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Gough M, Mills R, Brechany U, Nicholson C, Jenkins A, Hussain MA. Locating the ventral intermediate thalamic nucleus for deep brain stimulation surgery: analysis of a case series comparing CT and MR targeting. Br J Neurosurg 2024:1-6. [PMID: 38372013 DOI: 10.1080/02688697.2024.2313674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery targeting the ventral intermediate thalamic nucleus (Vim) has proven efficacy in the treatment of tremor. AIMS The primary aim is to investigate whether there is a statistically significant difference in patient outcomes when CT-guided targeting of the Vim is compared with MRI-guided targeting. METHODS This is a retrospective study concerning patients undergoing Vim-targeted DBS at the Department of Neurosurgery, Royal Victoria Infirmary in Newcastle (9th August 2012 to 4th January 2019). Fahn-Tolosa-Marin Tremor Scale (FTM TS) and EQ-5D scores were collected from patient notes. Statistical analysis was performed using IBM® SPSS® Statistics Version 24. Independent samples t-tests were used to compare means. RESULTS Independent samples t-test did not reveal a statistically significant difference between CT (n = 10; FTM TS mean = 65.40, SD = 11.40; EQ-5D mean = 39.50, SD = 17.87) and MR (n = 7; FTM TS mean = 60.57, SD = 7.50; EQ-5D mean = 32.14, SD = 9.94) groups in pre-surgery FTM TS (t(15) = 0.977, p = 0.344) and EQ-5D (t(15) = 0.982, p = 0.342) scores. No statistically significant difference between the CT (FTM TS mean = 24.12, SD = 20.47; EQ-5D mean = 75.56, SD = 15.63) and MR (FTM TS mean = 22.86, SD = 6.72; EQ-5D mean = 70.43, SD = 15.48) groups was revealed at 1 year assessment of FTM TS (t(14) = 0.155, p = 0.879) and EQ-5D (t(14) = 0.654, p = 0.524). The median difference between pre- and post-surgery FTM TS and EQ-5D scores in the CT group at 1 year was 43.00 and 35.00, respectively. The MR patient group median difference in pre- and post-surgery at 1 year was 35.00 and 35.00 respectively. CONCLUSION No statistically significant difference between CT and MR image-guided targeting patient groups was detected.
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Affiliation(s)
| | - Russell Mills
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Una Brechany
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Claire Nicholson
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Alistair Jenkins
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Mohammed Akbar Hussain
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Paranathala MP, Mills R, Rai P, Pavese N, Hussain MA, Duddy M, Nicholson C, Jenkins A. Patient selection and outcome of deep brain stimulation for multiple sclerosis-associated tremor. Br J Neurosurg 2023:1-6. [PMID: 37937771 DOI: 10.1080/02688697.2023.2277284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/22/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Tremor is a disabling symptom of multiple sclerosis (MS), with limited treatment modalities. Thalamic ventral-intermediate-nucleus (VIM) deep brain stimulation (DBS) is a method of neuromodulation. We describe the long-term outcomes of our carefully selected patients who underwent VIM DBS for their MS-associated tremor. METHODS Patients were referred from the regional neurology units. Pre-operative assessments included suitability for anesthesia, tremor quantification by the Fahn-Tolosa-Marin scores, and quality-of-life (EQ5D) measures. Exclusion criteria included prominent cerebellar symptoms such as ataxia and dysmetria, intracranial pathology such as ventriculomegaly, cerebellar plaques and thalamic abnormality, and comorbid psychiatric symptoms. Seven patients (3M:4F) underwent DBS for MS-associated tremor between September 2013 and February 2019. Mean age was 42 years (±SD 8 years). DBS was performed at a mean of 13 years (±SD 9 years) after diagnosis of MS. RESULTS There were no postoperative surgical complications. All patients showed improvement in FTM tremor scores, by up to 61% at 6 months postoperatively. There was an improvement of 30-175% in quality-of-life scores at 6 months. Improvement of tremor and quality of life, over baseline, was sustained over a long period of follow-up (mean 26.6 months ± SD 20.7 months), including our longest duration at 72 months. CONCLUSION With careful selection, DBS is a safe, efficacious intervention for MS-tremor and can positively impact on tremor and quality of life, with effects over a long period. As patients live longer with MS and the advent of new therapies, DBS should be considered for selected patients.
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Affiliation(s)
| | - Russell Mills
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Priya Rai
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
- Newcastle University Medical School, Newcastle, UK
| | - Nicola Pavese
- Department of Neurology, Royal Victoria Infirmary, Newcastle, UK
| | | | - Martin Duddy
- Department of Neurology, Royal Victoria Infirmary, Newcastle, UK
| | - Claire Nicholson
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
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Abdelazeem MH, Elwy R, Jenkins A, El Refaee E. Late Frontal Bone Reconstruction Using Three-dimensional Printed Models For Titanium Mesh Customization: A Case Series. World Neurosurg 2023:S1878-8750(23)00779-9. [PMID: 37302708 DOI: 10.1016/j.wneu.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The convex frontal bone is covered by thin skin rendering its reconstruction cosmetically challenging. Customized alloplastic implants provide better contouring than autologous bone, yet their high cost and availability limit their application. We assess customized titanium mesh implants pre-contoured using patient specific 3-D printed models for late frontal cranioplasty. METHODS We retrospectively analyzed the prospectively collected cases of unilateral frontal titanium mesh cranioplasty with 3-D printing assisted preplanning from 2017 to 2019. We used two 3-D printed patient specific skull models for preoperative planning: the mirrored normal model for implant contouring, and the defect model for edge trimming and fixation planning. The endoscope was used in four cases for percutaneous mesh fixation. We documented postoperative complications. We assessed the reconstruction symmetry clinically, and radiologically on postoperative computed tomography. RESULTS 15 patients were included. The duration after previous surgery ranged from 8-24 months. Four patients developed complications that were managed conservatively. Favorable cosmetic outcomes were achieved in all patients. CONCLUSIONS Pre-contouring of titanium mesh implants using in-house 3-D printed models could optimize cosmetic and surgical outcomes in late frontal cranioplasty. Preoperative planning could permit minimal access surgery that could be aided by the endoscope in select cases.
