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Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One 2022; 17:e0263595. [PMID: 35653330 PMCID: PMC9162376 DOI: 10.1371/journal.pone.0263595] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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A Comparison of Differentiated Thyroid Cancer Presenting in the UK Versus Internationally. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spiral T1 Spin-Echo for Routine Postcontrast Brain MRI Exams: A Multicenter Multireader Clinical Evaluation. AJNR Am J Neuroradiol 2020; 41:238-245. [PMID: 32029467 DOI: 10.3174/ajnr.a6409] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Spiral MR imaging has several advantages compared with Cartesian MR imaging that can be leveraged for added clinical value. A multicenter multireader study was designed to compare spiral with standard-of-care Cartesian postcontrast structural brain MR imaging on the basis of relative performance in 10 metrics of image quality, artifact prevalence, and diagnostic benefit. MATERIALS AND METHODS Seven clinical sites acquired 88 total subjects. For each subject, sites acquired 2 postcontrast MR imaging scans: a spiral 2D T1 spin-echo, and 1 of 4 routine Cartesian 2D T1 spin-echo/TSE scans (fully sampled spin-echo at 3T, 1.5T, partial Fourier, TSE). The spiral acquisition matched the Cartesian scan for scan time, geometry, and contrast. Nine neuroradiologists independently reviewed each subject, with the matching pair of spiral and Cartesian scans compared side-by-side, and scored on 10 image-quality metrics (5-point Likert scale) focused on intracranial assessment. The Wilcoxon signed rank test evaluated relative performance of spiral versus Cartesian, while the Kruskal-Wallis test assessed interprotocol differences. RESULTS Spiral was superior to Cartesian in 7 of 10 metrics (flow artifact mitigation, SNR, GM/WM contrast, image sharpness, lesion conspicuity, preference for diagnosing abnormal enhancement, and overall intracranial image quality), comparable in 1 of 10 metrics (motion artifacts), and inferior in 2 of 10 metrics (susceptibility artifacts, overall extracranial image quality) related to magnetic susceptibility (P < .05). Interprotocol comparison confirmed relatively higher SNR and GM/WM contrast for partial Fourier and TSE protocol groups, respectively (P < .05). CONCLUSIONS Spiral 2D T1 spin-echo for routine structural brain MR imaging is feasible in the clinic with conventional scanners and was preferred by neuroradiologists for overall postcontrast intracranial evaluation.
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The Role of Niacin in Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Niacin remains a therapeutic option for patients with cardiovascular disease, but recent studies have called into question the effectiveness of other HDL-C-raising drugs. We evaluated the evidence supporting current FDA-approved uses of niacin in cardiovascular prevention settings.
Methods
The systematic review included clinical trials involving niacin as a treatment for cardiovascular disease. The meta-analysis included randomized clinical trials reporting niacin’s effect on at least one long-term outcome: cardiovascular disease, coronary heart disease mortality, acute coronary syndrome, stroke, revascularization, major adverse cardiac events (MACE). Databases were searched up to October 2017. Study-level data were extracted and inverse-variance weighted methods were used to produce pooled risk ratios using random-effects models for between-study heterogeneity. Meta-regression analysis was used to assess the association between change in HDL-C and the log risk ratio of the pooled results.
Results
Out of 119 clinical trials, 17 documented niacin’s effect on at least one cardiovascular disease outcome. The meta-analysis covered 35,760 patients with history of cardiovascular disease or dyslipidemia. Cumulative evidence found no preventive effect of niacin on cardiovascular outcomes in secondary prevention. Stratified meta-analysis showed an association between niacin monotherapy and reduction of some cardiovascular events (acute coronary events, RR 0.74, 95%CI 0.58-0.96; stroke, RR 0.74, 95%CI 0.59-0.94; revascularization, RR 0.51, 95%CI 0.37-0.72). These results were mainly driven by two trials conducted in the 1970s and 1980s.
Conclusions
Niacin might have some use in lipid control for secondary prevention as monotherapy, perhaps in patients intolerant to statins, but evidence is from older studies on a population potentially not representative of current-day patients.
