by ARX/PDX1 expression did not independently correlate with RFS. Except for 4% of pulmonary carcinoids, ATRX/DAXX loss and ALT were only identified in primary (25% and 29%) and NF-PanNET metastases (62% and 71%). CONCLUSIONS ATRX/DAXX and ALT should be considered in the prognostic evaluation of NF-PanNETs including ≤2.0 cm tumours, and are highly specific for pancreatic origin among NET metastases of unknown primary.
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Affiliation(s)
- Wenzel M Hackeng
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joo Young Kim
- Department of Pathology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Roderick O'Sullivan
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - You-Na Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St, Louis, MO, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, St, Louis, MO, USA
| | - Michelle Heayn
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Soyeon An
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Folkert H M Morsink
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charlotte M Heidsma
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Gerlof D Valk
- Department of Endocrinology and Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Koen M A Dreijerink
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Endocrinology and Internal Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Herbert Zeh
- Department of Clinical Sciences, Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Amer H Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melissa Hogg
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Kenneth Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Wallis Marsh
- Department of Surgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James F Pingpank
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Nathan Bahary
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Muaz Aijazi
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Randall Brand
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Chennat
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rohit Das
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth E Fasanella
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Asif Khalid
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin McGrath
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Savreet Sarkaria
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Harkirat Singh
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adam Slivka
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Nalesnik
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoli Han
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rita Teresa Lawlor
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Andrea Mafficini
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Boris Rusev
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Vincenzo Corbo
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
- ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - Samantha Bersani
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Antonio Pea
- The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Sara Cingarlini
- The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
- The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Roberto Salvia
- ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
- The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Massimo Milione
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Michele Milella
- ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Aldo Scarpa
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
- ENETS Center of Excellence, University and Hospital Trust of Verona, Verona, Italy
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Christopher M Heaphy
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tetlow S, Segiet-Swiecicka A, O'Sullivan R, O'Halloran S, Kalb K, Brathwaite-Shirley C, Alger L, Ankuli A, Baig MS, Catmur F, Chan T, Dudley D, Fisher J, Iqbal MU, Puczynska J, Wilkins R, Bygate R, Roberts P. ACE inhibitors, angiotensin receptor blockers and endothelial injury in COVID-19. J Intern Med 2021; 289:688-699. [PMID: 33210357 PMCID: PMC7753609 DOI: 10.1111/joim.13202] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 is caused by the coronavirus SARS-CoV-2, which uses angiotensin-converting enzyme 2 (ACE-2) as a receptor for cellular entry. It is theorized that ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) may increase vulnerability to SARS-CoV-2 by upregulating ACE-2 expression, but ACE-I/ARB discontinuation is associated with clinical deterioration. OBJECTIVE To determine whether ACE-I and ARB use is associated with acute kidney injury (AKI), macrovascular thrombosis and in-hospital mortality. METHODS A retrospective, single-centre study of 558 hospital inpatients with confirmed COVID-19 admitted from 1 March to 30 April 2020, followed up until 24 May 2020. AKI and macrovascular thrombosis were primary end-points, and in-hospital mortality was a secondary end-point. RESULTS AKI occurred in 126 (23.1%) patients, 34 (6.1%) developed macrovascular thrombi, and 200 (35.9%) died. Overlap propensity score-weighted analysis showed no significant effect of ACE-I/ARB use on the risk of occurrence of the specified end-points. On exploratory analysis, severe chronic kidney disease (CKD) increases odds of macrovascular thrombi (OR: 8.237, 95% CI: 1.689-40.181, P = 0.009). The risk of AKI increased with advancing age (OR: 1.028, 95% CI: 1.011-1.044, P = 0.001) and diabetes (OR: 1.675, 95% CI: 1.065-2.633, P = 0.025). Immunosuppression was associated with lower risk of AKI (OR: 0.160, 95% CI: 0.029-0.886, P = 0.036). Advancing age, dependence on care, male gender and eGFR < 60 mL min-1 /1.73 m2 increased odds of in-hospital mortality. CONCLUSION We did not identify an association between ACE-I/ARB use and AKI, macrovascular thrombi or mortality. This supports the recommendations of the European and American Societies of Cardiology that ACE-Is and ARBs should not be discontinued during the COVID-19 pandemic.
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Affiliation(s)
- S Tetlow
- From the, Department of Acute Medicine, University College Hospital, Bloomsbury, London, UK
| | - A Segiet-Swiecicka
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warszawa, Poland.,Department of Coronary Artery Disease and Cardiac Rehabilitation, Cardinal Stefan Wyszynski Institute of Cardiology, Warszawa, Poland
| | - R O'Sullivan
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - S O'Halloran
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - K Kalb
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | | | - L Alger
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - A Ankuli
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - M S Baig
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - F Catmur
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - T Chan
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - D Dudley
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - J Fisher
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - M U Iqbal
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - J Puczynska
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - R Wilkins
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - R Bygate
- Department of Acute Medicine, Newham University Hospital NHS Trust, Newham University Hospital, London, UK
| | - P Roberts
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
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O'Sullivan R, Marron A, Brady K. Crouch gait or flexed-knee gait in cerebral palsy: Is there a difference? A systematic review. Gait Posture 2020; 82:153-160. [PMID: 32927222 DOI: 10.1016/j.gaitpost.2020.09.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Crouch or flexed-knee gait is one of the most common pathological gait patterns in cerebral palsy (CP). Differences exist in definitions used; the degree of knee flexion, inclusion of hip or ankle position, and timing in the gait cycle. This ambiguity may be responsible for variations in prevalence rates and difficulty comparing data across studies. RESEARCH QUESTION What are the kinematic parameters used to define crouch or flexed-knee gait in CP gait? A secondary aim was to examine the quality of data reporting, focusing on the sample characteristics, inclusion/exclusion criteria and the choice of limb included for analysis. METHODS Articles included in this review reported on a specified cohort of adults or children with crouch or flexed-knee gait assessed with 3-dimensional gait analysis. A customised data extraction and quality assessment table was designed specific to the research question. RESULTS The majority (75 %) of included studies used the term crouch gait. Where the pattern was defined, 80 % of crouch papers and 94 % of flexed-knee gait papers based this solely on knee position. Kinematic parameters were clearly defined when they provided objective values of knee flexion, supported this with rationale and provided a reference point in the gait cycle. Only 22 % of crouch papers and 19 % of flexed-knee gait papers provided this information. The majority of studies (67 % crouch; 90 % flexed-knee) specified which limb(s) were included for analysis with the majority including both limbs. Objective values of knee flexion ranged from 8 o to 30 o. SIGNIFICANCE This review highlights that crouch and flexed knee are synonymous and ambiguity exists in the kinematic definition making it difficult to make compare data amongst study cohorts. Future research should provide detailed definitions including the threshold value of knee flexion, how it was derived, the timing in the gait cycle and the limb(s) included in analysis.