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Affiliation(s)
| | - Reem Elwy
- Department of Neurosurgery, Cairo University, Cairo, Egypt.
| | - Alistair Jenkins
- Department of Neurosurgery Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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Jordan JR, Miles BWJ, Gudmundsson GH, Jamieson SSR, Jenkins A, Stokes CR. Increased warm water intrusions could cause mass loss in East Antarctica during the next 200 years. Nat Commun 2023; 14:1825. [PMID: 37005432 PMCID: PMC10067810 DOI: 10.1038/s41467-023-37553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023] Open
Abstract
The East Antarctic Ice Sheet (EAIS) is currently surrounded by relatively cool water, but climatic shifts have the potential to increase basal melting via intrusions of warm modified Circumpolar Deep Water (mCDW) onto the continental shelf. Here we use an ice sheet model to show that under the current ocean regime, with only limited intrusions of mCDW, the EAIS will likely gain mass over the next 200 years due to the increased precipitation from a warming atmosphere outweighing increased ice discharge due to ice-shelf melting. However, if the ocean regime were to become dominated by greater mCDW intrusions, the EAIS would have a negative mass balance, contributing up to 48 mm of SLE over this time period. Our modelling finds George V Land to be particularly at risk to increased ocean induced melting. With warmer oceans, we also find that a mid range RCP4.5 emissions scenario is likely to result in a more negative mass balance than a high RCP8.5 emissions scenario, as the relative difference between increased precipitation due to a warming atmosphere and increased ice discharge due to a warming ocean is more negative in the mid range RCP4.5 emission scenario.
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Affiliation(s)
- James R Jordan
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.
- Laboratoire de Glaciologie, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - B W J Miles
- Department of Geography, Durham University, Durham, DH1 3LE, UK
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - G H Gudmundsson
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - S S R Jamieson
- Department of Geography, Durham University, Durham, DH1 3LE, UK
| | - A Jenkins
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - C R Stokes
- Department of Geography, Durham University, Durham, DH1 3LE, UK
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Kamal MA, Eltayeb M, Coulter I, Jenkins A. Surgical management of anterior sacral meningoceles: an illustrated case series and review of the literature. Br J Neurosurg 2023:1-7. [PMID: 36594268 DOI: 10.1080/02688697.2022.2162852] [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: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Anterior sacral meningocele (ASM) is an uncommon variant of spinal dysraphism. Surgical correction for this condition is challenging and optimal corrective approaches are uncertain. OBJECTIVE To share our experience of managing this rare condition using the posterior trans-sacral approach and provide a contemporary review of the literature. METHODS Retrospective review of case notes, operative records, and imaging of eligible patients treated via the posterior trans-sacral approach between 2006 and 2020 at our regional neurosciences centre. RESULTS Three patients, two females and one male with a mean age of 30 years (range 16-38), were treated. Presenting symptoms included lower abdominal pain and recurrent miscarriages. Patients underwent corrective surgery using the posterior approach involving a sacral laminectomy, durotomy and closure of the communicating fistula. A single patient required reoperation due to early recurrence. Another patient proved challenging because of a very large sacral fistula and required two procedures due to the development of high-pressure headaches secondary to a recurrence. All patients improved symptomatically postoperatively and remained symptom free at the last clinic follow-up and have been discharged. Following review of the literature, only two other non-syndromic cases have been described. CONCLUSIONS ASM is an uncommon congenital abnormality, typically presenting with mass effect symptoms secondary to a presacral cystic mass. Surgical management using a posterior approach to close the meningeal sac is feasible and less invasive than an anterior approach. Long term clinical outcomes in our series were satisfactory.
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Affiliation(s)
- Muhmmad Ahmad Kamal
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Mohamed Eltayeb
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Ian Coulter
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Hospital, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
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van de Wal RSW, Nicholls RJ, Behar D, McInnes K, Stammer D, Lowe JA, Church JA, DeConto R, Fettweis X, Goelzer H, Haasnoot M, Haigh ID, Hinkel J, Horton BP, James TS, Jenkins A, LeCozannet G, Levermann A, Lipscomb WH, Marzeion B, Pattyn F, Payne AJ, Pfeffer WT, Price SF, Seroussi H, Sun S, Veatch W, White K. A High-End Estimate of Sea Level Rise for Practitioners. Earths Future 2022; 10:e2022EF002751. [PMID: 36590252 PMCID: PMC9787942 DOI: 10.1029/2022ef002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
Sea level rise (SLR) is a long-lasting consequence of climate change because global anthropogenic warming takes centuries to millennia to equilibrate for the deep ocean and ice sheets. SLR projections based on climate models support policy analysis, risk assessment and adaptation planning today, despite their large uncertainties. The central range of the SLR distribution is estimated by process-based models. However, risk-averse practitioners often require information about plausible future conditions that lie in the tails of the SLR distribution, which are poorly defined by existing models. Here, a community effort combining scientists and practitioners builds on a framework of discussing physical evidence to quantify high-end global SLR for practitioners. The approach is complementary to the IPCC AR6 report and provides further physically plausible high-end scenarios. High-end estimates for the different SLR components are developed for two climate scenarios at two timescales. For global warming of +2°C in 2100 (RCP2.6/SSP1-2.6) relative to pre-industrial values our high-end global SLR estimates are up to 0.9 m in 2100 and 2.5 m in 2300. Similarly, for a (RCP8.5/SSP5-8.5), we estimate up to 1.6 m in 2100 and up to 10.4 m in 2300. The large and growing differences between the scenarios beyond 2100 emphasize the long-term benefits of mitigation. However, even a modest 2°C warming may cause multi-meter SLR on centennial time scales with profound consequences for coastal areas. Earlier high-end assessments focused on instability mechanisms in Antarctica, while here we emphasize the importance of the timing of ice shelf collapse around Antarctica. This is highly uncertain due to low understanding of the driving processes. Hence both process understanding and emission scenario control high-end SLR.