Key messages
Niacin might have some use for cardiovascular secondary prevention in patients intolerant to statins, but evidence is from older studies on a population not representative of current-day patients. The FDA has to review the approved indications for Niacin in cardiovascular secondary prevention.
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Erfassung körperlicher Aktivität mittels Akzelerometrie – Möglichkeiten und Grenzen aus technischer Sicht. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1387721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Erfassung körperlicher Aktivität mittels Akzelerometrie – Möglichkeiten und Grenzen aus technischer Sicht. BEWEGUNGSTHERAPIE UND GESUNDHEITSSPORT 2014. [DOI: 10.1055/s-0033-1361577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Towards optimized MR thermometry of the human heart at 3T. NMR IN BIOMEDICINE 2012; 25:35-43. [PMID: 21732459 DOI: 10.1002/nbm.1709] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 12/14/2010] [Accepted: 02/15/2011] [Indexed: 05/31/2023]
Abstract
Catheter ablation using radio frequency (RF) has been used increasingly for the treatment of cardiac arrhythmias and may be combined with proton resonance frequency shift (PRFS) -based MR thermometry to determine the therapy endpoint. We evaluated the suitability of two different MR thermometry sequences (TFE and TFE-EPI) and three blood suppression techniques. Experiments were performed without heating, using an optimized imaging protocol including navigator respiratory compensation, cardiac triggering, and image processing for the compensation of motion and susceptibility artefacts. Blood suppression performance and its effect on temperature stability were evaluated in the ventricular septum of eight healthy volunteers using multislice double inversion recovery (MDIR), motion sensitized driven equilibrium (MSDE), and inflow saturation by saturation slabs (IS). It was shown that blood suppression during MR thermometry improves the contrast-to-noise ratio (CNR), the robustness of the applied motion correction algorithm as well as the temperature stability. A gradient echo sequence accelerated by an EPI readout and parallel imaging (SENSE) and using inflow saturation blood suppression was shown to achieve the best results. Temperature stabilities of 2 °C or better in the ventricular septum with a spatial resolution of 3.5 × 3.5 × 8mm(3) and a temporal resolution corresponding to the heart rate of the volunteer, were observed. Our results indicate that blood suppression improves the temperature stability when performing cardiac MR thermometry. The proposed MR thermometry protocol, which optimizes temperature stability in the ventricular septum, represents a step towards PRFS-based MR thermometry of the heart at 3 T.
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Simultaneous T1 measurements and proton resonance frequency shift based thermometry using variable flip angles. Magn Reson Med 2011; 67:457-63. [DOI: 10.1002/mrm.22987] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 03/30/2011] [Accepted: 04/08/2011] [Indexed: 11/11/2022]
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REALISIERUNG EINES LASER-VIBROMETERSYSTEMS ZUR BERÜHRUNGSLOSEN IN VIVO BESTIMMUNG DES INTRAOKULARDRUCKS. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.2001.46.s1.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Online correction of respiratory-induced field disturbances for continuous MR-thermometry in the breast. Magn Reson Med 2009; 61:1494-9. [DOI: 10.1002/mrm.21954] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
AIMS We piloted a motivational and solution-focused therapy group intervention to improve glycaemic control in young people 11-17 years with poorly controlled Type 1 diabetes (mean annual HbA1c >8.5%). METHODS Seventy-seven subjects agreed to be assessed for a pilot non-randomized controlled trial. Subjects completed psychological questionnaires and were given feedback designed to encourage entry into the intervention. Twenty-one young people opted to enter the intervention groups (cases). Two intervention groups consisting of five to six subjects were conducted in each age band 10-13 years and 14-17 years. Twenty of those who did not opt to join the groups were randomly selected to act as controls. Cases and controls were well matched for age, HbA1c, duration of diabetes and socio-economic status. RESULTS The intervention produced a significant improvement of 1.5% in HbA1c in cases (P<0.05) at 4-6 months post intervention compared with no change in controls. This improvement was partly maintained at 7-12 months post intervention. CONCLUSIONS These pilot data suggest that a motivational/solution-focused group intervention is promising in improving HbA1c in adolescents and should be investigated further in a randomized controlled trial.