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Affiliation(s)
- R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - K Brady
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Marron A, O'Sullivan R, Kelly E, Kiernan D. Tibial rotation outcomes following hamstring lengthening as part of single event multilevel surgery in children with cerebral palsy. Gait Posture 2020; 79:126-132. [PMID: 32408035 DOI: 10.1016/j.gaitpost.2020.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/03/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hamstring lengthening remains the most common surgical procedure in the treatment of crouch gait for children with cerebral palsy (CP). While sagittal plane knee kinematics have been shown to improve post-surgery, the effects on transverse plane kinematics have not been reported. Given the differing actions of the medial and lateral hamstring muscles there is potential for change in tibial rotation post hamstring lengthening. RESEARCH QUESTION What is the effect of medial only versus combined medial and lateral hamstring lengthening on tibial rotation during gait in children with CP? METHODS A retrospective analysis of children with a diagnosis of CP who underwent a hamstring lengthening procedure. These children were divided into 2 groups: G1 (n = 18) had isolated medial hamstring lengthening while G2 (n = 30) had combined medial and lateral hamstring lengthening. A matched non-surgical control group (n = 15) was also included. Kinematic data were analysed pre and post-operatively. Pre-operative to post-operative outcomes for G1 and G2, a comparison at baseline for both groups and the difference in outcomes between the groups were analysed. Baseline to follow-up outcomes for the control group were also analysed. RESULTS External tibial rotation increased significantly within groups (G1: -10°, p < 0.01; G2: -11°, p < 0.001, control: -7.7, p < 0.01), with no significant difference in the change between the intervention groups. Foot progression angles became more external in both intervention groups (G1: -15°, p < 0.001; G2: -15°, p < 0.0001) and did not change in the control group. SIGNIFICANCE Results demonstrated similar increases in external tibial rotation, regardless of whether an isolated medial or combined medial and lateral surgery was performed. The control group demonstrated a similar change in external tibial rotation suggesting that hamstring lengthening surgery does not contribute to increased external tibial rotation in children with CP compared to what would be expected due to natural progression.
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Affiliation(s)
- A Marron
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - E Kelly
- Children's Health Ireland at Temple Street, Temple Street, Dublin 1, Ireland
| | - D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Ibrahim H, O'Sullivan R, Casey D, Murphy J, MacSharry J, Plant BJ, Murphy DM. The effectiveness of Reslizumab in severe asthma treatment: a real-world experience. Respir Res 2019; 20:289. [PMID: 31861993 PMCID: PMC6923853 DOI: 10.1186/s12931-019-1251-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background Increased numbers of blood and sputum eosinophils are associated with higher exacerbation frequency and increased asthma severity. In clinical trials, targeting Interleukin-5 has been shown to be a useful therapeutic strategy for patients with severe eosinophilic asthma. Methods Twenty-six patients have been commenced on Reslizumab in our institution since early 2017. Safety and clinical efficacy parameters were recorded at regular intervals. Results Mean ACQ-6 score at the start of treatment was 3.5. The average number of exacerbations in the year preceding treatment was 8.3 per person. 30% of patients had been admitted to hospital at least once over the 12 months preceding therapy. 54% of our patients were on long term oral steroid. Our data showed sustained improvement of Asthma control (Mean improvement in ACQ-6 was 1.7 at 1 year, and 2.0 at 2 years, P = 0.0001). Of the patients who were on long term systemic steroids, 35.7% discontinued steroids completely, with a mean reduction of prednisolone dose of 5.2 mg at 1 year. There was a 79% reduction in the annual exacerbation frequency at 1 year, and 88% at 2 years (P = < 0.0001). Modest, albeit statistically significant increases in creatine kinase which seemed to plateau by 1 year were noted. Conclusions Overall, Reslizumab was well tolerated with discontinuation of treatment due to side effects recorded in only one patient. Our data confirm the utility of anti-IL5 therapy in a carefully selected phenotype of severe asthma with evidence of eosinophilic airway inflammation.
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Affiliation(s)
- H Ibrahim
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - R O'Sullivan
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - D Casey
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J MacSharry
- The Schools of Medicine and Microbiology, University College Cork, Cork, Ireland
| | - B J Plant
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The HRB funded Clinical Research Facility, University College Cork, Cork, Ireland
| | - D M Murphy
- The Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland. .,The HRB funded Clinical Research Facility, University College Cork, Cork, Ireland.
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10
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Kelly M, Sahm L, McCarthy S, O'Sullivan R, Mc Gillicuddy A, Shiely F. Randomised controlled trial of an intervention to improve parental knowledge and management practices of fever. BMC Pediatr 2019; 19:447. [PMID: 31739785 PMCID: PMC6863059 DOI: 10.1186/s12887-019-1808-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/28/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We know that parents require resources which can assist them to improve fever knowledge and management practices. The purpose of this study, using an RCT, was to examine the effectiveness of an information leaflet at increasing parental knowledge of fever, specifically temperature definition. METHODS A prospective, multi-centre, randomised, two-parallel arm, controlled trial with blinded outcome ascertainment was conducted. Parents presenting at purposively selected healthcare facilities who had a child aged ≤5 years of age were invited to participate. An information leaflet for use in the trial was designed based on previous studies with parents. Parents in the intervention arm read an information leaflet on fever and management of fever in children, completed a short questionnaire at Time 1 (T1) and again 2 weeks after randomisation at Time 2 (T2). Parents in the control arm did not receive the fever information leaflet but completed the same questionnaire as the intervention arm at T1 and againat T2. The primary outcome was the correct definition of fever (higher than ≥38 °C). RESULTS A total of 100 parents participated in the study at T1. A greater proportion of the intervention group (76%) than the control group (28%) selected the correct temperature (≥38 °C) at T1. 76% of the intervention arm correctly identified "higher than ≥38°C" as the temperature at which a fever is said to be present compared to 28% of the control arm. After 2 weeks, there was an increase of 6% of parents in the intervention arm (increase to 82.4%) who gave the correct temperature compared to just a 2.8% increase in the control arm (increase to 30.8%). Univariate logistic regression showed that parents in the intervention arm were significantly more likely to give the correct answer at both time-points (T1: OR 8.1; CI 95% 3.3-19.9: p < 0.01; T2: OR 10.5; CI 95% 3.4-32.0: p < 0.01). CONCLUSIONS Our RCT of this simple educational intervention has been shown to improve parental understanding of fever knowledge and correct management strategies. Education interventions providing simple, clear information is a key step to decreasing parental mismanagement of fever and febrile illness in children. TRIAL REGISTRATION ClinicalTrials.gov NCT02903342, September 16, 2016, Retrospectively registered.
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Affiliation(s)
- M Kelly
- Pharmaceutical Care Research Group, School of Pharmacy, University College, Cork, Ireland
- Trials Research and Methodologies Group (TRAMS), HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland
| | - L Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College, Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - S McCarthy
- Pharmaceutical Care Research Group, School of Pharmacy, University College, Cork, Ireland
- Department of Pharmacy, Cork University Hospital, Cork, Ireland
| | - R O'Sullivan
- School of Medicine, University College Cork, Cork, Ireland
- National Children's Research Centre, Dublin, 12, Ireland
| | - A Mc Gillicuddy
- Pharmaceutical Care Research Group, School of Pharmacy, University College, Cork, Ireland
| | - F Shiely
- Trials Research and Methodologies Group (TRAMS), HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
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11
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Kiernan D, O'Sullivan R. The influence of crouch gait on sagittal trunk position and lower lumbar spinal loading in children with cerebral palsy. Gait Posture 2019; 67:65-70. [PMID: 30290367 DOI: 10.1016/j.gaitpost.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/14/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Crouch gait is a common pattern in children with CP. Little investigation has been performed as to the role of the trunk during crouch gait. A compensatory movement of the trunk may alter the position of the ground reaction force with the effect of reducing the moment arm about the knee or hip. While this may benefit these joints in the context of reduced loading, there may be implications further up the kinematic chain at the level of the lumbar spine. RESEARCH QUESTION Are compensatory movements of the trunk present during crouch gait in children with CP and are levels of loading at the lower lumbar spine affected? METHODS A full barefoot lower limb and trunk 3-dimensional kinematic and kinetic analysis, with kinetics estimated at the spinal position of L5/S1, was performed on 3 groups of children, namely CP Crouch, CP No-Crouch and TD. Differences in trunk position and L5/S1 loading were compared between groups. RESULTS Mean trunk position in relation to the pelvis and laboratory was not statistically significant between groups. At the level of the spine, no differences were present in mean position between groups for L5/S1 sagittal moment or anterior/posterior force. SIGNIFICANCE Crouch gait does not elicit a compensatory response of the trunk in children with CP and, consequently, reactive forces and moments at the lower lumbar spine remain within normal limits. With this in mind, it is unlikely that a crouch gait pattern will affect the health of the spine over time in these children.