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Affiliation(s)
- R. S. W. van de Wal
- Institute for Marine and Atmospheric Research UtrechtUtrecht UniversityTA UtrechtThe Netherlands
- Department of Physical GeographyUtrecht UniversityTA UtrechtThe Netherlands
| | - R. J. Nicholls
- Tyndall Centre for Climate Change ResearchUniversity of East AngliaNorwichUK
| | - D. Behar
- San Francisco Public Utilities CommissionSan FranciscoCAUSA
| | - K. McInnes
- Climate Change Research CentreUNSW AustraliaSydneyNSWAustralia
| | - D. Stammer
- Centrum für Erdsystemforschung und NachhaltigkeitUniversität HamburgHamburgGermany
| | - J. A. Lowe
- Met Office Hadley CentreExeterUK
- Priestley CentreUniversity of LeedsLeedsUK
| | - J. A. Church
- Climate Change Research CentreUNSW AustraliaSydneyNSWAustralia
- Australian Centre for Excellence in Antarctic Science (ACEAS)University of TasmaniaHobartTASAustralia
| | - R. DeConto
- Department of GeosciencesUniversity of Massachusetts‐AmherstAmherstMAUSA
| | - X. Fettweis
- Department of GeographySPHERES Research UnitUniversity of LiègeLiègeBelgium
| | - H. Goelzer
- NORCE Norwegian Research CentreBjerknes Centre for Climate ResearchBergenNorway
| | | | - I. D. Haigh
- School of Ocean and Earth ScienceUniversity of SouthamptonNational Oceanography CentreSouthamptonUK
| | - J. Hinkel
- Adaptation and Social LearningGlobal Climate ForumBerlinGermany
| | - B. P. Horton
- Earth Observatory of SingaporeNanyang Technological UniversitySingaporeSingapore
- Asian School of the EnvironmentNanyang Technological UniversitySingaporeSingapore
| | - T. S. James
- Natural Resources CanadaGeological Survey of CanadaSidneyBCCanada
| | - A. Jenkins
- Department of Geography and Environmental SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - G. LeCozannet
- Coastal Risks and Climate Change UnitRisks and Prevention DivisionBRGMOrléansFrance
| | - A. Levermann
- Potsdam Institute for Climate Impact ResearchPotsdamGermany
- LDEOColumbia UniversityNew YorkNYUSA
- Physics InstituteUniversity of PotsdamPotsdamGermany
| | - W. H. Lipscomb
- Climate and Global Dynamics LaboratoryNational Center for Atmospheric ResearchBoulderCOUSA
| | - B. Marzeion
- Institute of Geography and MARUM ‐ Center for Marine Environmental SciencesUniversity of BremenBremenGermany
| | - F. Pattyn
- Laboratoire de GlaciologieUniversité libre de BruxellesBrusselsBelgium
| | - A. J. Payne
- School of Geographical SciencesUniversity of BristolBristolUK
| | - W. T. Pfeffer
- INSTAAR and Department of Civil, Environmental, Architectural EngineeringUniversity of ColoradoBoulderCOUSA
| | - S. F. Price
- Theoretical DivisionLos Alamos National LaboratoryLos AlamosNMUSA
| | - H. Seroussi
- Thayer School of EngineeringDartmouth CollegeHanoverNHUSA
| | - S. Sun
- Coastal Risks and Climate Change UnitRisks and Prevention DivisionBRGMOrléansFrance
| | - W. Veatch
- US Army Corps of Engineers, HeadquartersWashingtonDCUSA
| | - K. White
- US Department of DefenseOffice of the Deputy Assistant Secretary of Defense (Environment and Energy Resilience)DCWashingtonUSA
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Liu CY, Russin J, Adelson DP, Jenkins A, Hilmi O, Brown B, Lega B, Whitworth T, Bhattacharyya D, Schwartz TH, Krishna V, Williams Z, Uff C, Willie J, Hoffman C, Vandergrift WA, Achrol AS, Ali R, Konrad P, Edmonds J, Kim D, Bhatt P, Tarver BW, Pierce D, Jain R, Burress C, Casavant R, Prudente CN, Engineer ND. Vagus nerve stimulation paired with rehabilitation for stroke: Implantation experience from the VNS-REHAB trial. J Clin Neurosci 2022; 105:122-128. [PMID: 36182812 DOI: 10.1016/j.jocn.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vagus Nerve Stimulation (VNS) paired with rehabilitation delivered by the Vivistim® Paired VNS™ System was approved by the FDA in 2021 to improve motor deficits in chronic ischemic stroke survivors with moderate to severe arm and hand impairment. Vagus nerve stimulators have previously been implanted in over 125,000 patients for treatment-resistant epilepsy and the surgical procedure is generally well-tolerated and safe. In this report, we describe the Vivistim implantation procedure, perioperative management, and complications for chronic stroke survivors enrolled in the pivotal trial. METHODS The pivotal, multisite, randomized, triple-blind, sham-controlled trial (VNS-REHAB) enrolled 108 participants. All participants were implanted with the VNS device in an outpatient procedure. Thrombolytic agents were temporarily discontinued during the perioperative period. Participants were discharged within 48 hrs and started rehabilitation therapy approximately 10 days after the Procedure. RESULTS The rate of surgery-related adverse events was lower than previously reported for VNS implantation for epilepsy and depression. One participant had vocal cord paresis that eventually resolved. There were no serious adverse events related to device stimulation. Over 90% of participants were taking antiplatelet drugs (APD) or anticoagulants and no adverse events or serious adverse events were reported as a result of withholding these medications during the perioperative period. CONCLUSIONS This study is the largest, randomized, controlled trial in which a VNS device was implanted in chronic stroke survivors. Results support the use of the Vivistim System in chronic stroke survivors, with a safety profile similar to VNS implantations for epilepsy and depression.
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Affiliation(s)
- Charles Y Liu
- USC Neurorestoration Center and Department of Neurological Surgery, USC Keck School of Medicine, Los Angeles, CA, USA; Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.
| | - Jonathan Russin
- USC Neurorestoration Center and Department of Neurological Surgery, USC Keck School of Medicine, Los Angeles, CA, USA; Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - David P Adelson
- Barrow Neurological Institute, Phoenix Children's Hospital, University of Arizona, Phoenix, USA
| | - Alistair Jenkins
- Royal Victoria Infirmary Newcastle, Newcastle upon Tyne, England, UK
| | - Omar Hilmi
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | | | | | | | | | | | - Christopher Uff
- Royal London Hospital and Major Trauma Centre. Whitechapel, London, E1 1FR, UK
| | | | | | | | | | - Rushna Ali
- Department of Neurosciences, Spectrum Health, Grands Rapids, MI, USA
| | | | | | | | | | | | | | - Ravi Jain
- MicroTransponder Inc, Austin, TX, USA
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Garozzo D, Rispoli R, Graziano F, Gerardi RM, Grotenhuis A, Jenkins A, Sammons V, Visocchi M, Pinazzo S, Lima R, Martinez F, Emamhadi M, Pedro MT, Shirwari HS, Guedes F, Bhagavatula ID, Shukla DP, Bhat ID, Ojo OA, Tirsit A, Gonzales-Gonzales ME, Luna F, Kretschmer T, Benzel E, Cappelletto B. Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future. Front Surg 2022; 9:908540. [PMID: 35836607 PMCID: PMC9274114 DOI: 10.3389/fsurg.2022.908540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.