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[Device for vibration stimulation of the eye in noninvasive tonometry]. BIOMED ENG-BIOMED TE 2003; 47 Suppl 1 Pt 1:181-3. [PMID: 12451810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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CIRCULATION ESTIMATICS FROM CORNEAL PULSE AMPLITUDE MEASUREMENTS. BIOMED ENG-BIOMED TE 2003. [DOI: 10.1515/bmte.2003.48.s1.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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VERFAHREN ZUR SCHWINGUNGSANREGUNG DES AUGES FÜR DIE BERÜHRUNGSLOSE TONOMETRIE. BIOMED ENG-BIOMED TE 2002. [DOI: 10.1515/bmte.2002.47.s1a.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
FAVOR is the name for a family of superabsorbent cross-linked sodium polyacrylate polymers developed by Stockhausen GmbH & Co KG (Krefeld, Germany) that are known for their ability to absorb and retain large volumes of fluid. The absorption, distribution, rates and routes of excretion of radiolabeled FAVOR PAC (CAS Registry No. 9003-04-7; [14C]FAVOR PAC), one member of the FAVOR family, were evaluated following a single oral administration of the compound. Male Sprague-Dawley rats were administered single doses of 26 to 39 mg/kg [14C]FAVOR PAC by gavage. Approximately 98.8% (normalized mean) of the total administered dose was excreted in the feces within 5 days, and the majority ( approximately 88%) was excreted within the first 24 h. Urinary excretion accounted for 0.69% (normalized mean) of the total administered dose. Recovery of radioactivity in the organs, tissues, and carcass was generally less than 0.5% of the dose administered. Levels of total radioactivity in whole blood ranged from 0.75 to 1.20 microg equiv/g. Biliary elimination of total radioactivity accounted for less than 0.1% of the dose administered. The results indicate that FAVOR PAC is poorly absorbed and rapidly eliminated in feces following oral administration.
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Abstract
A series of in vitro and in vivo assays have been conducted using FAVOR PAC (CAS Registry No. 9003-04-7), a cross-linked sodium polyacrylate polymer, to test its ability to induce mutations. FAVOR PAC is a member of the FAVOR family of superabsorbent polymers (SAPs) developed by Stockhausen GmbH & Co KG (Krefeld, Germany). These SAPs are known for their ability to retain large volumes of fluid, even against pressure. The genotoxic potential of FAVOR PAC and its extracts was examined in the following five standard mutagenicity assays: the Salmonella typhimurium and Escherichia coli reverse mutation assay, the mouse lymphoma fluctuation assay, the mouse lymphoma forward mutation assay, the in vivo mouse micronucleus assay, and an in vitro rat DNA synthesis assay. Based on the results of these assays, it was concluded that FAVOR PAC was clearly not genotoxic under any of the conditions of the mutagenicity assays performed.
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Abstract
A short-term rat feeding study was conducted to evaluate the oral toxicity of FAVOR PAC (CAS Registry No. 9003-04-7), one member of a family of cross-linked sodium polyacrylate polymers developed by Stockhausen GmbH & Co KG (Krefeld, Germany). FAVOR polymers are classified as superabsorbent polymers because of their ability to absorb and retain large volumes of fluid. In this short-term study, three groups of 10 male and 10 female Sprague-Dawley rats were administered 0 (control), 1, or 5% FAVOR PAC in the diet daily for up to 32 days. No significant changes in clinical signs, body weight and food consumption, functional observation battery results, ophthalmoscopy, hematology and clinical chemistries, or absolute and relative organ weights were observed. Significant differences between treated and control animals were limited to increases in water consumption and modifications in urinary ionic excretion. Both findings were likely the result of the relatively high concentration of sodium in the test article, and thus consistent with adaptive physiologic changes, not overt toxicity. In conclusion, levels of up to 5% FAVOR PAC in the diet produced no treatment-related toxicity in rats under the conditions of this short-term test (i.e., a NOAEL of 5% FAVOR PAC in the diet was identified).