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Affiliation(s)
- D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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12
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McNevin C, McDowell R, Fitzpatrick F, O'Sullivan R, Wakai A. The Prevalence of Severe Sepsis or Septic Shock in an Irish Emergency Department. Ir Med J 2018; 111:692. [PMID: 29952441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Severe sepsis and septic shock are among the leading causes of death globally. Despite the central role the emergency department (ED) plays in the early identification of patients presenting to hospital with sepsis, the prevalence of severe sepsis and septic shock in the Irish ED setting has not been described. The primary aim of this study was to measure the prevalence of severe sepsis or septic shock in an Irish adult ED setting. The clinical records of patients presenting to the ED over a four-week period were retrospectively reviewed to determine if they met the current Health Service Executive (HSE) criteria for severe sepsis or septic shock. Overall, 3,585 adult patients attended the ED during the study period, with 42 patients meeting the criteria for severe sepsis or septic shock. The ED prevalence of severe sepsis or septic shock was 11.7 patients (95% CI 8.1 - 15.4%) per 1000 ED attendances.
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Affiliation(s)
- C McNevin
- Medical School, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - R McDowell
- RCSI Department of General Practice, Division of Population Health Sciences (PHS), Dublin 2, Ireland
| | - F Fitzpatrick
- Department of Clinical Microbiology, RCSI Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
- Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
| | - R O'Sullivan
- School of Medicine, University College Cork, Cork
- Bon Secours Hospital, Cork
| | - A Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Ireland
- Emergency Care Research Unit (ECRU), RCSI Department of General Practice, 123 St Stephens Green, Dublin 2, Ireland
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13
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Quirke M, Ayoub F, McCabe A, Boland F, Smith B, O'Sullivan R, Wakai A. Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis. Br J Dermatol 2017; 177:382-394. [DOI: 10.1111/bjd.15186] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/03/2023]
Affiliation(s)
- M. Quirke
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
| | - F. Ayoub
- Department of Surgery; Beaumont Hospital; Dublin Ireland
| | - A. McCabe
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
| | - F. Boland
- Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); Dublin Ireland
| | - B. Smith
- RCSI Library; Beaumont Hospital; Dublin Ireland
| | - R. O'Sullivan
- Paediatric Emergency Care Research Unit (PERU); National Children's Research Centre; Dublin Ireland
- School of Medicine; University College Cork; Cork Ireland
| | - A. Wakai
- Emergency Care Research Unit (ECRU); Division of Population Health Sciences (PHS); Royal College of Surgeons in Ireland (RCSI); 123 St Stephens Green Dublin 2 Ireland
- Department of Emergency Medicine; Beaumont Hospital; Dublin Ireland
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14
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Braganza A, Li J, Zeng X, Yates NA, Dey NB, Andrews J, Clark J, Zamani L, Wang XH, St Croix C, O'Sullivan R, Garcia-Exposito L, Brodsky JL, Sobol RW. UBE3B Is a Calmodulin-regulated, Mitochondrion-associated E3 Ubiquitin Ligase. J Biol Chem 2016; 292:2470-2484. [PMID: 28003368 DOI: 10.1074/jbc.m116.766824] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 11/08/2016] [Indexed: 11/06/2022] Open
Abstract
Recent genome-wide studies found that patients with hypotonia, developmental delay, intellectual disability, congenital anomalies, characteristic facial dysmorphic features, and low cholesterol levels suffer from Kaufman oculocerebrofacial syndrome (KOS, also reported as blepharophimosis-ptosis-intellectual disability syndrome). The primary cause of KOS is autosomal recessive mutations in the gene UBE3B However, to date, there are no studies that have determined the cellular or enzymatic function of UBE3B. Here, we report that UBE3B is a mitochondrion-associated protein with homologous to the E6-AP Cterminus (HECT) E3 ubiquitin ligase activity. Mutating the catalytic cysteine (C1036A) or deleting the entire HECT domain (amino acids 758-1068) results in loss of UBE3B's ubiquitylation activity. Knockdown of UBE3B in human cells induces changes in mitochondrial morphology and physiology, a decrease in mitochondrial volume, and a severe suppression of cellular proliferation. We also discovered that UBE3B interacts with calmodulin via its N-terminal isoleucine-glutamine (IQ) motif. Deletion of the IQ motif (amino acids 29-58) results in loss of calmodulin binding and a significant increase in the in vitro ubiquitylation activity of UBE3B. In addition, we found that changes in calcium levels in vitro disrupt the calmodulin-UBE3B interaction. These studies demonstrate that UBE3B is an E3 ubiquitin ligase and reveal that the enzyme is regulated by calmodulin. Furthermore, the modulation of UBE3B via calmodulin and calcium implicates a role for calcium signaling in mitochondrial protein ubiquitylation, protein turnover, and disease.
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Affiliation(s)
- Andrea Braganza
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261.,the Hillman Cancer Center, University of Pittsburgh Cancer Institute
| | - Jianfeng Li
- the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
| | - Xuemei Zeng
- Biomedical Mass Spectrometry Center, School of the Health Sciences, and
| | - Nathan A Yates
- the Hillman Cancer Center, University of Pittsburgh Cancer Institute.,Biomedical Mass Spectrometry Center, School of the Health Sciences, and.,the Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, and
| | - Nupur B Dey
- the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
| | - Joel Andrews
- the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
| | - Jennifer Clark
- the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
| | - Leila Zamani
- the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
| | - Xiao-Hong Wang
- the Hillman Cancer Center, University of Pittsburgh Cancer Institute
| | - Claudette St Croix
- Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213
| | - Roderick O'Sullivan
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261.,the Hillman Cancer Center, University of Pittsburgh Cancer Institute
| | - Laura Garcia-Exposito
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261.,the Hillman Cancer Center, University of Pittsburgh Cancer Institute
| | - Jeffrey L Brodsky
- the Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15260
| | - Robert W Sobol
- From the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, .,the Hillman Cancer Center, University of Pittsburgh Cancer Institute.,the Department of Oncologic Sciences, Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama 36604
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15
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O'Caoimh R, Cornally N, Svendrovski A, Weathers E, FitzGerald C, Healy E, O'Connell E, O'Keeffe G, O'Herlihy E, Gao Y, O'Donnell R, O'Sullivan R, Leahy-Warren P, Orfila F, Paúl C, Clarnette R, Molloy DW. Measuring the Effect of Carers on Patients' Risk of Adverse Healthcare Outcomes Using the Caregiver Network Score. J Frailty Aging 2016; 5:104-10. [PMID: 27224501 DOI: 10.14283/jfa.2016.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. OBJECTIVE To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one ("can manage") to five ("absent/liability"). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. DESIGN Observational cohort study. SETTING AND PARTICIPANTS Community-dwelling adults, aged >65, attending health centres in Ireland, (n=779). PROCEDURE AND MEASUREMENTS: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). RESULTS The majority of patients had a primary caregiver (582/779; 75%), most often their child (200/582; 34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%, p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. CONCLUSION This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.
