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Abstract
BACKGROUND Serum eosinophil cationic protein (ECP) levels affect the surgical outcome of chronic rhinosinusitis (CRS) with nasal polyps. Primary CRS can be classified into type 2 (T2) and non-T2. We aimed to differentiate the role of serum ECP levels in surgical outcomes between the distinct endotypes of primary CRS. METHODS We prospectively enrolled patients with bilateral primary CRS who underwent surgical treatment with postoperative follow-up for at least 12 months. Endotyping and serum parameter measurements were completed within 1 week before surgery. RESULTS In total, 113 patients were enrolled, including 65 with T2 CRS and 48 with non-T2 CRS. Patients in the T2 CRS group with uncontrolled CRS had significantly higher serum ECP levels than those in patients in the non-T2 CRS group. An optimal cut-off value was obtained at 17.0 μg/L using the receiver operating characteristic curve, attaining a sensitivity of 91.7% and specificity of 56.6%. Multivariate logistic regression analysis showed that a higher serum ECP level was an independent factor for postoperative uncontrolled disease. The hazard ratio was 11.3 for the T2 group, with serum ECP levels over 17.0 μg/L. In the non-T2 group, no parameters were significantly correlated with postoperative uncontrolled CRS. CONCLUSIONS Serum ECP levels appear to be a feasible predictor of postoperative uncontrolled disease in patients with T2 CRS as preoperative serum ECP levels >17.0 μg/L in these patients have an approximately 16.7-fold increased risk of postoperative uncontrolled disease and should be closely monitored.
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Affiliation(s)
- P C Tsai
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - T J Lee
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - P H Chang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C H Fu
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Lincoln AG, Benton SC, Piggott C, Sheikh SR, Beggs AD, Buckley L, DeSouza B, East JE, Sanders P, Lim M, Sheehan D, Snape K, Hanson H, Greenaway JR, Burn J, Nylander D, Hawkins M, Lalloo F, Green K, Lee TJ, Walker J, Matthews G, Rutherford T, Sasieni P, Monahan KJ. Risk-stratified faecal immunochemical testing (FIT) for urgent colonoscopy in Lynch syndrome during the COVID-19 pandemic. BJS Open 2023; 7:zrad079. [PMID: 37668669 PMCID: PMC10478750 DOI: 10.1093/bjsopen/zrad079] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented during the COVID-19 pandemic utilizing faecal immunochemical testing ('FIT') in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited. METHODS An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg of haemoglobin/g of faeces (µg/g)-scheduled within 6-12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g-triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance. RESULTS Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10 µg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001). CONCLUSION Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the 'FIT for Lynch' study (ISRCTN15740250).
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Affiliation(s)
- Anne G Lincoln
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Sally C Benton
- Department of Clinical Biochemistry and NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital, Berkshire and Surrey Pathology Services, Guildford, Surrey, UK
| | - Carolyn Piggott
- Department of Clinical Biochemistry and NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital, Berkshire and Surrey Pathology Services, Guildford, Surrey, UK
| | - Shama Riaz Sheikh
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Andrew D Beggs
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Leah Buckley
- Clinical Genetics, St Michael’s Hospital, Bristol, UK
| | - Bianca DeSouza
- Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Pete Sanders
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Michael Lim
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Donal Sheehan
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Katie Snape
- South West Thames Regional Genetics Service, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Helen Hanson
- South West Thames Regional Genetics Service, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - John R Greenaway
- Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK
| | - John Burn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Nylander
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Menna Hawkins
- Family Cancer Clinic, St Mark’s Hospital, London, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Kate Green
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Julie Walker
- Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Gillian Matthews
- Gastroenterology, County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Terry Rutherford
- Gastroenterology, County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Peter Sasieni
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Kevin J Monahan
- Family Cancer Clinic, St Mark’s Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
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Choo JH, Vivace BJ, Meredith LT, Kachare S, Lee TJ, Kachare M, Wilhelmi BJ. Obesity and the Latissimus Dorsi Flap: A Radiologic Study. Plast Surg (Oakv) 2023; 31:132-137. [PMID: 37188129 PMCID: PMC10170644 DOI: 10.1177/22925503211031927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography-guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.
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Affiliation(s)
- Joshua H. Choo
- Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA
| | | | | | - Swapnil Kachare
- Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA
| | - Thomas J. Lee
- Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA
| | - Milind Kachare
- Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA
| | - Bradon J. Wilhelmi
- Division of Plastic Surgery, Department of Surgery, University of Louisville, KY, USA
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Fan YH, Wu PW, Huang YL, Lee CC, Lee TJ, Huang CC, Chang PH, Huang CC. Identifying a sphenoid sinus fungus ball using a nomogram model. Rhinology 2022; 61:153-160. [PMID: 36375133 DOI: 10.4193/rhin22.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.
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Affiliation(s)
- Y H Fan
- Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - P W Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y L Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - C C Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - T J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - P H Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
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Roslan A, Tey YS, Ares F, Ashari A, Shaparudin A, Wan Rahimi WF, Koh HB, Lee TJ, Ahmad Tantawi JA, Kolanthaivelu J, Gurupparan K, Yahaya SA. Left ventricle geometry, atrial strain, ventricle strain, and hemodynamics across aortic valve before and after transcatheter aortic valve replacements. Med J Malaysia 2022; 77:736-743. [PMID: 36448393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacements (TAVRs) has become widespread throughout the world. To date, there are no echocardiographic studies of TAVR patients from Southeast Asia (SEA). We sought to evaluate (1) changes in echocardiographic and strain values pre- and post-TAVR (2) relationship between aortic stenosis (AS) severity and strain values, (3) left ventricle geometry in severe AS, (4) relationship of flow rate to dimensionless index (DVI) and acceleration time (AT), and (5) effect of strains on the outcome. MATERIALS AND METHODS Retrospective study of 112 TAVR patients in our centre from 2009 to 2020. The echocardiographic and strain images pre (within 1 month), post (day after), and 6 months post-TAVR were analyzed by expert echocardiographer. RESULTS The ejection fraction (EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%) (p=0.044). Interventricular septal thickness in diastole (IVSd) decreased (1.27 ± 0.21 cm to 1.21 ± 0.23 cm) (p=0.038) and left ventricle internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64 cm to 4.49 ± 0.65 cm (p=0.001). No changes in stroke volume index (SVI pre vs 6 months p=0.187), but the flow rate increases (217.80 ± 57.61 mls/s to 251.94 ± 69.59 mls/s, p<0.001). Global longitudinal strain (GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p<0.001), left atrial reservoir strain (Lar-S) increased from 17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). Eight patients (7.5%) had IVSd < 1.0 cm, and 4 patients (3.7%) had normal left ventricle (LV) geometry. There was linear relationship between IVSd and mean PG (r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic valve area index (AVAi) (r = - 0.305, p=0.001 and r= - 0.316, p= 0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI (r=0.35, p<0.001) with flow rate. Patients who died late (after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs Died; -12.43 ± 4.19%, p=0.001). CONCLUSION At 6 months, TAVR cause reverse remodelling of the LV with the reduction in IVSd, LVIDd, and improvement in GLS and LAr-S. There is a linear relationship between GLS and AVA and between IVSd and AVA.
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Affiliation(s)
- A Roslan
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia.
| | - Y S Tey
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - F Ares
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - A Ashari
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - A Shaparudin
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - W F Wan Rahimi
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - H B Koh
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - T J Lee
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - J A Ahmad Tantawi
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - J Kolanthaivelu
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - K Gurupparan
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
| | - S A Yahaya
- Institut Jantung Negara, Department of Cardiology, Kuala Lumpur, Malaysia
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Giannopulu I, Brotto G, Lee TJ, Frangos A, To D. Synchronised neural signature of creative mental imagery in reality and augmented reality. Heliyon 2022; 8:e09017. [PMID: 35309391 PMCID: PMC8928117 DOI: 10.1016/j.heliyon.2022.e09017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/05/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Creativity, transforming imaginative thinking into reality, is a mental imagery simulation in essence. It can be incorporeal, concerns sophisticated and/or substantial thinking, and involves objects. In the present study, a mental imagery task consisting of creating a scene using familiar (FA) or abstract (AB) physical or virtual objects in real (RMI) and augmented reality (VMI) environments, and an execution task involving effectively creating a scene in augmented reality (VE), were utilised. The beta and gamma neural oscillations of healthy participants were recorded via a 32 channel wireless 10/20 international EGG system. In real and augmented environments and for both the mental imagery and execution tasks, the participants displayed a similar cortico-cortical neural signature essentially based on synchronous vs asynchronous beta and gamma oscillatory activities between anterior (i.e. frontal) and posterior (i.e. parietal, occipito-parietal and occipito-temporal) areas bilaterally. The findings revealed a transient synchronised neural architecture that appears to be consistent with the hypothesis according to which, creativity, because of its inherent complexity, cannot be confined to a single brain area but engages various interconnected networks.