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The localization and expression of the class II starch synthases of wheat. PLANT PHYSIOLOGY 1999; 120:1147-56. [PMID: 10444098 PMCID: PMC59348 DOI: 10.1104/pp.120.4.1147] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/1999] [Accepted: 05/04/1999] [Indexed: 05/21/2023]
Abstract
The starch granules of hexaploid wheat (Triticum aestivum) contain a group of three proteins known as SGP-1 (starch granule protein-1) proteins, which have apparent molecular masses of 100, 108, and 115 kD. The nature and role of these proteins has not been defined previously. We demonstrate that these polypeptides are starch synthases that are present in both the starch granule and the soluble fraction at the early stages of wheat endosperm development, but that are exclusively granule bound at mid and late endosperm development. A partial cDNA clone encoding a fragment of the 100-kD protein was obtained by screening a wheat endosperm cDNA expression library using monoclonal antibodies. Three classes of cDNA were subsequently isolated from a wheat endosperm cDNA library by nucleic acid hybridization and were shown to encode the 100-, 108-, and 115-kD proteins. The cDNA sequences are highly homologous to class II starch synthases and have the highest homology with the maize SSIIa (starch synthase IIa) gene. mRNA for the SGP-1 proteins was detected in the leaf, pre-anthesis florets, and endosperm of wheat and is highly expressed in the leaf and in the grain during the early to mid stages of development. We discuss the roles of the SGP-1 proteins in starch biosynthesis in wheat.
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Marker molecules of human endometrial differentiation can be hormonally regulated under in-vitro conditions as in-vivo. Hum Reprod Update 1998; 4:539-49. [PMID: 10027607 DOI: 10.1093/humupd/4.5.539] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An established cell culture system of isolated human endometrial stromal and epithelial cells has been used to study the effects of oestrogen and progesterone, as well as their antagonists, upon endometrial cells. Normal hormonal regulation in vivo was investigated simultaneously in endometrial tissue samples taken at different phases of the menstrual cycle. Several marker molecules analysed by immunohistochemistry appeared to depend strongly on endocrine regulation and could be traced in culture. Immunohistochemically, basic parameters of cell biology were identified in vitro, e.g. cell proliferation (Ki-67), adhesion molecules (beta3 integrin) and paracrine factors (leukaemia inhibitory factor). The most reliable parameters to assess hormonal influences were oestrogen and progesterone receptor molecules. Immunohistochemical localization could be improved by molecular biological analysis using RT-PCR. In the presence of oestrogen, a significant expression of hormone receptors was also shown by RT-PCR, and withdrawal of oestrogens and addition of gestagen, i.e. medroxyprogesterone acetate, caused receptor downregulation. Addition of the anti-oestrogen ICI 182.780 to cell-culture medium significantly decreased the synthesis of progesterone receptors.
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Abstract
Since the appearance of the NHS Executive's guidance document, Purchasing Intelligence (1991), efforts have been concentrated on the development of 'purchasing intelligence facilities' staffed, in the main, by health librarians. However, the concept of 'intelligence' has a wider dimension that impacts upon the whole culture of an organization. The authors examine purchasing organizations against popular theories of organizational development. The characteristics of Handy's Task culture, with Athena as its patron, may be observed in many authorities. Using the results of two surveys, conducted in March 1995, they identify some key information management issues involving structure, tasks, technology and people. Skills in information 'transformation' must be acquired by all staff in purchasing authorities. The intelligence officer must become a modern-day Odysseus if the intelligence facility is to 'survive and thrive'.
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Sick doctors. Workaholics harm families also. BMJ (CLINICAL RESEARCH ED.) 1994; 309:1235. [PMID: 7987180 PMCID: PMC2541676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Brief Report of the Last Illness of T. Nunneley, F.R.C.S.; and of the Post Mortem Examination. West J Med 1870; 1:598-9. [DOI: 10.1136/bmj.1.493.598-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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On the Beneficial Results of Undesigned and Accidental Haemorrhage in Certain Cases. West J Med 1870; 1:101. [DOI: 10.1136/bmj.1.474.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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