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Affiliation(s)
- D Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, UAE
| | - R Rispoli
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Graziano
- Department of Neurosurgery, ARNAS Garibaldi Hospital, Catania, Italy
| | - R M Gerardi
- Department of Neurosurgery, University Hospital, Palermo, Italy
| | - A Grotenhuis
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - A Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - V Sammons
- Department of Neurosurgery, North Shore Private Hospital, Sydney, Australia
| | - M Visocchi
- Department of Neurosurgery, Agostino Gemelli IRCCS, Rome, Italy
| | - S Pinazzo
- Department of Neurosurgery, Hospital Maciel, Montevideo, Uruguay
| | - R Lima
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - F Martinez
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - M Emamhadi
- Brachial plexus and peripheral nerve injury center, Guilan University of Medical Sciences, Rasht, Iran
| | - M T Pedro
- Peripheral Nerve Unit, Department of Neurosurgery, BKH Günzburg at Ulm University, Günzburg, Germany
| | - H S Shirwari
- Department of Neurosurgery, Dawodzai Medical Complex, Jalalabad, Afghanistan
| | - F Guedes
- Division of Neurosurgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - D P Shukla
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - I D Bhat
- Department of Neurosurgery, RV Astor Hospital Sarakki Jp Nagar, Bengaluru, India
| | - O A Ojo
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Tirsit
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Gonzales-Gonzales
- Department of Neurosurgery, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
| | - F Luna
- Departament of Neurosurgery, Hospital Clínico Regional de Concepción, Universidad de Concepción. Concepcion, Chile
| | - T Kretschmer
- Dept. of Neurosurgery & Neurorestoration, Neurosurgical Intensive Care, Neurooncological Centre (DKG) Klinikum Klagenfurt, Klagenfurt, Austria
| | - E Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States of America
| | - B Cappelletto
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
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11
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Solomou G, Venkatesh A, Patel W, Chari A, Mohan M, Bandyopadhyay S, Gillespie CS, Mendoza N, Watts C, Jenkins A. A career in neurosurgery: perceptions and the impact of a national SBNS/NANSIG neurosurgery careers day. Br J Neurosurg 2022; 36:620-626. [PMID: 35603975 DOI: 10.1080/02688697.2022.2076807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Entrance to neurosurgical training is highly competitive. Without proper advice, information and opportunities, talented individuals may be dissuaded from applying. The Neurology and Neurosurgery Interest Group (NANSIG) organises a Careers Day in Neurosurgery every year. Our objective was to assess the overall utility of a neurosurgery careers day and the perceived factors that attract and detract from the specialty, from attendees of the ninth annual neurosurgery careers day. METHODS Eighteen-item pre-conference and 19-item post-conference questionnaires were disseminated electronically to conference attendees. Questions aimed to capture: (i) baseline demographics; (ii) previous experience and exposure in neurosurgery; (iii) interest in neurosurgery; (iv) understanding training and a career in neurosurgery; (v) perceived factors of attraction and dissuasion of neurosurgery; and (vi) perceived value, quality and educational purpose of the conference. RESULTS In total, 77 delegates attended the careers day. Most did not have a formal neurosurgical rotation during medical school (24.7%, n = 19), but almost half had gained neurosurgical experience and presented research work. The careers day increased knowledge of the neurosurgical application process (median Likert score 3/5 to 4/5, p < 0.01), duration of training (72.7-88.3%), and desire to pursue a career in neurosurgery (75.3-81.8%). The most commonly reported factors attracting delegates to neurosurgery were interest in neuroanatomy (80.5%, n = 62), practical skills (64.9%, n = 50), and impact on patients (62.3%, n = 48). The most common dissuasive factors were competition to entry (64.9%, n = 50), long working hours (40.3%, n = 31), and other career interests (35.1%, n = 27). Almost all would recommend the event to a colleague (94.9%, n = 73). CONCLUSIONS Formal undergraduate exposure to neurosurgery is limited. Neurosurgery careers days increase awareness and understanding of the application process and improve interest in a selected cohort. The factors attracting applicants to neurosurgery remain practical links to neuroanatomy, opportunities in neurosurgery for innovation and research, and direct impact on patients.
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Affiliation(s)
- Georgios Solomou
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ashwin Venkatesh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Waqqas Patel
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aswin Chari
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Midhun Mohan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Nigel Mendoza
- West London Neurosciences Unit, Charing Cross Hospital NHS Trust, London, UK
| | - Colin Watts
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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12
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Hasanain AA, Soliman MAR, Elwy R, Ezzat AAM, Abdel-Bari SH, Marx S, Jenkins A, El Refaee E, Zohdi A. An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article. Br J Neurosurg 2022; 36:329-339. [PMID: 35579079 DOI: 10.1080/02688697.2022.2074373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Congenital hydrocephalus affects approximately one in 1000 newborn children and is fatal in approximately 50% of untreated cases. The currently known management protocols usually necessitate multiple interventions and long-term use of healthcare resources due to a relatively high incidence of complications, and many of them mostly provide a treatment of the effect rather than the cause of cerebrospinal fluid flow reduction or outflow obstruction. Future studies discussing etiology specific hydrocephalus alternative treatments are needed. We systematically reviewed the available literature on the effect of ciliary abnormality on congenital hydrocephalus pathogenesis, to open a discussion on the feasibility of factoring ciliary abnormality in future research on hydrocephalus treatment modalities. Although there are different forms of ciliopathies, we focused in this review on primary ciliary dyskinesia. There is growing evidence of association of other ciliary syndromes and hydrocephalus, such as the reduced generation of multiple motile cilia, which is distinct from primary ciliary dyskinesia. Data for this review were identified by searching PubMed using the search terms 'hydrocephalus,' 'Kartagener syndrome,' 'primary ciliary dyskinesia,' and 'immotile cilia syndrome.' Only articles published in English and reporting human patients were included. Seven studies met our inclusion criteria, reporting 12 cases of hydrocephalus associated with primary ciliary dyskinesia. The patients had variable clinical presentations, genetic backgrounds, and ciliary defects. The ependymal water propelling cilia differ in structure and function from the mucus propelling cilia, and there is a possibility of isolated non-syndromic ependymal ciliopathy causing only hydrocephalus with growing evidence in the literature for the association ependymal ciliary abnormality and hydrocephalus. Abdominal and thoracic situs in children with hydrocephalus can be evaluated, and secondary damage of ependymal cilia causing hydrocephalus in cases with generalized ciliary abnormality can be considered.