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Affiliation(s)
- R O'Caoimh
- Dr Rónán O'Caoimh, , Telephone: +353214901461, Facsimile: +3534901635
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16
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O’Caoimh R, Sweeney C, Hynes H, McGlade C, Cornally N, Daly E, Weathers E, Coffey A, FitzGerald C, Healy E, O’Connell E, O’Keeffe G, O'Sullivan R, Timmons S, Foley T, Creed E, Hynes M, Twomey A, Sammon M, Cullen D, Mullan E, Orfila F, Paúl C, Clarnette R, Campbell S, Lupari M, McCarthy S, Sahm L, Byrne S, O’Leary C, O'Shea S, O’Donoghue J, McAdoo J, Kearney P, Galvin P, O’Byrne-Maguire I, Browne J, Kenny R, O’Herlihy E, O’Toole P, McFarlane A, Deery M, Bond R, Martin J, Shorten G, Molloy W. COLLaboration on AGEing-COLLAGE: Ireland's three star reference site for the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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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17
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O'Sullivan R, O'Brien T. Idiopathic Toe Walking: A Gait Laboratory Review. Ir Med J 2015; 108:214-216. [PMID: 26349353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Idiopathic toe walking (ITW) is defined as one who is neurologically normal but demonstrates a preference for walking on the toes. It is a diagnosis of exclusion so differential diagnoses such as cerebral palsy, neuropathy or myopathy must be ruled out. A review of 102 patients attending a gait laboratory with a presumptive diagnosis of ITW found that gait analysis data agreed with this diagnosis in 81 (79.4%) of cases while the remaining 21 (20.6%) were not typical of this diagnosis. The features found to be significantly different between the groups were Babinski response, fast stretch of the gastrocnemius, knee flexion at initial contact and asymmetry at the ankles during gait. This study highlights that clinical gait analysis can be a useful, non-invasive means of diagnosing idiopathic toe walking and recommending appropriate intervention based on clinical and dynamic assessment of calf tightness.
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18
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Quirke M, Saunders J, O'Sullivan R, Milenkovski H, Wakai A. A pilot cross-sectional study of patients presenting with cellulitis to emergency departments. Ir Med J 2014; 107:316-318. [PMID: 25556256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To characterise the Emergency Department (ED) prevalence of cellulitis, factors predicting oral antibiotic therapy and the utility of the Clinical Resource Efficiency Support Team (CREST) guideline in predicting patient management in the ED setting, a prospective, cross-sectional study of consecutive adult patients presenting to 3 Irish EDs was performed. The overall prevalence of cellulitis was 12 per 1,000 ED visits. Of 59 patients enrolled, 45.8% were discharged. Predictors of treatment with oral antibiotics were: CREST, Class 1 allocation (odds ratio (OR) 6.81, 95% Cl =1.5-30.1, p=0.012), patient self-referral (OR= 6.2, 95% Cl 1.9- 20.0, p=0.03) and symptom duration longer than 48 hours (OR 1.2, 95% Cl = 1.0-1.5,p=0.049). In conflict with guideline recommendation, 43% of patients in CREST Class 1 received IV therapy. Treatment with oral antibiotics was predicted by CREST Class 1 allocation, self-referral, symptom duration of more than 48 hours and absence of pre-EO antibiotic therapy.
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Affiliation(s)
- M Quirke
- Emergency Care Research Unit, Division of Population Health Sciences, RCSI, 123 St Stephens Green, Dublin
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19
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Morris I, Lyttle MD, O'Sullivan R, Sargant N, Doull IJM, Powell CVE. Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland? Thorax 2014; 70:88-91. [PMID: 25303945 DOI: 10.1136/thoraxjnl-2014-206041] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
During a prospective 10-week assessment period, 3238 children aged 1-16 years presented with acute wheeze to Paediatric Emergency Research in the UK and Ireland centres. 110 (3.3%) received intravenous bronchodilators. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered. When used sequentially the most common order was salbutamol, then MgSO4, then aminophylline. Overall, 30 different intravenous treatment regimens were used varying in drugs, dose, rate and duration.
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Affiliation(s)
- I Morris
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - M D Lyttle
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK Academic Department of Emergency Care, University of the West of England, Bristol, UK
| | - R O'Sullivan
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - N Sargant
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - I J M Doull
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - C V E Powell
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK Institute of Molecular and Experimental Medicine, Cardiff University, School of Medicine, Cardiff, UK
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20
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Kiernan D, Walsh M, O'Sullivan R, O'Brien T, Simms CK. The influence of estimated body segment parameters on predicted joint kinetics during diplegic cerebral palsy gait. J Biomech 2013; 47:284-8. [PMID: 24200337 DOI: 10.1016/j.jbiomech.2013.10.024] [Citation(s) in RCA: 16] [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: 07/30/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 11/25/2022]
Abstract
Inverse Dynamic calculations are routinely used in joint moment and power estimates during gait with anthropometric data often taken from published sources. Many biomechanical analyses have highlighted the need to obtain subject-specific anthropometric data (e.g. Mass, Centre of Mass, Moments of Inertia) yet the types of imaging techniques required to achieve this are not always available in the clinical setting. Differences in anthropometric sets have been shown to affect the reactive force and moment calculations in normal subjects but the effect on a paediatric diplegic cerebral palsy group has not been investigated. The aim of this study was to investigate the effect of using different anthropometric sets on predicted sagittal plane moments during normal and diplegic cerebral palsy gait. Three published anthropometric sets were applied to the reactive force and moment calculations of 14 Cerebral Palsy and 14 Control subjects. Statistically significant differences were found when comparing the different anthropometric sets but variability in the resulting sagittal plane moment calculations between sets was low (0.01-0.07 Nm/kg). In addition, the GDI-Kinetic, used as an outcome variable to assess whether differences were clinically meaningful, indicated no clinically meaningful difference between sets. The results suggest that the effects of using different anthropometric sets on the kinetic profiles of normal and diplegic cerebral palsy subjects are clinically insignificant.
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Affiliation(s)
- D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland; Trinity Centre for Bioengineering, Parsons Building, Trinity College Dublin, Dublin 2, Ireland.
| | - M Walsh
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - T O'Brien
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
| | - C K Simms
- Trinity Centre for Bioengineering, Parsons Building, Trinity College Dublin, Dublin 2, Ireland
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21
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Samuji M, O'Sullivan R, Shireen R. Uterine sarcoma after tamoxifen therapy for breast cancer. Ir Med J 2013; 106:246. [PMID: 24282897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tamoxifen has been shown to significantly reduce the risk of tumour recurrence in women with receptor positive breast cancer and has been used for chemoprevention in women with both non-invasive cancer and those with a high risk of developing breast cancer. An established and accepted risk with this treatment is the increased incidence of adenocarcinoma of the endometrium. Less well recognised is uterine sarcoma, a rare and aggressive tumour accounting for under five percent of uterine malignancies, with five year survival rates in the order of 50%.
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Affiliation(s)
- Mat Samuji
- Department of Radiation Oncology, Cork University Hospital, Wilton, Cork.