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Affiliation(s)
- I Giannopulu
- Creative Robotics Lab, UNSW, 2021, Sydney, Australia.,Clinical Research and Technological Innovation, 75016, Paris, France
| | - G Brotto
- Interdisciplinary Centre for the Artificial Mind (iCAM), Bond University, 4229, Robina, Australia
| | - T J Lee
- Interdisciplinary Centre for the Artificial Mind (iCAM), Bond University, 4229, Robina, Australia
| | - A Frangos
- Interdisciplinary Centre for the Artificial Mind (iCAM), Bond University, 4229, Robina, Australia
| | - D To
- Interdisciplinary Centre for the Artificial Mind (iCAM), Bond University, 4229, Robina, Australia
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Moulton MN, Yabes JM, Berglund AJ, Lee TJ, Mason PE, Warren WA. A 21-Year-Old Man With a Cough. Chest 2021; 158:e181-e185. [PMID: 33036116 DOI: 10.1016/j.chest.2020.05.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022] Open
Abstract
CASE PRESENTATION A 21-year-old male African American college student from Southern California, with no significant medical history, was visiting family in southwestern Texas when he presented to the hospital with 1 week history of cough, shortness of breath, lower back pain, and a 10-pound weight loss.
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Affiliation(s)
- Michael N Moulton
- Department of Medicine, Brooke Army Medical Center, San Antonio, TX.
| | - Joseph M Yabes
- Infectious Disease, Brooke Army Medical Center, San Antonio, TX
| | - Andrew J Berglund
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX
| | - Thomas J Lee
- Pediatric Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX
| | - Phillip E Mason
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX
| | - Whittney A Warren
- Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX
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8
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Affiliation(s)
- Alexis Wolfe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Thomas J Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, and
| | - Colin T Gillespie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Sambasiva Rao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - James M Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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9
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Rutter MD, Brookes M, Lee TJ, Rogers P, Sharp L. Impact of the COVID-19 pandemic on UK endoscopic activity and cancer detection: a National Endoscopy Database Analysis. Gut 2021; 70:537-543. [PMID: 32690602 PMCID: PMC7385747 DOI: 10.1136/gutjnl-2020-322179] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [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: 06/11/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a major global impact on endoscopic services. This reduced capacity, along with public reluctance to undergo endoscopy during the pandemic, might result in excess mortality from delayed cancer diagnosis. Using the UK's National Endoscopy Database (NED), we performed the first national analysis of the impact of the pandemic on endoscopy services and endoscopic cancer diagnosis. DESIGN We developed a NED COVID-19 module incorporating procedure-level data on all endoscopic procedures. Three periods were designated: pre-COVID (6 January 2020 to 15 March), transition (16-22 March) and COVID-impacted (23 March-31 May). National, regional and procedure-specific analyses were performed. The average weekly number of cancers, proportion of missing cancers and cancer detection rates were calculated. RESULTS A weekly average of 35 478 endoscopy procedures were performed in the pre-COVID period. Activity in the COVID-impacted period reduced to 12% of pre-COVID levels; at its low point, activity was only 5%, recovering to 20% of pre-COVID activity by study end. Although more selective vetting significantly increased the per-procedure cancer detection rate (pre-COVID 1.91%; COVID-impacted 6.61%; p<0.001), the weekly number of cancers detected decreased by 58%. The proportion of missing cancers ranged from 19% (pancreatobiliary) to 72% (colorectal). CONCLUSION This national analysis demonstrates the remarkable impact that the pandemic has had on endoscopic services, which has resulted in a substantial and concerning reduction in cancer detection. Major, urgent efforts are required to restore endoscopy capacity to prevent an impending cancer healthcare crisis.
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Affiliation(s)
- Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Brookes
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
- Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Mangan JJ, Goyal DKC, Divi SN, Bowles DR, Nicholson KJ, Mujica VE, Lee TJ, DePaola RV, Saline A, Fang T, Galetta MS, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Does Smoking Status Influence Health-Related Quality of Life Outcome Measures in Patients Undergoing ACDF? Global Spine J 2021; 11:50-56. [PMID: 32875848 PMCID: PMC7734264 DOI: 10.1177/2192568219890292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE Whereas smoking has been shown to affect the fusion rates for patients undergoing an anterior cervical discectomy and fusion (ACDF), the relationship between smoking and health-related quality of life outcome measurements after an ACDF is less clear. The purpose of this study was to evaluate whether smoking negatively affects patient outcomes after an ACDF for cervical degenerative pathology. METHODS Patients with tumor, trauma, infection, and previous cervical spine surgery and those with less than a year of follow-up were excluded. Smoking status was assessed by self-reported smoking history. Patient outcomes, including Neck Disability Index, Short Form 12 Mental Component Score, Short Form 12 Physical Component Score (PCS-12), Visual Analogue Scale (VAS) arm pain, VAS neck pain, and pseudarthrosis rates were evaluated. Outcomes were compared between smoking groups using multiple linear and logistic regression, controlling for age, sex, and body mass index (BMI), among other factors. A P value <.05 was considered significant. RESULTS A total of 264 patients were included, with a mean follow-up of 19.8 months, age of 53.1 years, and BMI of 29.6 kg/m2. There were 43 current, 69 former, and 152 nonsmokers in the cohort. At baseline, nonsmokers had higher PCS-12 scores than current smokers (P = .010), lower VAS neck pain than current (P = .035) and former (P = .014) smokers, as well as lower VAS arm pain than former smokers (P = .006). Postoperatively, nonsmokers had higher PCS-12 scores than both current (P = .030) and former smokers (P = .035). Smoking status was not a significant predictor of change in patient outcome in multivariate analysis. CONCLUSIONS Whereas nonsmokers had higher function and lower pain than former or current smokers preoperatively, smoking status overall was not found to be an independent predictor of outcome scores after ACDF. This supports the notion that smoking status alone should not deter patients from undergoing ACDF for cervical degenerative pathology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Taolin Fang
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Mark F. Kurd
- Thomas Jefferson University, Philadelphia, PA, USA
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11
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Rees CJ, Brand A, Ngu WS, Stokes C, Hoare Z, Totton N, Bhandari P, Sharp L, Bastable A, Rutter MD, Verma AM, Lee TJ, Walls M. BowelScope: Accuracy of Detection Using Endocuff Optimisation of Mucosal Abnormalities (the B-ADENOMA Study): a multicentre, randomised controlled flexible sigmoidoscopy trial. Gut 2020; 69:1959-1965. [PMID: 32245908 DOI: 10.1136/gutjnl-2019-319621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/11/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Adenoma detection rate (ADR) is an important quality marker at lower GI endoscopy. Higher ADRs are associated with lower postcolonoscopy colorectal cancer rates. The English flexible sigmoidoscopy (FS) screening programme (BowelScope), offers a one-off FS to individuals aged 55 years. However, variation in ADR exists. Large studies have demonstrated improved ADR using Endocuff Vision (EV) within colonoscopy screening, but there are no studies within FS. We sought to test the effect of EV on ADR in a national FS screening population. DESIGN BowelScope: Accuracy of Detection Using ENdocuff Optimisation of Mucosal Abnormalities was a multicentre, randomised controlled trial involving 16 English BowelScope screening centres. Individuals were randomised to Endocuff Vision-assisted BowelScope (EAB) or Standard BowelScope (SB). ADR, polyp detection rate (PDR), mean adenomas per procedure (MAP), polyp characteristics and location, participant experience, procedural time and adverse events were measured. Comparison of ADR within the trial with national BowelScope ADR was also undertaken. RESULTS 3222 participants were randomised (53% male) to receive EAB (n=1610) or SB (n=1612). Baseline demographics were comparable between arms. ADR in the EAB arm was 13.3% and that in the SB arm was 12.2% (p=0.353). No statistically significant differences were found in PDR, MAP, polyp characteristics or location, participant experience, complications or procedural characteristics. ADR in the SB control arm was 3.1% higher than the national ADR. CONCLUSION EV did not improve BowelScope ADR when compared with SB. ADR in both arms was higher than the national ADR. Where detection rates are already high, EV is unable to improve detection further. TRIAL REGISTRATION NUMBERS NCT03072472, ISRCTN30005319 and CPMS ID 33224.