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Affiliation(s)
| | - Mohamed A R Soliman
- Department of Neurosurgery, Cairo University, Cairo, Egypt.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Reem Elwy
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Alistair Jenkins
- Department of Neurosurgery Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt.,Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Ahmed Zohdi
- Department of Neurosurgery, Cairo University, Cairo, Egypt
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13
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Park JJ, Ooi SZY, Gillespie CS, Bandyopadhyay S, Chowdhury YA, Solomou G, Gough M, Kanmounye US, Yanez Touzet A, Poon MTC, Demetriades AK, Jenkinson MD, Jenkins A. The Neurology and Neurosurgery Interest Group (NANSIG)-ten years of cultivating interest in clinical neurosciences. Acta Neurochir (Wien) 2022; 164:937-946. [PMID: 35039958 PMCID: PMC8763620 DOI: 10.1007/s00701-022-05113-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/02/2022] [Indexed: 11/03/2022]
Abstract
Collaboration and successful teamworking are important components of clinical practise, and these skills should be cultivated early in medical school. The breadth of current medical school curricula means that students often have limited exposure to clinical neurosciences. Since its inception in 2009, the Neurology and Neurosurgery Interest Group (NANSIG) has become a national (UK and Republic of Ireland) example of student and junior doctor synergistic collaboration to deliver educational materials, research, conferences, seminars and workshops, as well as advocating for diversity in this field. Recently, it has expanded to incorporate an international audience and cater for a larger group of young medical professionals. The organisation has overcome numerous challenges and is constantly innovating new approaches to harness the necessary knowledge, skills and network to succeed in a career in neurosciences, neurology and neurosurgery. This article summarises the initiatives undertaken by the group over its first 10 years of existence and its organisational structure, as well as its future plans.
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Affiliation(s)
- Jay J Park
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Setthasorn Zhi Yang Ooi
- Cardiff University School of Medicine, University Hospital of Wales Main Building, Heath Park, Cardiff, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | - Yasir A Chowdhury
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Melissa Gough
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael T C Poon
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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14
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Jenkins A. Obituary - Rab Hide (1935-2020). Br J Neurosurg 2022. [PMID: 35021952 DOI: 10.1080/02688697.2021.2016130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Richardson GE, Gillespie CS, Bandyopadhyay S, Norton EJ, Joshi JM, Mantle O, Ciuculete C, Nazari A, Ong J, Anand A, Park J, De Koning R, Ooi SZY, Erhabor J, Daler HK, Borbas B, Sibanda Z, Lerou I, Touzet AY, Mcelnay P, Murray S, Hutchinson PJ, Jenkins A. Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience. Cureus 2022; 14:e21162. [PMID: 35165612 PMCID: PMC8836971 DOI: 10.7759/cureus.21162] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. Methods: Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. Results: The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day. Conclusions: The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return.
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16
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Curl C, Varma U, Raaijmakers A, Hemphill K, Janssens J, Jenkins A, Mellor K, Delbridge L. Treatment of Type 1 Diabetes With Metformin Reduces Diastolic Dysfunction and Cardiac Lipid Accumulation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Paranathala MP, Crossman J, Jenkins A. Delayed presentation of bamboo foreign body in brainstem, with novel skull base foramen. Br J Neurosurg 2021:1-3. [PMID: 34806507 DOI: 10.1080/02688697.2021.2005779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
We describe the extremely unusual case of a childhood injury to the skull base presenting after many years, as a foreign body with chronic granulomatous infection of the brainstem, mimicking neoplasm. TB had an inconsequential penetrating injury to the left cheek, from a bamboo spike aged 15. After 4 years, he developed worsening left sided weakness, imaging at this time was normal. After a car accident aged 40, the weakness worsened further and imaging demonstrated a foreign body entering the skull base. At its tip, it had caused a chronic granulomatous reaction within the brainstem. Surgical removal of this bamboo splinter was via an infratemporal, transzygomatic craniotomy and TB made a good recovery postoperatively. This unusual case demonstrates the important of close inspection of imaging, and thorough history taking. It also questions the chronology of the ossification of the skull base.
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Affiliation(s)
| | - John Crossman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
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18
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: an ARISTOPHANES analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0574] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patient-centered outcomes, such as home time, are becoming increasingly important quality-of-life measures. There are limited data on the impact of oral anticoagulants (OACs) on home time among patients with non-valvular atrial fibrillation.
Purpose
This analysis, based on the previously published ARISTOPHANES study, used five US insurance claims databases (CMS Medicare and four commercial databases) to compare home time among NVAF patients who were prescribed non-vitamin K antagonist OACs (NOACs).
Methods
Adult NVAF patients who were newly prescribed apixaban, dabigatran, or rivaroxaban (01JAN2013–30SEP2015) were selected. Time at home was calculated as the number of days from the index date (NOAC prescription) without any of the following: an inpatient, skilled nursing facility (SNF) or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days from index date without any events from the home time endpoint or any days with a claim for bleeding, stroke/systemic embolism (S/SE), AF, or an INR test. Time at home and without external AF-related care were measured during the 180 days of follow-up; patients were required to have been alive and have 180 days of follow-up post index. In each database, three 1:1 NOAC-NOAC propensity-score-matched (PSM) cohorts were created before combining the databases. For each NOAC-NOAC matched cohort, Poisson regression was conducted to compare time at home and time at home without external AF-related care.
Results
After PSM, 37,314 apixaban-dabigatran, 107,236 apixaban-rivaroxaban, and 37,693 rivaroxaban-dabigatran patient pairs were created of which 37–44% had 180 days of follow-up available. Across the NOAC cohorts, approximately 21–25% of patients had an admission to a hospital, SNF, nursing facility, rehabilitation center, or hospice during the 180-day follow-up. The time at home was generally consistent between the NOAC cohorts (177 days); however, apixaban patients had 0.5 more days at home compared to rivaroxaban patients. Across all NOAC cohorts, 7–8% had a claim for a S/SE, 11–15% had a claim for bleeding, and 15–22% had an INR test, while 87–89% of all patients had an AF-claim during the 180-day follow-up. Patients prescribed apixaban had 1 more day at home without external AF-related care compared to dabigatran, and 1.5 more days at home without external AF-related care compared to rivaroxaban. Dabigatran had <1 more day at home without external AF-related care compared to rivaroxaban.