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22
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O'Sullivan R, Kiernan D, Walsh M, Brien TO. The difficulty identifying intoeing gait in cerebral palsy. Ir Med J 2013; 106:144-145. [PMID: 23914575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In-toeing in children with cerebral palsy can lead to functional difficulties during gait. This may require surgical management to restore a normal foot progression angle. For this reason it is important to indentify the presence of internal rotation and to establish where the abnormal rotation is occurring. This can be done relatively easily in otherwise healthy subjects by examining foot progression angle as the subject walks towards the assessor. In cerebral palsy the often severely affected gait pattern and potential asymmetry at the pelvis means that in-toeing may be more difficult to identify. Gait laboratory data of 245 subjects with cerebral palsy were studied retrospectively. Of these 102 (41.63%) demonstrated in-toeing relative to the pelvis of one or both limbs. Eleven diplegic subjects (16.18%) in-toed bilaterally giving a total of 113 in-toeing limbs for analysis. Of those, 17 (50%) hemiplegic limbs and 20 (25.32%) diplegic limbs demonstrated a foot progression angle within normal limits due to compensations at the pelvis.
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Affiliation(s)
- R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Vernon Ave, Clontarf, Dublin 3.
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Hackett I, O'Sullivan R, Zaid AA, Rea D, Walsh S. Acute cerebellitis associated with dual influenza A (H1N1) and B infection. Ir Med J 2013; 106:87-88. [PMID: 23951981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We describe the case of a 6-year old girl who presented to our Emergency Department (ED) with acute onset of ataxia and speech disturbance. Investigative workup included a nasopharyngeal aspirate (NPA) which was influenza A (H1N1) and B positive during the 2010/2011 influenza season. Magnetic resonance imaging (MRI) of the brain confirmed findings consistent with cerebellitis.
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Affiliation(s)
- I Hackett
- Paediatric Emergency Research Unit (PERU), Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12
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McCabe A, Staunton P, Walsh S, O'Sullivan R. Must we review printed lab reports without checking them? A prospective analysis of emergency department practice. Ir Med J 2012; 105:113-114. [PMID: 22708224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study investigated if results of haematology and biochemistry laboratory tests, carried out at the point of care in our Emergency Department, are checked by the clinician who ordered the test, mitigating the requirement to check printed reports later. Five hundred and nineteen (519) laboratory reports were examined for significant abnormal results and documentation in clinical notes. Thirty percent (30%, n = 158) of these met the inclusion criteria for 'significantly abnormal' laboratory results. Of the 158 significantly abnormal results, 34.8% (n = 55) were not documented in the ED clinical case notes. No patient was discharged inappropriately. Our study suggests it is safe to stop routinely rechecking printed biochemistry and haematology laboratory reports in our department.
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Affiliation(s)
- A McCabe
- Department of Paediatric Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12
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25
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26
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Morgan D, Prendiville W, O'Sullivan R. A Laparoscopic Surgical Skills Program Utilising a ‘Take-Home’ Laparoscopic Simulator. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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O'Sullivan R, McMenamin M. Changing Patterns of Gynaecological Surgical Workloads in Dublin over 20 Years. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.351] [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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28
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Wang Y, Wluka AE, Hodge AM, English DR, Giles GG, O'Sullivan R, Cicuttini FM. Effect of fatty acids on bone marrow lesions and knee cartilage in healthy, middle-aged subjects without clinical knee osteoarthritis. Osteoarthritis Cartilage 2008; 16:579-83. [PMID: 17937997 DOI: 10.1016/j.joca.2007.09.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 09/02/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There is evidence that omega-3 polyunsaturated fatty acids alleviate the progression of osteoarthritis (OA). However, little work has been done to investigate the effect of fatty acids on bone marrow lesions and knee cartilage in healthy subjects. We examined this in a cohort of healthy middle-aged subjects without clinical knee OA. METHODS Two hundred and ninety-three healthy adults without knee pain or injury were recruited from an existing community-based cohort. Intakes of fatty acids and food sources of these were estimated from a food frequency questionnaire at baseline. Tibial cartilage volume, tibial plateau bone area, tibiofemoral cartilage defects and bone marrow lesions were assessed approximately 10 years later using magnetic resonance imaging. RESULTS In multivariate analyses, higher intakes of monounsaturated fatty acids (OR=2.14, 95% CI 1.04-4.39, P=0.04), total (OR=1.77, 95% CI 1.13-2.77, P=0.01) and n-6 polyunsaturated fatty acids (OR=1.69, 95% CI 1.10-2.61, P=0.02) were associated with an increased risk of bone marrow lesions. Intake of fatty acids was not significantly associated with cartilage volume or cartilage defects. CONCLUSION These findings support the dietary recommendation towards a shift to foods rich in n-3 polyunsaturated fatty acids in order to maintain an optimal balance between dietary n-3 and n-6 polyunsaturated fatty acids, which is also important in the prevention of atherosclerosis. Although our findings will need to be confirmed in longitudinal studies, they suggest the potential of fatty acids to adversely effect the knee joint.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
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Racunica TL, Szramka M, Wluka AE, Wang Y, English DR, Giles GG, O'Sullivan R, Cicuttini FM. A positive association of smoking and articular knee joint cartilage in healthy people. Osteoarthritis Cartilage 2007; 15:587-90. [PMID: 17291790 DOI: 10.1016/j.joca.2006.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 12/23/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether smoking affects knee cartilage in healthy adults by examining the association of tobacco use with tibial cartilage volume and tibiofemoral cartilage defects. METHODS Two hundred and ninety-seven healthy adult subjects were recruited from an existing cohort examining healthy aging, the Melbourne Collaborative Cohort Study (MCCS). Questionnaire data were obtained at recruitment to the MCCS in 1990-1994 and at magnetic resonance imaging to determine cartilage outcomes in 2003. RESULTS Tibial cartilage volume was positively associated with subjects who ever smoked as well as pack-years smoked, suggesting a dose-response. There was no association between smoking and presence of tibiofemoral cartilage defects. CONCLUSION Our findings demonstrate that smoking is associated with increased tibial cartilage volume but not presence of tibiofemoral cartilage defects, providing further support for a beneficial effect on articular knee cartilage.
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Affiliation(s)
- T L Racunica
- Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria 3004, Australia
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O'Sullivan R, Walsh M, Jenkinson A, O'Brien T. Factors associated with pelvic retraction during gait in cerebral palsy. Gait Posture 2007; 25:425-31. [PMID: 16806934 DOI: 10.1016/j.gaitpost.2006.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 05/09/2006] [Accepted: 05/14/2006] [Indexed: 02/02/2023]
Abstract
Clinical and dynamic (gait-related) measures thought to be associated with pelvic retraction were investigated in patients with cerebral palsy. Gait laboratory data of 233 patients with cerebral palsy were studied retrospectively. Two groups were selected; those who demonstrated pelvic retraction during gait <-6.85 degrees (mean - 2 standard deviations from normal (n=88) and those with >-4.83 degrees (mean - 1 standard deviation from normal) (n=101). About 37.8% of the total population reviewed showed pelvic retraction of <-6.85 degrees . There was a higher prevalence of retraction among hemiplegics (46.3%) compared to diplegics (30.4%). Differences were also found between hemiplegic and diplegic subjects in terms of factors associated with pelvic retraction. Clinical and dynamic tightness of the gastro-soleus were the most significant features associated with pelvic retraction among hemiplegic subjects. Clinical and dynamic flexion and internal rotation of the hip were the most significant features associated with retraction in the diplegic population. This study suggests that pelvic retraction is multifactorial in origin and secondary to both static clinical measures as well as dynamic features during gait.