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Affiliation(s)
- Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Wee Sing Ngu
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
| | - Clive Stokes
- Research, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Pradeep Bhandari
- Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, Portsmouth, UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Alexandra Bastable
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, Gwynedd, UK
| | - Matthew D Rutter
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK.,Medicine, University of Durham, Durham, Durham, UK
| | - Ajay Mark Verma
- Gastroenterology, Kettering General Hospital NHS Foundation Trust, Kettering, Northamptonshire, UK
| | - Thomas J Lee
- Gastroenterology Research, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Martin Walls
- Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
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12
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Koochekpour S, Maresh GA, Katner A, Parker-Johnson K, Lee TJ, Hebert FE, Kao YS, Skinner J, Rayford W. Correction: Establishment and characterization of a primary androgen‐responsive African‐American prostate cancer cell line, E006AA. Prostate 2004;60(2):145‐152. Prostate 2019; 79:815. [PMID: 31416301 DOI: 10.1002/pros.23800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Ngu WS, Bevan R, Tsiamoulos ZP, Bassett P, Hoare Z, Rutter MD, Clifford G, Totton N, Lee TJ, Ramadas A, Silcock JG, Painter J, Neilson LJ, Saunders BP, Rees CJ. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut 2019; 68:280-288. [PMID: 29363535 PMCID: PMC6352411 DOI: 10.1136/gutjnl-2017-314889] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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: 07/19/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Low adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC). DESIGN Patients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured. RESULTS 1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events. CONCLUSION EV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection. TRIAL REGISTRATION NUMBER NCT02552017, Results; ISRCTN11821044, Results.
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Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton, UK
| | | | | | - Zoë Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton, UK
| | - Gayle Clifford
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Thomas J Lee
- Department of Gastroenterology, Northumbria NHS Trust, North Tyneside, UK
| | - Arvind Ramadas
- Department of Gastroenterology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - John G Silcock
- Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - John Painter
- Department of Gastroenterology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Colin J Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK,Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
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14
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Rolnik DL, da Silva Costa F, Lee TJ, Schmid M, McLennan AC. Association between fetal fraction on cell-free DNA testing and first-trimester markers for pre-eclampsia. Ultrasound Obstet Gynecol 2018; 52:722-727. [PMID: 29318732 DOI: 10.1002/uog.18993] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the association between fetal fraction on cell-free DNA (cfDNA) testing and first-trimester markers for pre-eclampsia, and to investigate the possible association of low fetal fraction with increased risks for pre-eclampsia (PE) and fetal growth restriction (FGR). METHODS This was a retrospective cohort study including all women with a singleton pregnancy who had risk calculation for PE and FGR between 11 + 0 and 13 + 6 weeks' gestation and who also had cfDNA as a primary or secondary screening test for chromosomal abnormalities at any gestational age at two fetal medicine clinics in Sydney and Melbourne, Australia, between March 2013 and May 2017. Logarithmically transformed fetal fraction results were adjusted for gestational age and maternal characteristics. Associations with mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), and risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks were analyzed using correlation analysis and univariable and multivariable linear regressions. RESULTS In total, 4317 singleton pregnancies that underwent cfDNA testing with fetal fraction reported were included. Significant prediction of fetal fraction was provided by gestational age, conception by in-vitro fertilization, maternal age, body mass index, chronic hypertension, diabetes mellitus, South Asian ethnicity and being parous without history of PE or FGR. Fetal fraction was associated inversely with MAP and UtA-PI and associated positively with PAPP-A and PlGF. The lower the fetal fraction, the higher were the risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks (P < 0.001 for all). CONCLUSIONS There is a significant association between fetal fraction result and first-trimester markers for adverse pregnancy outcome. Low fetal fraction is associated with an increased risk for pregnancy complication, but its capacity to act an as independent first-trimester marker in an algorithm for screening for PE and FGR requires further research. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D L Rolnik
- Perinatal Services, Monash Medical Centre, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - F da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Monash Ultrasound for Women, Clayton, Victoria, Australia
| | - T J Lee
- Monash Ultrasound for Women, Clayton, Victoria, Australia
| | - M Schmid
- Roche Sequencing Solutions, San Jose, CA, USA
| | - A C McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, New South Wales, Australia
- Sydney Ultrasound for Women, Sydney, New South Wales, Australia
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15
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Dart AH, Michelson KA, Aronson PL, Garro AC, Lee TJ, Glerum KM, Nigrovic PA, Kocher MS, Bachur RG, Nigrovic LE. Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area. Pediatrics 2018; 141:peds.2017-3810. [PMID: 29669751 PMCID: PMC5914490 DOI: 10.1542/peds.2017-3810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with septic hip arthritis require surgical drainage, but they can be difficult to distinguish from patients with Lyme arthritis. The ability of synovial fluid white blood cell (WBC) counts to help discriminate between septic and Lyme arthritis of the hip has not been investigated. METHODS We assembled a retrospective cohort of patients ≤21 years of age with hip monoarticular arthritis and a synovial fluid culture obtained who presented to 1 of 3 emergency departments located in Lyme disease endemic areas. Septic arthritis was defined as a positive synovial fluid culture result or synovial fluid pleocytosis (WBC count ≥50 000 cells per µL) with a positive blood culture result. Lyme arthritis was defined as positive 2-tiered Lyme disease serology results and negative synovial fluid bacterial culture results. All other patients were classified as having other arthritis. We compared median synovial fluid WBC counts by arthritis type. RESULTS Of the 238 eligible patients, 26 (11%) had septic arthritis, 32 (13%) had Lyme arthritis, and 180 (76%) had other arthritis. Patients with septic arthritis had a higher median synovial fluid WBC count (126 130 cells per µL; interquartile range 83 303-209 332 cells per µL) than patients with Lyme arthritis (53 955 cells per µL; interquartile range 33 789-73 375 cells per µL). Eighteen patients (56%) with Lyme arthritis had synovial fluid WBC counts ≥50 000 cells per µL. Of the 94 patients who underwent surgical drainage, 13 were later diagnosed with Lyme arthritis. CONCLUSIONS In Lyme disease endemic areas, synovial fluid WBC counts cannot always help differentiate septic from Lyme arthritis. Rapid Lyme diagnostics could help avoid unnecessary operative procedures in patients with Lyme arthritis.
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Affiliation(s)
- Arianna H. Dart
- Divisions of Emergency Medicine and,Macalester College, St Paul, Minnesota
| | | | - Paul L. Aronson
- Departments of Pediatrics and,Emergency Medicine, Yale School of Medicine, Yale Unviersity, New Haven, Connecticut
| | - Aris C. Garro
- Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
| | | | - Kimberly M. Glerum
- Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
| | - Peter A. Nigrovic
- Immunology, and,Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mininder S. Kocher
- Department of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts
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16
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Affiliation(s)
| | - Paul L Aronson
- Departments of Pediatrics and .,Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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17
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Gupta M, Lee TJ, Schriger DL, Gupta M, Gertz M, Lee TJ. Not So Fast: The Downsides of Rapid Test Ordering at Triage. Ann Emerg Med 2017; 70:436-437. [PMID: 28844269 DOI: 10.1016/j.annemergmed.2017.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Malkeet Gupta
- Department of Emergency Medicine, UCLA School of Medicine, Los Angeles, CA
| | - Thomas J Lee
- Department of Emergency Medicine, UCLA School of Medicine, Los Angeles, CA
| | - David L Schriger
- Department of Emergency Medicine, UCLA School of Medicine, Los Angeles, CA
| | | | | | - Thomas J Lee
- Antelope Valley Emergency Department, Lancaster, CA
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18
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Abstract
BACKGROUND Empty nose syndrome (ENS) describes symptomatology and radiographic findings after surgeries on turbinates.The treatment of ENS is still debatable. PURPOSE To analyse clinical outcomes of submucosal Medpor® implantation for ENS. METHODS A total of 18 patients underwent submucosal Medpor® implantation from 2006 to 2011. We applied SNOT-22 (SinoNasalOutcome Test) for statistical survey of the patients' symptoms before and after surgery. RESULTS Two patients were lost to follow up after the surgery. Most of the patients developed ENS-related symptoms gradually within 2 years to 16 years after the previous nasal surgery or treatment. The sites of submucosal implantation are mainly septum and nasal floor, unilaterally or bilaterally. There is a significant improvement of SNOT-22 pre-operatively to one year post-operatively. CONCLUSIONS The symptomatolgy remains the most important point when dealing with patients with ENS. Submucosal implantation of Medpor® is a feasible surgical treatment to ENS. A positive cotton test is suggested for the surgical indication and planning.