Conclusion
Among NVAF patients treated with NOACs, there were small differences in the time at home and time at home without external AF-related care during the first 6 months of NOAC treatment. As NVAF is a chronic condition, it is important to understand the impact of NOAC treatment on these patient-centered outcomes.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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19
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants versus warfarin. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0573] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical trials and real-world database studies have shown the benefits of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin; however, measures of functional outcomes are critical in evaluating a patient's quality of life. Previous measures of time spent out of hospital in a home setting and time spent receiving disease-related care among non-valvular atrial fibrillation (NVAF) patients are lacking in the current literature.
Purpose
This analysis was based on the previously published ARISTOPHANES study, and used multiple data sources to evaluate the amount of time spent at a patient's home among NVAF patients who were prescribed NOACs versus warfarin.
Methods
This retrospective observational study used US data from CMS Medicare and four commercial databases to select adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30SEP2015). Time at home and time at home without external AF-related care were measured during the 180 days after the index date (OAC prescription). Time at home was defined as days from index date without any of the following: an inpatient, skilled nursing facility or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days away from home and days with a claim for bleeding, stroke/systemic embolism, AF, or an INR test. Each day a claim was observed was counted as one day. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. After PSM, a subgroup of patients who were alive and had ≥180 days of follow-up was created. Poisson regression was conducted in each NOAC-warfarin matched cohort to compare time at home and time at home without external AF-related care.
Results
After matching, a total of 100,977 apixaban-warfarin, 36,990 dabigatran-warfarin, and 125,068 rivaroxaban-warfarin patient pairs were selected. Of those patients, 38–46% had 180 days of follow-up available. Across treatment cohorts, approximately 75% of patients were at home for the 180-day follow-up. Apixaban, dabigatran, and rivaroxaban patients had 1.3, 0.9, and 0.8 more days at home, respectively, compared to warfarin patients. Patients treated with apixaban had 13.4 more days at home without AF-related care compared to warfarin, while dabigatran and rivaroxaban had 11.6 and 11.7 more days at home without AF-related care compared to warfarin. A greater proportion of warfarin patients than NOAC patients had an INR test (81–82% vs 14–21%), and days with INR testing were the main driver for external AF-related care for warfarin patients.
Conclusion
Among NVAF patients treated with OACs, NOACs were associated with a longer time at home and time at home without external AF-related care compared to warfarin. These results can help inform healthcare providers and patients regarding the impact of NOAC treatment in NVAF patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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20
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Rojas-Villabona A, Magnaye L, Jenkins A, Surash S. Two cases of asymptomatic Teflon granulomas following microvascular decompression mimicking cerebellopontine angle tumours: lessons learnt in the neuro-oncology multidisciplinary team. Ann R Coll Surg Engl 2021; 103:e324-e326. [PMID: 34414772 DOI: 10.1308/rcsann.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present the cases of two patients with asymptomatic Teflon granulomas which were incidentally found years after microvascular decompression and presented to the neuro-oncology multidisciplinary team as possible cerebellopontine angle tumours. Teflon granulomas can be asymptomatic and they can radiologically resemble cerebellopontine angle tumours. It is important that all relevant information is available to the neuro-oncology multidisciplinary team for adequate assessment and appropriate treatment recommendations.
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Affiliation(s)
| | - L Magnaye
- University of Newcastle, Newcastle Upon Tyne, UK
| | - A Jenkins
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S Surash
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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21
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22
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Ige TA, Jenkins A, Burt G, Angal-Kalinin D, McIntosh P, Coleman CN, Pistenmaa DA, O'Brien D, Dosanjh M. Surveying the Challenges to Improve Linear Accelerator-based Radiation Therapy in Africa: a Unique Collaborative Platform of All 28 African Countries Offering Such Treatment. Clin Oncol (R Coll Radiol) 2021; 33:e521-e529. [PMID: 34116903 DOI: 10.1016/j.clon.2021.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate and service, especially for low- and middle-income countries (LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime. A global initiative was launched in 2016 to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognised that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries. This report presents the method used to conduct this multilevel study of the macro- and microenvironments, the organisation of departments, the technology, the training and the service models that will provide input into the design of a LINAC prototype for a LINAC-based radiation therapy system that will improve access to radiation therapy and thus improve cancer treatment outcomes. It is important to note that new technology should be introduced in a contextual manner so as not to disrupt existing health systems inadvertently, especially with regards to existing staffing, infrastructure and socioeconomic issues. A detailed analysis of data is underway and will be presented in a follow-up report. Selected preliminary results of the study are the observation that LINAC-based facilities in LMICs experience downtime associated with failures in multileaf collimators and vacuum pumps, as well as power instability. Also, that there is a strong association of gross national product per capita with the number of LINACs per population.
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Affiliation(s)
- T A Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - G Burt
- University of Lancaster, Lancaster, UK
| | | | - P McIntosh
- STFC Daresbury Laboratory, Warrington, UK
| | - C N Coleman
- International Cancer Expert Corps, Washington, DC, USA
| | - D A Pistenmaa
- International Cancer Expert Corps, Washington, DC, USA
| | - D O'Brien
- International Cancer Expert Corps, Washington, DC, USA
| | - M Dosanjh
- University of Oxford, Oxford, UK; International Cancer Expert Corps, Washington, DC, USA; CERN, Geneva, Switzerland.