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Affiliation(s)
- R O'Sullivan
- Gait Laboratory, Central Remedial Clinic, Vernon Avenue, Clontarf, Dublin 11, Ireland
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31
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Hanna FS, Bell RJ, Davis SR, Wluka AE, Teichtahl AJ, O'Sullivan R, Cicuttini FM. Factors affecting patella cartilage and bone in middle-aged women. ACTA ACUST UNITED AC 2007; 57:272-8. [PMID: 17330276 DOI: 10.1002/art.22535] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the effects of age, physical activity, and body mass index (BMI) on patella cartilage volume and defects and bone volume in middle-aged women without knee pain. METHODS Magnetic resonance imaging was performed in 176 healthy women, ages 40-67 years, without knee pain to measure patella cartilage and bone volume and patella cartilage defects. The effects of age, physical activity, BMI, smoking, and alcohol were analyzed to determine whether associations existed between these variables and patella cartilage and bone volume and cartilage defects. RESULTS Patella cartilage volume decreased with age (P = 0.01) and BMI (P = 0.05) after adjusting for age and patella bone volume. Patella bone volume was positively associated with body height in both the univariate and multivariate models. Cartilage defects in the patellofemoral compartment were present in 36.4% of the study population. Age, weight, and BMI were positively associated with the presence of cartilage defects in the multivariate analysis. CONCLUSION This study demonstrated that although age is positively associated with both patella bone volume and cartilage defects, it is inversely associated with patella cartilage volume in healthy individuals. Moreover, BMI is inversely associated with both patella cartilage volume and patella bone volume in middle-aged women without knee osteoarthritis. Longitudinal studies will be required to determine whether avoiding a high BMI will reduce the risk of developing patellofemoral osteoarthritis.
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Affiliation(s)
- F S Hanna
- Monash University Medical School, Alfred Hospital, Prahran, Victoria, Australia
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Hanna F, Ebeling PR, Wang Y, O'Sullivan R, Davis S, Wluka AE, Cicuttini FM. Factors influencing longitudinal change in knee cartilage volume measured from magnetic resonance imaging in healthy men. Ann Rheum Dis 2005; 64:1038-42. [PMID: 15640270 PMCID: PMC1755566 DOI: 10.1136/ard.2004.029355] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [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
OBJECTIVE To determine whether the amount of joint cartilage in healthy, middle aged men is stable or changes over time, and what factors may influence this. METHODS In a cohort study, 28 healthy men (70% of the original cohort; mean (SD) age, 51.9 (12.8) years) had baseline knee magnetic resonance imaging (MRI) of their dominant knee and repeat MRI of the same knee approximately 2.0 years later. Knee cartilage volume was measured at baseline and follow up. Risk factors assessed at baseline, including sex hormones and metabolic bone markers, were tested for their association with change in knee cartilage volume over time. RESULTS Mean (SD) reduction in tibial cartilage volume per year was 162 (93) microl. This represented a 2.8% reduction in total tibial articular cartilage per year (95% confidence interval, 0.2% to 5.5%). Tibial cartilage loss was associated with serum free testosterone level, independently of age, body mass index, baseline tibial cartilage volume tibial plateau area, and total bone mineral content. Overall, testosterone accounted for 14.5% (partial r2) of the variation in change in tibial cartilage volume. There was a trend towards a positive association between tibial cartilage loss and urinary N-telopeptide cross-links of type I collagen (Ntx) (p = 0.057). CONCLUSIONS Further studies will be required to determine whether hormonal manipulation or treatment with antiresorptive drugs will reduce the risk of knee osteoarthritis in men in later life.
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Affiliation(s)
- F Hanna
- Department of Epidemiology and Preventive Medicine, Monash University - Central and Eastern Clinical School, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia
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Abstract
The values for 'mild', 'moderate' and 'severe' urinary incontinence have not been determined for the 24-hour pad test. To define these values, a prospective observational study was performed on 110 women with the primary symptom of urinary incontinence. Consenting women performed two 1-hour pad tests one week apart, and seven 24-hour pad tests for seven consecutive days. The 1-hour pad test definitions for mild, moderate and severe were translated to centiles, and used to categorise the 24-hour test values. This revealed that the range for 'mild incontinence' was between 1.3 and 20 g, 'moderate incontinence' ranged from 21 to 74 g, and 'severe incontinence' was defined as 75 g or more in 24 hours. Severity of leakage was analysed in relation to urodynamic diagnosis, age, parity and pelvic floor muscle strength. Increasing severity was associated with increasing age and parity. Women with detrusor overactivity were most likely to have severe leakage. In conclusion, this study defines the three grades of severity for the 24-hour pad test, which may help to guide patients' choice between conservative and surgical treatment and is useful for stratified randomisation of controlled trial participants.
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Affiliation(s)
- R O'Sullivan
- The Pelvic Floor Unit, St George Hospital, Kogarah, Sydney, New South Wales, Australia
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34
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Karantanis E, Allen W, Stevermuer TL, Simons AM, O'Sullivan R, Moore KH. The repeatability of the 24-hour pad test. Int Urogynecol J 2004; 16:63-8; discussion 68. [PMID: 15647965 DOI: 10.1007/s00192-004-1199-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 06/01/2004] [Indexed: 12/18/2022]
Abstract
A prospective observational study was conducted in a tertiary urogynaecology unit in women with the primary symptom of urinary incontinence to assess the repeatability of the 24-hour pad test. One hundred and eight women undertook seven 24-hour pad tests over 7 consecutive days together with 7 simultaneous fluid and activity charts. The results were analysed collectively and according to urodynamic subsets. Repeatability was assessed by repeated measures analysis of variance and univariate analysis of variance for each urodynamic diagnosis group (USI, mixed and no USI). Variation between pad test weights over the 7 days was low, supporting good repeatability. The number of days of pad testing required to approximate the 7-day average was 3 days. However, a single 24-hour pad test correlated highly with the 7-day average (r=0.881) and was considered sufficient to gauge leakage severity.
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Affiliation(s)
- E Karantanis
- The Pelvic Floor Unit, Department of Obstetrics and Gynaecology, Level 1, Clinical Sciences Building, The St. George Hospital, University of NSW, 2217, Kogarah, NSW, Australia
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Abstract
Ladder fall injuries are associated with a wide spectrum of injury patterns. However, the healthcare cost of these injuries is unknown. The aim of this study was to determine the healthcare cost and duration of the morbidity associated with ladder fall injuries. A retrospective observational study involving patients with ladder injuries who presented to a Level 1 Trauma Centre over a 3-year period was performed. Patients then underwent a structured telephone interview to provide information about the duration of their disability and unemployment. There were 72 patients in the study, of whom 89% were male. Thirteen patients (18%) required hospital admission. The median length and cost of hospital stay was 1 week and 3555 (US$ 3950), respectively. The median duration of disability and unemployment was 6 weeks. The longest duration of disability was associated with foot fractures. The majority of patients fell between 5 and 10ft, and fell at work. The upper extremity was the most commonly injured anatomical region. There were no fatalities. Ladder injury falls are expensive to the health service and may warrant investment in their prevention.