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19
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Lee JY, Park JH, Choi HJ, Won HY, Joo HS, Shin DH, Park MK, Han B, Kim KP, Lee TJ, Croce CM, Kong G. LSD1 demethylates HIF1α to inhibit hydroxylation and ubiquitin-mediated degradation in tumor angiogenesis. Oncogene 2017; 36:5512-5521. [PMID: 28534506 DOI: 10.1038/onc.2017.158] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/02/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022]
Abstract
Lysine-specific demethylase 1 (LSD1), which has been considered as a potential therapeutic target in human cancer, has been known to regulate many biological functions through its non-histone substrates. Although LSD1-induced hypoxia-inducible factor alpha (HIF1α) demethylation has recently been proposed, the effect of LSD1 on the relationship between HIF1α post-translational modifications (PTMs) and HIF1α-induced tumor angiogenesis remains to be elucidated. Here, we identify a new methylation site of the HIF1α protein antagonized by LSD1 and the interplay between HIF1α protein methylation and other PTMs in regulating tumor angiogenesis. LSD1 demethylates HIF1α at lysine (K) 391, which protects HIF1α against ubiquitin-mediated protein degradation. LSD1 also directly suppresses PHD2-induced HIF1α hydroxylation, which has a mutually dependent interplay with Set9-mediated HIF1α methylation. Moreover, the HIF1α acetylation that occurs in a HIF1α methylation-dependent manner is inhibited by the LSD1/NuRD complex. HIF1α stabilized by LSD1 cooperates with CBP and MTA1 to enhance vascular endothelial growth factor (VEGF)-induced tumor angiogenesis. Thus, LSD1 is a key regulator of HIF1α/VEGF-mediated tumor angiogenesis by antagonizing the crosstalk between PTMs involving HIF1α protein degradation.
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Affiliation(s)
- J-Y Lee
- Institute for Bioengineering and Biopharmaceutical Research (IBBR), Hanyang University, Seoul, Republic of Korea
| | - J-H Park
- Institute for Bioengineering and Biopharmaceutical Research (IBBR), Hanyang University, Seoul, Republic of Korea
| | - H-J Choi
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - H-Y Won
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - H-S Joo
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - D-H Shin
- Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - M K Park
- National Cancer Center, Goyang, Republic of Korea
| | - B Han
- Department of Applied Chemistry, College of Applied Science, Kyung Hee University, Yongin, Korea
| | - K P Kim
- Department of Applied Chemistry, College of Applied Science, Kyung Hee University, Yongin, Korea
| | - T J Lee
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, OH, USA
| | - C M Croce
- Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, OH, USA
| | - G Kong
- Institute for Bioengineering and Biopharmaceutical Research (IBBR), Hanyang University, Seoul, Republic of Korea.,Department of Pathology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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20
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Brown J, Lee TJ, Joiner T, Wrightson W. Using Electromagnetic Navigation Bronchoscopy and Dye Injection to Aid in Video-Assisted Lung Resection. Am Surg 2016; 82:1052-1054. [PMID: 28206930] [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: 06/06/2023]
Abstract
Small (2 cm) peripheral lung lesions and ground glass opacities remain a difficult subset of lung lesions for the diagnosis and management of lung cancer. Surgical biopsy is more difficult for these lesions because intraoperative localization has to be made without the aid of direct visualization or manual palpation. Electromagnetic navigation bronchoscopy can be used in the operating room to identify a small peripheral lesion and marked using an injection of methylene blue, which can be seen on the visceral pleura of the lung. We present our initial experience using this technique. The sample was eight patients who had peripheral lesions with an average size of 19 mm. Surgical wedge biopsy was diagnostic in all cases, with an average procedure time of 28 minutes. There were no complications from this procedure. In conclusion, these data suggest that electromagnetic navigation bronchoscopy can be performed safely with high diagnostic accuracy by the operating thoracic surgeon, but further data are needed to establish its utility and safety.
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Affiliation(s)
- Jordan Brown
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky, USA
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21
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Abstract
Small (2 cm) peripheral lung lesions and ground glass opacities remain a difficult subset of lung lesions for the diagnosis and management of lung cancer. Surgical biopsy is more difficult for these lesions because intraoperative localization has to be made without the aid of direct visualization or manual palpation. Electromagnetic navigation bronchoscopy can be used in the operating room to identify a small peripheral lesion and marked using an injection of methylene blue, which can be seen on the visceral pleura of the lung. We present our initial experience using this technique. The sample was eight patients who had peripheral lesions with an average size of 19 mm. Surgical wedge biopsy was diagnostic in all cases, with an average procedure time of 28 minutes. There were no complications from this procedure. In conclusion, these data suggest that electromagnetic navigation bronchoscopy can be performed safely with high diagnostic accuracy by the operating thoracic surgeon, but further data are needed to establish its utility and safety.
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Affiliation(s)
- Jordan Brown
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky
| | - Thomas J. Lee
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky
| | - Theresa Joiner
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky
| | - William Wrightson
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky
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22
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Joo HJ, Lee TJ, Lee SH, Lee EJ. Lymphangioma Arising From the Ovary. Lymphology 2016; 49:21-26. [PMID: 29906061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Primary lymphangioma arising from the ovary is a rare tumor, with only 24 cases reported to date. As it is often accompanied by ascites or recurrence, similar to a malignant tumor, an aggressive treatment approach is used for disease control. In this report, we describe a 75-year-old woman with a left ovarian lymphangioma that increased in size during the menopause period. Microscopic examination of the tumor showed thin-walled multilocular cystic spaces and immunoreactivity for D2-40, a specific marker for lymphatic endothelium, lining the cystic spaces. The patient has been doing well for 5 years postoperatively. Ovarian cystic lymphangioma should be included in the differential diagnosis of an ovarian cyst and long-term follow-up is recommended to exclude malignant behavior. We also summarize a total of 25 cases, including the case presented here.
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23
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Huang KL, Huang CC, Lee TJ, Huang CC. An isolated intracranial mucocoele herniated from the frontal sinus. B-ENT 2015; 11:245-247. [PMID: 26601560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Mucocoeles are chronic mucosa-lined retention cysts that occur due to sinus ostium obstruction and expand along the path of least resistance, most commonly involving the frontal sinus. A frontal mucocoele typically appears as a smooth and rounded expansile enlargement of a completely opacified frontal sinus, with or without thinning of the bony wall of the sinus. Here we report a rare case of isolated intracranial mucocoele that presented with posterior herniation to the anterior cranial fossa through a small bony defect on the posterior table of the frontal sinus. The findings upon imaging could easily be confused with intracranial abscess, potentially leading to craniotomy drainage. In the present case of mucocoele, the frontal intracranial lesion was completely resolved following endoscopic frontal sinusotomy.
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24
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Washington CH, Tyler FJ, Davis J, Shapiro DR, Richards A, Richard M, Lee TJ, Colton TL, Berk L, Rauch L, Shwe Oo EK, Hahn R, Stock LM. Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar. Int J Emerg Med 2014; 7:46. [PMID: 25624953 PMCID: PMC4298949 DOI: 10.1186/s12245-014-0046-z] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/02/2014] [Indexed: 11/11/2022] Open
Abstract
Background Myanmar has struggled through decades of internal conflict, which has negatively impacted the country’s health outcomes. Recent government changes have brought hope and reduced conflict. The ethnic minority groups have suffered the brunt of the health consequences and reside in regions that lack health infrastructure, resources, and providers. Due to the chronic lack of healthcare providers within conflict areas, health workers (HWs) have been trained in an effort to fill the void. Research has shown that these non-physician clinicians positively impact health outcomes in developing countries. These HWs are supported by community-based organizations in collaboration with foreign non-governmental organizations. Started in 2000, the trauma training course was developed to meet the educational needs of these HWs. Methods Essential procedures for HWs in conflict zones were identified, and teaching methods were adapted to develop models that were simple, reproducible, cost effective, and able to facilitate effective learning within the limitations of these challenging environments. This paper presents simulation models developed to teach trauma injury evaluation and management in resource-limited settings to HWs. Results Material and construction of the models described include breathing, chest, cricothyroidotomy, circulation, wound repair, fracture/dislocation, splinting, fasciotomy/amputation, and an animal model. In 2013, a pre/post test and post-training evaluation were completed, which demonstrated an increase in understanding of the material and satisfaction with the training. Conclusions The simulation models described engage the HWs in clinical skills practice specific to injury management, which builds upon the HWs existing knowledge and facilitates an increased understanding of life-saving procedures. Through observation of the HW performance and HW feedback, these simulation models have increased the understanding of trauma management. Limitations include lack of a graduated learning system for the HWs, logistics, and time constraints. Despite the barriers faced, we feel that this is a necessary program that has reduced morbidity and mortality due to traumatic injury in the geographic areas that the HWs serve. With the changing political environment in Myanmar and the development of peace agreements between the government and the ethnic minority groups, these HWs can be integrated into Myanmar’s evolving health system.