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Connelly A, Thwaites V, Turnbull H, Neil J, Walker K, Short A, Keast T, Sweeney L, Jenkins A. P.29 Predicting post-delivery anaemia: Development of the MABL table. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bandyopadhyay S, Khan DZ, Marcus HJ, Schroeder BE, Patel V, O'Donnell A, Ahmed S, Alalade AF, Ali AM, Allison C, Al-Barazi S, Al-Mahfoudh R, Amarouche M, Bahl A, Bennett D, Bhalla R, Bhatt P, Boukas A, Cabrilo I, Chadwick A, Chowdhury YA, Choi D, Cudlip SA, Donnelly N, Dorward NL, Dow G, Fountain DM, Grieve J, Giamouriadis A, Gilkes C, Gnanalingham K, Halliday J, Hanna B, Hayhurst C, Hempenstall J, Henderson D, Hossain-Ibrahim K, Hirst T, Hughes M, Javadpour M, Jenkins A, Kamel M, Mannion RJ, Kolias AG, Khan MH, Khan MS, Lacy P, Mahmood S, Maratos E, Martin A, Mathad N, McAleavey P, Mendoza N, Millward CP, Mirza S, Muquit S, Murray D, Naik PP, Nair R, Nicholson C, Paluzzi A, Pathmanaban O, Paraskevopoulos D, Pollock J, Phillips N, Piper RJ, Ram B, Robertson I, Roman E, Ross P, Santarius T, Sayal P, Shapey J, Sharma R, Shaw S, Shoakazemi A, Shumon S, Sinha S, Solomou G, Soon WC, Stapleton S, Statham P, Stew B, Thomas N, Tsermoulas G, Tysome JR, Varma A, Weir P, Williams A, Youssef M, Veljanoski D. CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 2: Impact of COVID-19. World Neurosurg 2021; 149:e1090-e1097. [PMID: 33444833 PMCID: PMC7965443 DOI: 10.1016/j.wneu.2020.12.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised regarding the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, especially during endonasal neurosurgical operations. The Pituitary Society has produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the effects of COVID-19. METHODS A multicenter prospective observational cohort study was conducted at 12 tertiary neurosurgical units (United Kingdom and Ireland). Data were collected from March 23 to July 31, 2020, inclusive. The data points collected included patient demographics, preoperative COVID-19 test results, operative modifications, and 30-day COVID-19 infection rates. RESULTS A total of 124 patients were included. Of the 124 patients, 116 (94%) had undergone COVID-19 testing preoperatively (transsphenoidal approach, 97 of 105 [92%]; expanded endoscopic endonasal approach, 19 of 19 [100%]). One patient (1 of 116 [0.9%]) had tested positive for COVID-19 preoperatively, requiring a delay in surgery until the infection had been confirmed as resolved. Other than transient diabetes insipidus, no other complications were reported for this patient. All operating room staff had worn at least level 2 personal protective equipment. Adaptations to surgical techniques included minimizing drilling, draping modifications, and the use of a nasal iodine wash. At 30 days postoperatively, no evidence of COVID-19 infection (symptoms or positive formal testing results) were found in our cohort and no mortality had occurred. CONCLUSIONS Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with the Pituitary Society guidelines followed for most of these operations. We found no evidence of COVID-19 infection in our cohort and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves.
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25
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Hemphill K, Varma U, Curl C, Raaijmakers H, Bernasochi G, Mellor K, Jenkins A, Delbridge L. Molecular Mechanisms of Cardio-Protection Conferred By Metformin in Type 1 Diabetes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Khan DZ, Bandyopadhyay S, Patel V, Schroeder BE, Cabrilo I, Choi D, Cudlip SA, Donnelly N, Dorward NL, Fountain DM, Grieve J, Halliday J, Kolias AG, Mannion RJ, O'Donnell A, Phillips N, Piper RJ, Ramachandran B, Santarius T, Sayal P, Sharma R, Solomou G, Tysome JR, Marcus HJ, Alalade AF, Ahmed S, Al-Barazi S, Al-Mahfoudh R, Bahl A, Bennett D, Bhalla R, Bhatt P, Dow G, Giamouriadis A, Gilkes C, Gnanalingham K, Hanna B, Hayhurst C, Hempenstall J, Hossain-Ibrahim K, Hughes M, Javadpour M, Jenkins A, Kamel M, Habibullah Khan M, Lacy P, Maratos E, Martin A, Mathad N, Mendoza N, Mirza S, Muquit S, Nair R, Nicholson C, Paluzzi A, Paraskevopoulos D, Pathmanaban O, Pollock J, Ram B, Robertson I, Ross P, Shaw S, Shoakazemi A, Sinha S, Stapleton S, Statham P, Stew B, Thomas N, Tsermoulas G, Weir P, Williams A. CSF rhinorrhoea after endonasal intervention to the anterior skull base (CRANIAL): proposal for a prospective multicentre observational cohort study. Br J Neurosurg 2020; 35:408-417. [PMID: 32909855 DOI: 10.1080/02688697.2020.1795622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The endonasal transsphenoidal approach (TSA) has emerged as the preferred approach in order to treat pituitary adenoma and related sellar pathologies. The recently adopted expanded endonasal approach (EEA) has improved access to the ventral skull base whilst retaining the principles of minimally invasive surgery. Despite the advantages these approaches offer, cerebrospinal fluid (CSF) rhinorrhoea remains a common complication. There is currently a lack of comparative evidence to guide the best choice of skull base reconstruction, resulting in considerable heterogeneity of current practice. This study aims to determine: (1) the scope of the methods of skull base repair; and (2) the corresponding rates of postoperative CSF rhinorrhoea in contemporary neurosurgical practice in the UK and Ireland. METHODS We will adopt a multicentre, prospective, observational cohort design. All neurosurgical units in the UK and Ireland performing the relevant surgeries (TSA and EEA) will be eligible to participate. Eligible cases will be prospectively recruited over 6 months with 6 months of postoperative follow-up. Data points collected will include: demographics, tumour characteristics, operative data), and postoperative outcomes. Primary outcomes include skull base repair technique and CSF rhinorrhoea (biochemically confirmed and/or requiring intervention) rates. Pooled data will be analysed using descriptive statistics. All skull base repair methods used and CSF leak rates for TSA and EEA will be compared against rates listed in the literature. ETHICS AND DISSEMINATION Formal institutional ethical board review was not required owing to the nature of the study - this was confirmed with the Health Research Authority, UK. CONCLUSIONS The need for this multicentre, prospective, observational study is highlighted by the relative paucity of literature and the resultant lack of consensus on the topic. It is hoped that the results will give insight into contemporary practice in the UK and Ireland and will inform future studies.