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Affiliation(s)
- J O'Sullivan
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
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36
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García-Cao M, O'Sullivan R, Peters AHFM, Jenuwein T, Blasco MA. Epigenetic regulation of telomere length in mammalian cells by the Suv39h1 and Suv39h2 histone methyltransferases. Nat Genet 2003; 36:94-9. [PMID: 14702045 DOI: 10.1038/ng1278] [Citation(s) in RCA: 393] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Accepted: 11/17/2003] [Indexed: 11/08/2022]
Abstract
Telomeres are capping structures at the ends of eukaryotic chromosomes composed of TTAGGG repeats bound to an array of specialized proteins. Telomeres are heterochromatic regions. Yeast and flies with defects in activities that modify the state of chromatin also have abnormal telomere function, but the putative role of chromatin-modifying activities in regulating telomeres in mammals is unknown. Here we report on telomere length and function in mice null with respect to both the histone methyltransferases (HMTases) Suv39h1 and Suv39h2 (called SUV39DN mice). Suv39h1 and Suv39h2 govern methylation of histone H3 Lys9 (H3-Lys9) in heterochromatic regions. We show that primary cells derived from SUV39DN mice have abnormally long telomeres relative to wild-type controls. Using chromatin immunoprecipitation (ChIP) analysis, we found that telomeres were enriched in di- and trimethylated H3-Lys9 but that telomeres of SUV39DN cells had less dimethylated and trimethylated H3-Lys9 but more monomethylated H3-Lys9. Concomitant with the decrease in H3-Lys9 methylation, telomeres in SUV39DN cells had reduced binding of the chromobox proteins Cbx1, Cbx3 and Cbx5, homologs of Drosophila melanogaster heterochromatin protein 1 (HP1). These findings indicate substantial changes in the state of telomeric heterochromatin in SUV39DN cells, which are associated with abnormal telomere elongation. Taken together, the results indicate epigenetic regulation of telomere length in mammals by Suv39h1 and Suv39h2.
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Affiliation(s)
- Marta García-Cao
- Molecular Oncology Program, Spanish National Cancer Centre (CNIO), E-28029 Madrid, Spain
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O'Sullivan R, Simons A, Prashar S, Anderson P, Louey M, Moore KH. Is objective cure of mild undifferentiated incontinence more readily achieved than that of moderate incontinence? Costs and 2-year outcome. Int Urogynecol J 2003; 14:193-8; discussion 198. [PMID: 12955342 DOI: 10.1007/s00192-003-1062-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 10/02/2002] [Accepted: 02/21/2003] [Indexed: 11/27/2022]
Abstract
Because the prognostic value of 1-h pad testing has received scant attention, we tested the hypothesis that mild incontinence of any etiology is more readily cured than moderate incontinence. A consecutive series of 150 patients with mild (2-9.9 g) to moderate (10-49.9 g) incontinence (as judged by weight gain on 1-h pad testing) [1] attending a urogynecology unit were recruited, of whom 145 completed all baseline objective measures: 110 completed 12 weeks of conservative therapy, with follow-up data at 2 years available for 51 subjects. At 12 weeks 81% of 'mild' patients became 'dry' on the 1-h pad test versus 36.8% in the moderate group (chi2<0.0001). Interestingly the post-treatment changes seen in all other outcomes demonstrated equally positive responses for the mild and moderate groups. At 2-year follow-up 29/71 (40.8%) of patients with mild incontinence and 22/74 (29.7%) of patients with moderate incontinence were satisfied and had no requirement for further therapy, the remainder having sought other treatments (chi2=1.963 P=0.161). Of the responders, (11/29) (37.9%) of mildly incontinent patients and (8/22 (36.4%)) of moderately affected subjects remained continent (on 20-point incontinence score < or =2 m, chi2=0.013, P=0.9087). Improvements in quality of life persisted to an equal degree in both groups.
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Affiliation(s)
- R O'Sullivan
- The Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
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Karantanis E, O'Sullivan R, Moore KH. The 24-hour pad test in continent women and men: normal values and cyclical alterations. BJOG 2003; 110:567-71. [PMID: 12798473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To obtain control values for the 24-hour pad test in a wide age range of continent women using accurate weighing scales and to compare the results obtained from pantyliners and pads in women and men. DESIGN Prospective anonymous study. SETTING A Sydney Tertiary Urogynaecology Unit. POPULATION One hundred and forty continent women and 14 continent men. METHODS A 24-hour pad test was performed in 120 continent women of widely varying ages, in whom hormonal status and exercise habits were documented. These continent women wore a standardised pantyliner for 24 hours and a high precision beam balance (accuracy 0.1 g) was used to measure the loss on the pad. To assess any variation in pad weights with differing pads, 20 female volunteers undertook the 24-hour test firstly with pantyliners then larger pads. To understand evaporative qualities of the two types of pads, one male wore each type of pad, instilled with 5 mL normal saline for eight hours overnight. Furthermore, to understand the contribution of vaginal secretions, a group of male volunteers performed a 24-hour test with pantyliners followed by pads. MAIN OUTCOMES MEASURES Pad weight, with regard to hormonal status, exercise, pad type and gender. The median age of subjects was 48 (interquartile range [IQR] 32-60), with a median pad weight gain of 0.3 g (IQR 0.2-0.6; 95th centile 1.3 g). Subgroup analysis showed no significant trends for pad loss in relation to menopause status, use of hormone replacement therapy or hormonal contraception and exercise status during the 24-hour period. Control values for pantyliners were not significantly different from those for continence pads. In addition, normal values in 14 males showed similar results, regardless of pad type. CONCLUSIONS The response rate of 39% might limit the applicability of the results. However, our finding that women lose only 0.3 g of vaginal secretions in 24 hours is much lower than previously reported. This might arise from the use of a highly accurate beam balance and the recruitment of a large sample of women with widely varying ages. This result might lower the threshold for objective diagnosis of urinary incontinence and alters the pad test definition of 'cure'.
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Affiliation(s)
- E Karantanis
- Pelvic Floor Unit, St George Hospital, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVES To understand the factors that influence joint cartilage in health and disease as they are important for the prevention and management of osteoarthritis. METHODS We conducted a cross-sectional study to determine factors influencing knee cartilage volume in 45 males aged (mean+/-S.D.) 52.5+/-13.2 yr. RESULTS Total and medial tibial volumes were inversely associated with age, body mass index (BMI) and amount of physical activity and positively associated with total bone content. BMI explained the largest amount of the variation in tibial cartilage volume (18.7%). There were similar findings at the lateral tibial cartilage, but for age and total bone content this did not reach statistical significance. There was a positive association with serum testosterone at all tibial cartilage sites, but this only reached statistical significance for medial tibial cartilage, where serum testosterone explained up to 8% of the variation in cartilage volume. CONCLUSIONS Modifiable risk factors of osteoarthritis also appear to be significant determinants of tibial cartilage volume. Serum testosterone may provide one possible explanation for gender differences in tibial cartilage volume and prevalence of tibiofemoral osteoarthritis. The proposed link between osteoarthritis and knee cartilage volume and the effect of testosterone will need to be confirmed in longitudinal studies.
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Affiliation(s)
- F M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Alfred Hospital, Prahran 3181, Australia.
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Hegarty PK, Tan B, O'Sullivan R, Cronin CC, Brady MP. Prevention of postsplenectomy sepsis: how much do patients know? Hematol J 2002; 1:357-9. [PMID: 11920213 DOI: 10.1038/sj.thj.6200056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2000] [Accepted: 04/19/2000] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Asplenia causes a deficiency in immunity with a long-term risk of fulminant infection, associated with significant mortality. Patient compliance requires an understanding of risks of infection and its prevention. The impact of patient education has been little studied. MATERIALS AND METHODS To ascertain the degree of knowledge held by patients who have undergone splenectomy, a comprehensive survey was designed. This also aimed to determine which group of health professionals was most successful in conveying information to patients. Patients who had undergone total splenectomy were interviewed by telephone, using a standardised list of questions to assess their understanding of the post-operation risks. RESULTS Of 40 consecutive patients, 32.5% had a good knowledge of the risks of asplenia and their prevention, 52.5% had a fair knowledge and 15% a poor knowledge. Haematologists were most successful in initially conveying information to patients, and general practitioners also played a critical role in patient education. In this survey, it appears that surgeons were not effective at educating patients. CONCLUSION Patient education postsplenectomy is poor. Measures to prevent infection in the asplenic patient are not being adequately implemented.