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Affiliation(s)
- Charles H Washington
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Francis J Tyler
- Access Aid International, PO box 6086, St Kilda Road, Melbourne, VIC 3004 Australia
| | - Julia Davis
- Community Partners International, 2550 Ninth Street, Suite 111, Berkeley, CA 94710 USA
| | - Douglas R Shapiro
- Ross University School of Medicine, PO box 266, Roseau, West Indies Commonwealth of Dominica
| | - Adam Richards
- Division of General Internal Medicine & Health Services Research at UCLA, 911 Broxton Plaza, Los Angeles, CA 90024 USA
| | - Matthew Richard
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
| | - Thomas J Lee
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
| | - Taryn L Colton
- University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724 USA
| | - Louis Berk
- University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Loren Rauch
- Antelope Valley Hospital, 1600 W Avenue J, Lancaster, CA 93534 USA
| | - Eh Kalu Shwe Oo
- Karen Department of Health and Welfare, Mae Sot, Tak Province Thailand
| | - Richard Hahn
- High Desert Health Systems, Los Angeles County Department of Health Services, 44900 60th Street West, Lancaster, CA 93536 USA
| | - Lawrence M Stock
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095 USA
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Park NK, Park JY, Lee TJ. Response of a ZnO single crystal rod-based chemical sensor for hydrogen sulfide. J Nanosci Nanotechnol 2014; 14:6326-6330. [PMID: 25936113 DOI: 10.1166/jnn.2014.8803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A zinc oxide single crystal rod was grown by a thermal evaporation method for application as a chemical gas-sensing material in this study. Zinc acetate (20 wt%) impregnated over activated carbon was used as the precursor for the epitaxial growth of ZnO single crystal rods. The response tests were carried out across a range of sensing temperatures (100, 150 and 200 °C) and the hydrogen sulfide content (10.2-51.0 ppmv) was balanced with nitrogen gas. The response of the ZnO single crystal rods grown on the gas sensors varied with the H2S content and the sensing temperature. A high response for H2S was obtained at 150 and 200 °C due to the high reactivity between H2S and ZnO at high temperature. Since H2S absorption rate and ZnS oxidation rate over ZnO single crystal rods at 100 °C lower than that at 150 and 200 °C, the changing rate of electric resistance decreased with the decrease of temperature. Meanwhile, a different response, which is the changing rate of electric resistance for H2S absorption and ZnS oxidation over ZnO single crystal rods at 100 °C, was observed with changing amount of H2S in feed gas. Therefore, it was concluded that the ZnO single crystal rods based gas sensor is operated above 200 °C for the shortly response time.
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Cho JH, Chang SH, Shin NH, Choi BY, Oh HJ, Yoon MJ, Lee EY, Lee EB, Lee TJ, Song YW. Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea. Lupus 2014; 23:949-57. [PMID: 24563501 DOI: 10.1177/0961203314524849] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 07/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea. METHOD Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression. RESULTS The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.
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Affiliation(s)
- J H Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - S H Chang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - N H Shin
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - B Y Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - H J Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - M J Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - E Y Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - E B Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - T J Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Y W Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Hsu DP, Lee TJ, Barker JA. Outcome of pediatric inpatient asthma clinical pathway implementation in a military medical center. Mil Med 2014; 178:e477-82. [PMID: 23707835 DOI: 10.7205/milmed-d-12-00418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A performance improvement project was instituted at our facility to standardize pediatric inpatient asthma care by instituting an asthma clinical pathway (ACP). Formal asthma education and standardized postdischarge follow-up plans for all asthma inpatients were initiated. Patients treated by following the ACP were compared against historically similar patients from the previous 4 years. Differences in hospital length-of-stay (LOS) for patients treated on the ACP were compared to historical LOS. Adherence to The Joint Commission's home management plan of care metric, CAC-3, was also compared. There was a 25% lower hospital LOS in the ACP group compared to historical control group, 45.8 hours versus 60.9 hours (p < 0.002). CAC-3 adherence significantly increased from 48% to 89% (p < 0.001) after initiating formal asthma education. The implementation of a pediatric asthma inpatient performance improvement project was associated with a significant decrease in hospital LOS, when compared to historic controls. It also led to a significant improvement in adherence with The Joint Commission's CAC-3 measures.
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Affiliation(s)
- Daniel P Hsu
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
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Abstract
Aim: Esophagectomy is the primary surgical treatment for localized malignant neoplasms of the esophagus, and while outcomes have shown that substantial improvement has been made, the ceiling for improvement is still high. Methods: A total of 2506 publications published from January 2002 to March 2012 were identified from PubMed, MEDLINE and the Cochrane Library using the keywords: ‘esophagectomy’, ‘esophagus’, ‘neoplasm’ and ‘cancer’ to identify quality key surgical articles in esophagectomy that were broken down into three groups: preoperative, intraoperative and postoperative care. Discussion: There have been limited preoperative surgical trials, mostly in preoperative antibiotic use, which have led to changes in surgical management. Key and substantial changes have occurred in the intraoperative management for esophageal malignancies around surgical anastomosis technique and anesthesia. Nutritional outcomes still remain a key challenge, and currently there is no established standard of care in the postoperative management of esophagectomy patients. Conclusion: We established quality parameters for leak rates, overall morbidity and mortality, and these form the foundation from which all esophageal surgeons should rank their results. We then utilized the techniques described above to maintain those rates or, better yet, to significantly improve those rates in each surgeons’ practice.
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Affiliation(s)
- Thomas J Lee
- Division of Surgical Oncology, University of Louisville School of Medicine, Department of Surgery, 315 East Broadway, Suite 313, Louisville, KY 40202, USA
| | - Robert CG Martin
- Division of Surgical Oncology, University of Louisville School of Medicine, Department of Surgery, 315 East Broadway, Suite 313, Louisville, KY 40202, USA.
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Lee TJ, Fox MP, Trivedi J, van Berkel V. Donors with a history of cocaine use and lung transplant outcomes. J Heart Lung Transplant 2012; 31:1144-6. [DOI: 10.1016/j.healun.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 07/21/2012] [Accepted: 08/04/2012] [Indexed: 10/28/2022] Open
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Brown T, Smith LS, Oo EKS, Shawng K, Lee TJ, Sullivan D, Beyrer C, Richards AK. Molecular surveillance for drug-resistant Plasmodium falciparum in clinical and subclinical populations from three border regions of Burma/Myanmar: cross-sectional data and a systematic review of resistance studies. Malar J 2012; 11:333. [PMID: 22992214 PMCID: PMC3518194 DOI: 10.1186/1475-2875-11-333] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/15/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Confirmation of artemisinin-delayed parasite clearance in Plasmodium falciparum along the Thai-Myanmar border has inspired a global response to contain and monitor drug resistance to avert the disastrous consequences of a potential spread to Africa. However, resistance data from Myanmar are sparse, particularly from high-risk areas where limited health services and decades of displacement create conditions for resistance to spread. Subclinical infections may represent an important reservoir for resistance genes that confer a fitness disadvantage relative to wild-type alleles. This study estimates the prevalence of resistance genotypes in three previously unstudied remote populations in Myanmar and tests the a priori hypothesis that resistance gene prevalence would be higher among isolates collected from subclinical infections than isolates collected from febrile clinical patients. A systematic review of resistance studies is provided for context. METHODS Community health workers in Karen and Kachin States and an area spanning the Indo-Myanmar border collected dried blood spots from 988 febrile clinical patients and 4,591 villagers with subclinical infection participating in routine prevalence surveys. Samples positive for P. falciparum 18 s ribosomal RNA by real-time PCR were genotyped for P. falciparum multidrug resistance protein (pfmdr1) copy number and the pfcrt K76T polymorphism using multiplex real-time PCR. RESULTS Pfmdr1 copy number increase and the pfcrt K76 polymorphism were determined for 173 and 269 isolates, respectively. Mean pfmdr1 copy number was 1.2 (range: 0.7 to 3.7). Pfmdr1 copy number increase was present in 17.5%, 9.6% and 11.1% of isolates from Karen and Kachin States and the Indo-Myanmar border, respectively. Pfmdr1 amplification was more prevalent in subclinical isolates (20.3%) than clinical isolates (6.4%, odds ratio 3.7, 95% confidence interval 1.1 - 12.5). Pfcrt K76T prevalence ranged from 90-100%. CONCLUSIONS Community health workers can contribute to molecular surveillance of drug resistance in remote areas of Myanmar. Marginal and displaced populations under-represented among previous resistance investigations can and should be included in resistance surveillance efforts, particularly once genetic markers of artemisinin-delayed parasite clearance are identified. Subclinical infections may contribute to the epidemiology of drug resistance, but determination of gene amplification from desiccated filter samples requires further validation when DNA concentration is low.