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Affiliation(s)
- P K Hegarty
- Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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Jacobi CA, Bonjer HJ, Puttick MI, O'Sullivan R, Lee SW, Schwalbach P, Tomita H, Kim ZG, Hewett P, Wittich P, Fleshman JW, Paraskeva P, Gessman T, Neuhaus SJ, Wildbrett P, Reymond MA, Gutt C, Whelan RI. Oncologic implications of laparoscopic and open surgery. Surg Endosc 2002; 16:441-5. [PMID: 11928024 DOI: 10.1007/s00464-001-8112-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2001] [Accepted: 01/24/2001] [Indexed: 10/28/2022]
Abstract
Although instrumental manipulation and mechanical tumor cell spillage seem to play the major role in port-site metastases from laparoscopic cancer surgery, minimally invasive procedures are used more and more in the resection of malignancies. However, port-site metastases also have been reported after resection of colon cancer in International Union Against Cancer (UICC) stage I [2, 14]. Therefore, changes in the peritoneal environment during laparoscopy also might influence intra- and extraperitoneal tumor growth during laparoscopy and pneumoperitoneum. Different results of experimental studies presented at the Third International Conference for Laparoscopic Surgery are analyzed and discussed.
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Affiliation(s)
- C A Jacobi
- Surgical Department, University of Berlin, Charité, Schumannstar. 20 / 21, D-10098 Berlin, Germany
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Keane J, O'Sullivan R, Field D, Crowley N, Windle M, Namara CM. Talon cusps: a review. J Ir Dent Assoc 1998; 43:86-8. [PMID: 9584760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J Keane
- Eastern Regional Orthodontic Department, St. James's Hospital, Dublin
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44
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Fava M, Davidson K, Alpert JE, Nierenberg AA, Worthington J, O'Sullivan R, Rosenbaum JF. Hostility changes following antidepressant treatment: relationship to stress and negative thinking. J Psychiatr Res 1996; 30:459-67. [PMID: 9023789 DOI: 10.1016/s0022-3956(96)00034-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is unclear whether changes in hostility following treatment are primarily related to improvement in depressive symptoms or are also closely associated with reductions in negative thinking or perceived stress. We evaluated 94 outpatients with major depression before and after eight weeks of fluoxetine treatment by administering the Symptom Questionnaire (SQ) Hostility Scale, the Hamilton Rating Scale for Depression (HAM-D), the Cognitions Questionnaire (CQ) and the Perceived Stress Scale (PSS). We observed significant elevations in scores on these questionnaires in depressed patients as compared to normal controls. Following treatment with fluoxetine, there was a statistically significant reduction in scores on all four questionnaires. We observed that changes in SQ Hostility were significantly positively related to changes in both depression severity and perceived stress, with these relationships remaining significant after adjusting for gender and baseline SQ Hostility. The relationship between SQ Hostility changes and reductions in negative thinking became significant only after adjusting for gender and baseline SQ hostility. Our results suggest that the marked decrease in hostility following antidepressant treatment is related to a reduction in depressive symptoms, stress levels and negative thinking.
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Affiliation(s)
- M Fava
- Depression Research Program, Massachusetts General Hospital, Boston, USA
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45
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Alpert JE, Maddocks A, Nierenberg AA, O'Sullivan R, Pava JA, Worthington JJ, Biederman J, Rosenbaum JF, Fava M. Attention deficit hyperactivity disorder in childhood among adults with major depression. Psychiatry Res 1996; 62:213-9. [PMID: 8804131 DOI: 10.1016/0165-1781(96)02912-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The prevalence of attention deficit hyperactivity disorder (ADHD) with childhood onset and its relationship to course and treatment outcome of major depressive disorder (MDD) in adults was studied in 116 patients (ages 18-65) consecutively enrolled for treatment of MDD. Sixteen percent of the patient were found to meet full or subthreshold criteria for the DSM-III-R diagnosis of childhood ADHD. Twelve percent endorsed persistence of ADHD symptoms into adulthood. Depressed adults meeting criteria for childhood ADHD did not differ significantly from other depressed adults on any measures related to the chronicity or severity of the mood disorder, Axis I comorbidity, or response to acute antidepressant treatment. Our results are clinically important as they suggest that clinicians need to be aware of the possibility that a substantial proportion of patients with MDD may suffer from comorbid ADHD and that treatments need to include the targeting of possible residual ADHD symptoms in addition to those of depression.
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Affiliation(s)
- J E Alpert
- Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA
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46
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Abstract
"Anger attacks" are outbursts of anger which are accompanied by intense autonomic arousal and are clearly inappropriate to the situation in which they occur. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 164 consecutive patients (78 men and 86 women; mean age, 40.5 +/- 11.0 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. These patients were treated openly with fluoxetine, 20 mg/day for 8 weeks, and the prevalence of anger attacks was assessed before and after treatment. At baseline, 64 (39%) (26 men and 38 women) of these patients reported having anger attacks according to our criteria. Forty-one (64%) of the 64 depressed patients with anger attacks at baseline did not report anger attacks following fluoxetine treatment, while 7 (7%) of the 100 patients who did not have anger attacks at baseline reported these attacks following treatment, with this difference being statistically significant (chi 2 = 22.7, p < .0005).
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Affiliation(s)
- M Fava
- Depression Research Program, Massachusetts General Hospital, Boston 02114, USA
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47
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Pyman BC, Seldon HL, O'Sullivan R, Tillner WD, Donnelly M, Scott M, Mack KF, Clark GM. Assessment of intracochlear ossification by three-dimensional reconstruction of computerized scans. Ann Otol Rhinol Laryngol Suppl 1995; 166:79-83. [PMID: 7668766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B C Pyman
- Human Communication Research Centre, University of Melbourne, Australia
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48
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Abstract
We present a case of a vascular anomaly with Dieulafoy's disease in a young man. The diagnosis was made by coeliac and selective left gastric angiography after endoscopy, laparotomy and angiography had failed to detect the lesion. The patient was treated successfully by laparotomy and resection of the bleeding area in the stomach. This is the second report of a vascular anomaly with Dieulafoy's disease.
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Affiliation(s)
- P A Grace
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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49
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Satorre J, Antle CM, O'Sullivan R, White VA, Nugent RA, Rootman J. Orbital lesions with granulomatous inflammation. Can J Ophthalmol 1991; 26:174-95. [PMID: 1889019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Orbital lesions characterized by granulomatous inflammation are a heterogeneous group of diseases of various causes with a common histopathological substrate involving aggregates of epithelioid cells. Forty-one patients (27 females and 14 males) with biopsy-proven granulomatous inflammation were seen at an orbital clinic between 1978 and 1989. The mean age at presentation was 40.2 (extremes 6 and 77) years. Two main clinical presentations were noted: painless, subacute or chronic mass effect, and tender, subacute inflammatory process. Six patients had secondary features that were infiltrative in character. The lesions were primarily located in the anterior superior orbit. In nearly half the patients the granulomatous reaction was confined to the orbit (predominantly ruptured dermoid and localized orbital sarcoid), and the remainder had either regional involvement (Wegener's granulomatosis or fibro-osseous process) or systemic involvement (sarcoidosis).
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Affiliation(s)
- J Satorre
- Department of Ophthalmology, Vancouver General Hospital, BC
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Baxter MA, Barnard M, Sandler LM, O'Sullivan R, Joplin GF. Hyperprolactinaemia. BMJ 1989; 298:118. [PMID: 2493286 PMCID: PMC1835385 DOI: 10.1136/bmj.298.6666.118] [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: 01/01/2023]
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