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Affiliation(s)
- Tyler Brown
- Johns Hopkins University School of Medicine, Broadway Research Building, 733 N. Broadway, Suite 147, Baltimore, MD, 21205, USA
- Global Health Access Program, 2550 Ninth Street, Ste 111, Berkeley, CA, 94710, USA
| | - Linda S Smith
- Global Health Access Program, 2550 Ninth Street, Ste 111, Berkeley, CA, 94710, USA
| | - Eh Kalu Shwe Oo
- Karen Department of Health and Welfare, PO Box 189, Mae Sot, Tak, 63110, Thailand
| | - Kum Shawng
- Office of the Director of the Health Department, Kachin Baptist Convention 135/Shan Su (South), Myitkyina, Kachin State, Myanmar
| | - Thomas J Lee
- Global Health Access Program, 2550 Ninth Street, Ste 111, Berkeley, CA, 94710, USA
- School of Medicine, University of California at Los Angeles, 924 Westwood Blvd, Suite 300, Los Angeles, CA, 90024, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health 615 North Wolfe St, Room E5628, Baltimore, MD, 21205, USA
| | - Chris Beyrer
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Suite E7152, Baltimore, MD, 21205, USA
| | - Adam K Richards
- Global Health Access Program, 2550 Ninth Street, Ste 111, Berkeley, CA, 94710, USA
- Department of General Internal Medicine and Health Services Research, University of California at Los Angeles, 911 Broxton Ave, Los Angeles, CA, 90025, USA
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Abstract
Heart failure (HF) is increasing worldwide and represents a major burden in terms of health care resources and costs. Despite advances in medical care, prognosis with HF remains poor, especially in advanced stages. The large patient population with advanced HF and the limited number of donor organs stimulated the development of mechanical circulatory support (MCS) devices as a bridge to transplant and for destination therapy. However, MCS devices require a major operative intervention, cardiopulmonary bypass, and blood component exposure, which have been associated with significant adverse event rates, and long recovery periods. Miniaturization of MCS devices and the development of an efficient and reliable transcutaneous energy transfer system may provide the vehicle to overcome these limitations and usher in a new clinical paradigm in heart failure therapy by enabling less invasive beating heart surgical procedures for implantation, reduce cost, and improve patient outcomes and quality of life. Further, it is anticipated that future ventricular assist device technology will allow for a much wider application of the therapy in the treatment of heart failure including its use for myocardial recovery and as a platform for support for cell therapy in addition to permanent long-term support.
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Affiliation(s)
- Guruprasad A Giridharan
- Departments of Bioengineering & Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
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Affiliation(s)
- Thomas J Lee
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Park NK, Lee SY, Lee TJ. Application of ZnO single-crystal wire grown by the thermal evaporation method as a chemical gas sensor for hydrogen sulfide. J Nanosci Nanotechnol 2011; 11:614-618. [PMID: 21446509 DOI: 10.1166/jnn.2011.3246] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A zinc oxide single-crystal wire was synthesized for application as a gas-sensing material for hydrogen sulfide, and its gas-sensing properties were investigated in this study. The gas sensor consisted of a ZnO thin film as the buffer layer and a ZnO single-crystal wire. The ZnO thin film was deposited over a patterning silicon substrate with a gold electrode by the CFR method. The ZnO single-crystal wire was synthesized over the ZnO thin film using zinc and activated carbon as the precursor for the thermal evaporation method at 800 degrees C. The electrical properties of the gas sensors that were prepared for the growth of ZnO single-crystal wire varied with the amount of zinc contained in the precursor. The charged current on the gas sensors increased with the increasing amount of zinc in the precursor. It was concluded that the charged current on the gas sensors was related to ZnO single-crystal wire growth on the silicon substrate area between the two electrodes. The charged current on the gas sensor was enhanced when the ZnO single-crystal wire was exposed to a H2S stream. The experimental results obtained in this study confirmed that a ZnO single-crystal wire can be used as a gas sensor for H2S.
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Affiliation(s)
- N K Park
- Institute of Clean Technology, Yeungnam University, 712-749, Korea
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Lee TJ, Speed MP. The effect of metapopulation dynamics on the survival and spread of a novel, conspicuous prey. J Theor Biol 2010; 267:319-29. [PMID: 20804773 DOI: 10.1016/j.jtbi.2010.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/30/2010] [Accepted: 08/24/2010] [Indexed: 11/29/2022]
Abstract
Animals that deploy chemical defences against predators often signal their unprofitability using bright colouration. This pairing of toxicity and conspicuous patterning is known as aposematism. Explaining the evolution and spread of aposematic traits in previously cryptic species has been the focus of much empirical and theoretical work over the last two decades. Existing research concerning the initial evolution of aposematism does not however properly consider that many aposematic species (such as members of the hymenoptera, the lepidoptera, and amphibia) are highly mobile. We argue in this paper that the evolution of aposematic displays is therefore often best understood within a metapopulation framework; hence in this paper we present the first explicit metapopulation model of the evolution of aposematism. Our most general finding is that migration tends to reduce the probability that an aposematic prey can increase from rarity and spread across a large population. Hence, the best case scenarios for the spread of aposematism required fixation of the aposematic form in one or more isolated sub-habitats prior to some event which subsequently enabled migration. We observed that changes in frequency of new aposematic forms within source habitats are likely to be nonmonotonic. First, aposematic prey tend to decline in frequency as they migrate outwards from the source habitat to neighbouring sink habitats, but subsequently they increase in relative abundance in the source, as the descendents of earlier migrants migrate back from newly converted sub-populations. This pattern of initial loss and subsequent gain between new source and neighbouring sink habitats is then repeated as the aposematic form spreads via a moving cline.
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Affiliation(s)
- Thomas J Lee
- School of Biological Science, Biosciences Building, Crown Street, University of Liverpool, Liverpool L69 7ZB, UK.
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Huang CC, Lee TJ, Chang PH, Lee YS, Chuang CC, Jhang YJ, Chen YW, Chen CW, Fu CH, Tsai CN. Expression of cathepsin S and its inhibitor stefin A in sinonasal inverted papilloma. Rhinology 2010. [DOI: 10.4193/rhin09.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mullany LC, Lee TJ, Yone L, Lee CI, Teela KC, Paw P, Shwe Oo EK, Maung C, Kuiper H, Masenior NF, Beyrer C. Impact of community-based maternal health workers on coverage of essential maternal health interventions among internally displaced communities in eastern Burma: the MOM project. PLoS Med 2010; 7:e1000317. [PMID: 20689805 PMCID: PMC2914639 DOI: 10.1371/journal.pmed.1000317] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/23/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Access to essential maternal and reproductive health care is poor throughout Burma, but is particularly lacking among internally displaced communities in the eastern border regions. In such settings, innovative strategies for accessing vulnerable populations and delivering basic public health interventions are urgently needed. METHODS Four ethnic health organizations from the Shan, Mon, Karen, and Karenni regions collaborated on a pilot project between 2005 and 2008 to examine the feasibility of an innovative three-tiered network of community-based providers for delivery of maternal health interventions in the complex emergency setting of eastern Burma. Two-stage cluster-sampling surveys among ever-married women of reproductive age (15-45 y) conducted before and after program implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services. RESULTS Among 2,889 and 2,442 women of reproductive age in 2006 and 2008, respectively, population characteristics (age, marital status, ethnic distribution, literacy) were similar. Compared to baseline, women whose most recent pregnancy occurred during the implementation period were substantially more likely to receive antenatal care (71.8% versus 39.3%, prevalence rate ratio [PRR] = 1.83 [95% confidence interval (CI) 1.64-2.04]) and specific interventions such as urine testing (42.4% versus 15.7%, PRR = 2.69 [95% CI 2.69-3.54]), malaria screening (55.9% versus 21.9%, PRR = 2.88 [95% CI 2.15-3.85]), and deworming (58.2% versus 4.1%, PRR = 14.18 [95% CI 10.76-18.71]. Postnatal care visits within 7 d doubled. Use of modern methods to avoid pregnancy increased from 23.9% to 45.0% (PRR = 1.88 [95% CI 1.63-2.17]), and unmet need for contraception was reduced from 61.7% to 40.5%, a relative reduction of 35% (95% CI 28%-40%). Attendance at birth by those trained to deliver elements of emergency obstetric care increased almost 10-fold, from 5.1% to 48.7% (PRR = 9.55 [95% CI 7.21-12.64]). CONCLUSIONS Coverage of maternal health interventions and higher-level care at birth was substantially higher during the project period. The MOM Project's focus on task-shifting, capacity building, and empowerment at the community level might serve as a model approach for similarly constrained settings.
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Affiliation(s)
- Luke C Mullany
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Karp PD, Paley SM, Krummenacker M, Latendresse M, Dale JM, Lee TJ, Kaipa P, Gilham F, Spaulding A, Popescu L, Altman T, Paulsen I, Keseler IM, Caspi R. Pathway Tools version 13.0: integrated software for pathway/genome informatics and systems biology. Brief Bioinform 2009; 11:40-79. [PMID: 19955237 DOI: 10.1093/bib/bbp043] [Citation(s) in RCA: 374] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pathway Tools is a production-quality software environment for creating a type of model-organism database called a Pathway/Genome Database (PGDB). A PGDB such as EcoCyc integrates the evolving understanding of the genes, proteins, metabolic network and regulatory network of an organism. This article provides an overview of Pathway Tools capabilities. The software performs multiple computational inferences including prediction of metabolic pathways, prediction of metabolic pathway hole fillers and prediction of operons. It enables interactive editing of PGDBs by DB curators. It supports web publishing of PGDBs, and provides a large number of query and visualization tools. The software also supports comparative analyses of PGDBs, and provides several systems biology analyses of PGDBs including reachability analysis of metabolic networks, and interactive tracing of metabolites through a metabolic network. More than 800 PGDBs have been created using Pathway Tools by scientists around the world, many of which are curated DBs for important model organisms. Those PGDBs can be exchanged using a peer-to-peer DB sharing system called the PGDB Registry.
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Affiliation(s)
- Peter D Karp
- Artificial Intelligence Center, SRI International, 333 Ravenswood Ave, AE206, Menlo Park, CA 94025, USA.
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Lee CI, Smith LS, Shwe Oo EK, Scharschmidt BC, Whichard E, Kler T, Lee TJ, Richards AK. Internally displaced human resources for health: villager health worker partnerships to scale up a malaria control programme in active conflict areas of eastern Burma. Glob Public Health 2009; 4:229-41. [PMID: 19384681 DOI: 10.1080/17441690802676360] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Approaches to expand malaria control interventions in areas of active conflict are urgently needed. Despite international agreement regarding the imperative to control malaria in eastern Burma, there are currently no large-scale international malaria programmes operating in areas of active conflict. A local ethnic health department demonstrated that village health workers are capable of implementing malaria control interventions among internally displaced persons (IDPs). This paper describes how these internally displaced villagers facilitated rapid expansion of the programme. Clinic health workers received training in malaria diagnosis and treatment, vector control and education at training sites along the border. After returning to programme areas inside Burma, they trained villagers to perform an increasingly comprehensive set of interventions. This iterative training strategy to increase human resources for health permitted the programme to expand from 3000 IDPs in 2003 to nearly 40,000 in 2008. It was concluded that IDPs are capable of delivering essential malaria control interventions in areas of active conflict in eastern Burma. In addition, health workers in this area have the capacity to train community members to take on implementation of such interventions. This iterative strategy may provide a model to improve access to care in this population and in other conflict settings.
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Affiliation(s)
- C I Lee
- Global Health Access Program, Mae Sot, Tak, Thailand.
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Richards AK, Banek K, Mullany LC, Lee CI, Smith L, Oo EKS, Lee TJ. Cross-border malaria control for internally displaced persons: observational results from a pilot programme in eastern Burma/Myanmar. Trop Med Int Health 2009; 14:512-21. [DOI: 10.1111/j.1365-3156.2009.02258.x] [Citation(s) in RCA: 26] [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: 11/30/2022]
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Mahn M, Maung C, Oo EKS, Smith L, Lee CI, Whichard E, Neumann C, Richards AK, Mullany LC, Kuiper H, Lee TJ. Multi-level partnerships to promote health services among internally displaced in eastern Burma. Glob Public Health 2009; 3:165-86. [PMID: 19288369 DOI: 10.1080/17441690801942821] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ethnic populations in eastern Burma are the target of military policies that result in forced labour, destruction of food supplies, and massive forced displacement. Despite international assistance to Burmese refugees along the Thai-Burma border, traditional humanitarian models have failed to reach these internally displaced persons (IDPs) within Burma. Nevertheless, through the cultivation of a model (cross border local-global partnerships) 300,000 IDPs in eastern Burma now receive critical health services where, otherwise, there would be none. We describe key elements of the partnership model's genesis in eastern Burma. The role of the local partner, Backpack Health Worker Team (BPHWT), is highlighted for its indigenous access to the IDP populations and its maintenance of programmatic autonomy. These local elements are potentiated by international support for technical assistance, training, resources, and advocacy. International policy and investment should prioritize support of locally-driven health initiatives that utilize local-global partnerships to reach not only IDPs but also other war-torn or traditionally inaccessible populations worldwide.
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Affiliation(s)
- M Mahn
- Backpack Health Worker Team, Tak, Mae Sot, Thailand
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Teela KC, Mullany LC, Lee CI, Poh E, Paw P, Masenior N, Maung C, Beyrer C, Lee TJ. Community-based delivery of maternal care in conflict-affected areas of eastern Burma: perspectives from lay maternal health workers. Soc Sci Med 2009; 68:1332-40. [PMID: 19232808 DOI: 10.1016/j.socscimed.2009.01.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 10/21/2022]
Abstract
In settings where active conflict, resource scarcity, and logistical constraints prevail, provision of maternal health services within health centers and hospitals is unfeasible and alternative community-based strategies are needed. In eastern Burma, such conditions necessitated implementation of the "Mobile Obstetric Maternal Health Worker" (MOM) project, which has employed a community-based approach to increase access to essential maternal health services including emergency obstetric care. Lay Maternal Health Workers (MHWs) are central to the MOM service delivery model and, because they are accessible to both the communities inside Burma and to outside project managers, they serve as key informants for the project. Their insights can facilitate program and policy efforts to overcome critical delays and insufficient management of maternal complications linked to maternal mortality. Focus group discussions (n=9), in-depth interviews (n=18), and detailed case studies (n=14) were collected from MHWs during centralized project management meetings in February and October of 2007. Five case studies are presented to characterize and interpret the realities of reproductive health work in a conflict-affected setting. Findings highlight the process of building supportive networks and staff ownership of the MOM project, accessing and gaining community trust and participation to achieve timely delivery of care, and overcoming challenges to manage and appropriately deliver essential health services. They suggest that some emergency obstetric care services that are conventionally delivered only within healthcare settings might be feasible in community or home-based settings when alternatives are not available. This paper provides an opportunity to hear directly from community-based workers in a conflict setting, perspectives seldom documented in the scientific literature. A rights-based approach to service delivery and its suitability in settings where human rights violations are widespread is highlighted.
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Mullany LC, Lee CI, Yone L, Paw P, Oo EKS, Maung C, Lee TJ, Beyrer C. Access to essential maternal health interventions and human rights violations among vulnerable communities in eastern Burma. PLoS Med 2008; 5:1689-98. [PMID: 19108601 PMCID: PMC2605890 DOI: 10.1371/journal.pmed.0050242] [Citation(s) in RCA: 46] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/30/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Health indicators are poor and human rights violations are widespread in eastern Burma. Reproductive and maternal health indicators have not been measured in this setting but are necessary as part of an evaluation of a multi-ethnic pilot project exploring strategies to increase access to essential maternal health interventions. The goal of this study is to estimate coverage of maternal health services prior to this project and associations between exposure to human rights violations and access to such services. METHODS AND FINDINGS Selected communities in the Shan, Mon, Karen, and Karenni regions of eastern Burma that were accessible to community-based organizations operating from Thailand were surveyed to estimate coverage of reproductive, maternal, and family planning services, and to assess exposure to household-level human rights violations within the pilot-project target population. Two-stage cluster sampling surveys among ever-married women of reproductive age (15-45 y) documented access to essential antenatal care interventions, skilled attendance at birth, postnatal care, and family planning services. Mid-upper arm circumference, hemoglobin by color scale, and Plasmodium falciparum parasitemia by rapid diagnostic dipstick were measured. Exposure to human rights violations in the prior 12 mo was recorded. Between September 2006 and January 2007, 2,914 surveys were conducted. Eighty-eight percent of women reported a home delivery for their last pregnancy (within previous 5 y). Skilled attendance at birth (5.1%), any (39.3%) or > or = 4 (16.7%) antenatal visits, use of an insecticide-treated bed net (21.6%), and receipt of iron supplements (11.8%) were low. At the time of the survey, more than 60% of women had hemoglobin level estimates < or = 11.0 g/dl and 7.2% were Pf positive. Unmet need for contraceptives exceeded 60%. Violations of rights were widely reported: 32.1% of Karenni households reported forced labor and 10% of Karen households had been forced to move. Among Karen households, odds of anemia were 1.51 (95% confidence interval [CI] 0.95-2.40) times higher among women reporting forced displacement, and 7.47 (95% CI 2.21-25.3) higher among those exposed to food security violations. The odds of receiving no antenatal care services were 5.94 (95% CI 2.23-15.8) times higher among those forcibly displaced. CONCLUSIONS Coverage of basic maternal health interventions is woefully inadequate in these selected populations and substantially lower than even the national estimates for Burma, among the lowest in the region. Considerable political, financial, and human resources are necessary to improve access to maternal health care in these communities.
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Affiliation(s)
- Luke C Mullany
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Abstract
Motivation: We present a method for inferring and constructing transport reactions for transporter proteins based primarily on the analysis of the names of individual proteins in the genome annotation of an organism. Transport reactions are declarative descriptions of transporter activities, and thus can be manipulated computationally, unlike free-text protein names. Once transporter activities are encoded as transport reactions, a number of computational analyses are possible including database queries by transporter activity; inclusion of transporters into an automatically generated metabolic-map diagram that can be painted with omics data to aid in their interpretation; detection of anomalies in the metabolic and transport networks, such as substrates that are transported into the cell but are not inputs to any metabolic reaction or pathway; and comparative analyses of the transport capabilities of different organisms. Results: On randomly selected organisms, the method achieves precision and recall rates of 0.93 and 0.90, respectively in identifying transporter proteins by name within the complete genome. The method obtains 67.5% accuracy in predicting complete transport reactions; if allowance is made for predictions that are overly general yet not incorrect, reaction prediction accuracy is 82.5%. Availability: The method is implemented as part of PathoLogic, the inference component of the Pathway Tools software. Pathway Tools is freely available to researchers at non-commercial institutions, including source code; a fee applies to commercial institutions. Contact:tomlee@ai.sri.com Supplementary information:Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Thomas J Lee
- Artificial Intelligence Center, SRI International, Menlo Park, CA, USA.
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Mullany LC, Lee CI, Paw P, Shwe Oo EK, Maung C, Kuiper H, Mansenior N, Beyrer C, Lee TJ. The MOM Project: Delivering Maternal Health Services among Internally Displaced Populations in Eastern Burma. Reproductive Health Matters 2008; 16:44-56. [DOI: 10.1016/s0968-8080(08)31341-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
OBJECTIVE By functioning as a heat-shock protein (HSP), alpha-enolase has an important role in the pathophysiology of multivariant vasculitis. Kawasaki disease (KD) is a type of vasculitis occurring primarily in children. The role of alpha-enolase in KD was assessed by measuring anti-alpha-enolase antibody (Ab) titres in patients with KD and the usefulness of anti-alpha-enolase Ab as a diagnostic tool in atypical KD patients was evaluated. METHODS Anti-alpha-enolase Ab titres were measured by using an enzyme-linked immunosorbent assay (ELISA) in seven normal control patients, nine febrile control patients and 14 KD patients (10 typical KD, four atypical KD). A standard deviation (SD) of 3 above the mean of the normal control group was considered to be positive reactivity. Western blotting using recombinant human alpha-enolase was performed in four KD patients and three normal controls. RESULTS With the positive reactivity limited to +3 SD over the mean (>0.6), 10 out of 14 patients (71%) were positive at the acute onset and 12 out of 14 patients (85.7%) were positive before discharge. In total, 12 out of 14 patients (85.7%) were positive either at acute onset or before discharge. All four atypical KD patients showed positive reactivity. Specific positive bands against recombinant human alpha-enolase were detected by western blotting in all four KD patients, but no reactivity was seen in three patients with normal controls. CONCLUSION This is the first study to demonstrate that autoantibodies against the alpha-enolase are present in the sera of KD patients. We suggest that anti-alpha-enolase Ab should be a good candidate for a diagnostic tool in atypical KD.
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Affiliation(s)
- J-K Chun
- Department of Paediatrics, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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Mullany LC, Richards AK, Lee CI, Suwanvanichkij V, Maung C, Mahn M, Beyrer C, Lee TJ. Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma. J Epidemiol Community Health 2008; 61:908-14. [PMID: 17873229 PMCID: PMC2652972 DOI: 10.1136/jech.2006.055087] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Case reports of human rights violations have focused on individuals' experiences. Population-based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. OBJECTIVE We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma. METHODS Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. RESULTS Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one-third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. CONCLUSIONS Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.
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Affiliation(s)
- Luke C Mullany
- Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Richards AK, Smith L, Mullany LC, Lee CI, Whichard E, Banek K, Mahn M, Shwe Oo EK, Lee TJ. Prevalence of Plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data. Confl Health 2007; 1:9. [PMID: 17803819 PMCID: PMC2034373 DOI: 10.1186/1752-1505-1-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 09/05/2007] [Indexed: 11/29/2022] Open
Abstract
Background Burma records the highest number of malaria deaths in southeast Asia and may represent a reservoir of infection for its neighbors, but the burden of disease and magnitude of transmission among border populations of Burma remains unknown. Methods Plasmodium falciparum (Pf) parasitemia was detected using a HRP-II antigen based rapid test (Paracheck-Pf®). Pf prevalence was estimated from screenings conducted in 49 villages participating in a malaria control program, and four retrospective mortality cluster surveys encompassing a sampling frame of more than 220,000. Crude odds ratios were calculated to evaluate Pf prevalence by age, sex, and dry vs. rainy season. Results 9,796 rapid tests were performed among 28,410 villagers in malaria program areas through four years (2003: 8.4%, 95% CI: 8.3 – 8.6; 2004: 7.1%, 95% CI: 6.9 – 7.3; 2005:10.5%, 95% CI: 9.3 – 11.8 and 2006: 9.3%, 95% CI: 8.2 – 10.6). Children under 5 (OR = 1.99; 95% CI: 1.93 – 2.06) and those 5 to 14 years (OR = 2.24, 95% CI: 2.18 – 2.29) were more likely to be positive than adults. Prevalence was slightly higher among females (OR = 1.04, 95% CI: 1.02 – 1.06) and in the rainy season (OR = 1.48, 95% CI: 1.16 – 1.88). Among 5,538 rapid tests conducted in four cluster surveys, 10.2% were positive (range 6.3%, 95% CI: 3.9 – 8.8; to 12.4%, 95% CI: 9.4 – 15.4). Conclusion Prevalence of plasmodium falciparum in conflict areas of eastern Burma is higher than rates reported among populations in neighboring Thailand, particularly among children. This population serves as a large reservoir of infection that contributes to a high disease burden within Burma and likely constitutes a source of infection for neighboring regions.
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Affiliation(s)
- Adam K Richards
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 305 East 161Street, Bronx, USA 10451
- Global Health Access Program, Mae Sot, Thailand
| | - Linda Smith
- Global Health Access Program, Mae Sot, Thailand
- Planet Care/Global Health Access Program, 801 Cedar Street Suite 200, Berkeley, CA, USA 94710
| | - Luke C Mullany
- Global Health Access Program, Mae Sot, Thailand
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, USA 21205
| | - Catherine I Lee
- Global Health Access Program, Mae Sot, Thailand
- Planet Care/Global Health Access Program, 801 Cedar Street Suite 200, Berkeley, CA, USA 94710
| | - Emily Whichard
- Global Health Access Program, Mae Sot, Thailand
- Planet Care/Global Health Access Program, 801 Cedar Street Suite 200, Berkeley, CA, USA 94710
| | - Kristin Banek
- Global Health Access Program, Mae Sot, Thailand
- The MENTOR Initiative-Liberia, Monrovia, Liberia
- 15806 East Saratoga Place Aurora, CO 80015 USA
| | - Mahn Mahn
- Backpack Health Worker Team, 659, Moo 1 – Thasailuad, Mae Sot, Tak, Thailand, 63110
| | - Eh Kalu Shwe Oo
- Karen Department of Health and Welfare, No. 663 Moo 1 – Thasailuad, Asia High Way, Mae Sot, Tak, Thailand 63110
| | - Thomas J Lee
- Global Health Access Program, Mae Sot, Thailand
- Department of Medicine, University of California at Los Angeles, 924 Westwood Blvd. Suite 300, Los Angeles, CA, USA 90024
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Abstract
OBJECTIVE To determine whether serum levels of macrophage migration inhibitory factor (MIF) increase in patients with Kawasaki disease (KD) and also correlate with other inflammatory indices. METHODS Serum samples from 10 patients with KD, 15 normal healthy subjects, and seven febrile control subjects were assayed for MIF by enzyme-linked immunosorbent assay (ELISA). RESULTS There was a significant increase in the serum levels of MIF in the acute stage of KD [113.06 (range 20.6-157.36) ng/mL] compared with those in the subacute stage [28.11 (8.57-143.48) ng/mL, p<0.01], normal controls [12.95 (8.40-18.67) ng/mL, p<0.001], and febrile controls [36.58 (21.31-59.67) ng/mL, p = 0.01]. The increase in MIF correlated with an increase in interleukin-6 (IL-6) (r = 0.52, p = 0.047). CONCLUSION MIF may be a useful marker in the acute stage of KD and may provide important clues to the pathogenesis of this disease.
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Affiliation(s)
- T J Lee
- Department of Paediatrics, Institute for immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
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