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Affiliation(s)
- Danyal Z Khan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | | | - Vikesh Patel
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Ivan Cabrilo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - David Choi
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon A Cudlip
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil Donnelly
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | - Neil L Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Halliday
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Richard J Mannion
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Alice O'Donnell
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Clinical lead for Cranial Neurosurgery, Getting it Right First Time, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bhavna Ramachandran
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals Trust, Cambridge, UK
| | - Parag Sayal
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rishi Sharma
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | | | - James R Tysome
- Department of ENT Surgery, University of Cambridge and Cambridge University Hospitals, Cambridge, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Wang J, Bose S, Frenk CS, Gao L, Jenkins A, Springel V, White SDM. Universal structure of dark matter haloes over a mass range of 20 orders of magnitude. Nature 2020; 585:39-42. [PMID: 32879500 DOI: 10.1038/s41586-020-2642-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/23/2020] [Indexed: 11/09/2022]
Abstract
Cosmological models in which dark matter consists of cold elementary particles predict that the dark halo population should extend to masses many orders of magnitude below those at which galaxies can form1-3. Here we report a cosmological simulation of the formation of present-day haloes over the full range of observed halo masses (20 orders of magnitude) when dark matter is assumed to be in the form of weakly interacting massive particles of mass approximately 100 gigaelectronvolts. The simulation has a full dynamic range of 30 orders of magnitude in mass and resolves the internal structure of hundreds of Earth-mass haloes in as much detail as it does for hundreds of rich galaxy clusters. We find that halo density profiles are universal over the entire mass range and are well described by simple two-parameter fitting formulae4,5. Halo mass and concentration are tightly related in a way that depends on cosmology and on the nature of the dark matter. For a fixed mass, the concentration is independent of the local environment for haloes less massive than those of typical galaxies. Haloes over the mass range of 10-3 to 1011 solar masses contribute about equally (per logarithmic interval) to the luminosity produced by dark matter annihilation, which we find to be smaller than all previous estimates by factors ranging up to one thousand3.
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Affiliation(s)
- J Wang
- Key Laboratory for Computational Astrophysics, National Astronomical Observatories, Chinese Academy of Sciences, Beijing, China. .,School of Astronomy and Space Science, University of Chinese Academy of Sciences, Beijing, China.
| | - S Bose
- Center for Astrophysics
- Harvard and Smithsonian, Cambridge, MA, USA
| | - C S Frenk
- Institute for Computational Cosmology, Department of Physics, Durham University, Durham, UK.
| | - L Gao
- Key Laboratory for Computational Astrophysics, National Astronomical Observatories, Chinese Academy of Sciences, Beijing, China.,School of Astronomy and Space Science, University of Chinese Academy of Sciences, Beijing, China
| | - A Jenkins
- Institute for Computational Cosmology, Department of Physics, Durham University, Durham, UK
| | - V Springel
- Max-Planck-Institut für Astrophysik, Garching, Germany
| | - S D M White
- Max-Planck-Institut für Astrophysik, Garching, Germany.
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28
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Affiliation(s)
- Alistair Jenkins
- Department of Neurosurgery Royal Victoria Infirmary Newcastle-upon-Tyne, United Kingdom
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29
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Hvidsten D, Frafjord K, Gray JS, Henningsson AJ, Jenkins A, Kristiansen BE, Lager M, Rognerud B, Slåtsve AM, Stordal F, Stuen S, Wilhelmsson P. The distribution limit of the common tick, Ixodes ricinus, and some associated pathogens in north-western Europe. Ticks Tick Borne Dis 2020; 11:101388. [PMID: 32122808 DOI: 10.1016/j.ttbdis.2020.101388] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
In north-western Europe, the common tick, Ixodes ricinus, is widely established, its distribution appears to be increasing and the spread of tick-borne diseases is of increasing concern. The project 'Flått i Nord' (Ticks in northern Norway) commenced in spring 2009 with the intention of studying the tick's distribution and that of its pathogens in northern Norway. Several methods were used: cloth-dragging, collecting from trapped small mammals, and collecting from pets. Since 2010, the occurrence of ticks in the region of northern Norway was determined directly by cloth-dragging 167 times in 109 separate locations between the latitudes of 64 °N and 70 °N (included seven locations in the northern part of Trøndelag County). The northernmost location of a permanent I. ricinus population was found to be Nordøyvågen (66.2204 °N, 12.59 °E) on the Island of Dønna. In a sample of 518 nymphal and adult ticks, the Borrelia prevalence collected close to this distribution limit varied but was low (1-15 %) compared with the locations in Trøndelag, south of the study area (15-27 %). Five specimens (1 %) were positive for Rickettsia helvetica. The length of the vegetation growing season (GSL) can be used as an approximate index for the presence of established populations of I. ricinus. The present study suggests that the threshold GSL for tick establishment is about 170 days, because the median GSL from 1991 to 2015 was 174-184 days at sites with permanent tick populations, showing a clear increase compared with the period 1961-1990. This apparent manifestation of climate change could explain the northward extension of the range of I. ricinus.
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Affiliation(s)
- D Hvidsten
- University Hospital of North Norway, Department of Microbiology and Infection Control, Tromsø, Norway; Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway.
| | - K Frafjord
- UiT The Arctic University of Norway, Tromsø University Museum, Tromsø, Norway
| | - J S Gray
- University College Dublin, Dublin, Ireland
| | - A J Henningsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - A Jenkins
- University of South-Eastern Norway, Department of Natural Science and Environmental Health, Bø, Norway
| | | | - M Lager
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Rognerud
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - A M Slåtsve
- Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway
| | - F Stordal
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - S Stuen
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Section for Small Ruminants Research, Sandnes, Norway
| | - P Wilhelmsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Xu D, Jenkins A, Ryan C, Keech A, Brown A, Boffa J, O'Dea K, Bursell SE, Brazionis L. Health-related behaviours in a remote Indigenous population with Type 2 diabetes: a Central Australian primary care survey in the Telehealth Eye and Associated Medical Services Network [TEAMSnet] project. Diabet Med 2019; 36:1659-1670. [PMID: 31385331 DOI: 10.1111/dme.14099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2019] [Indexed: 12/01/2022]
Abstract
AIM There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. METHODS We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. RESULTS At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. CONCLUSIONS Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
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Affiliation(s)
- D Xu
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - A Jenkins
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - C Ryan
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Keech
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - J Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - K O'Dea
- The University of Melbourne, Melbourne, VIC
| | - S E Bursell
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
- Telehealth Research Institute, University of Hawaii, Hawaii, HI, USA
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31
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Johnsen S, Madsen M, Linder M, Sulo G, Ghanima W, Gislason G, Halvorsen S, Hohnloser SH, Jenkins A, Al-Khalili F, Tell GS, Ehrenstein V. P3470Comparative effectiveness and safety of non-vitamin K oral anticoagulants and warfarin in non-valvular atrial fibrillation - a cohort study in 3 Nordic countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-vitamin K oral anticoagulants (NOACs) are an alternative to warfarin in the prevention of stroke in non-valvular atrial fibrillation (NVAF). Nordic countries have high quality of warfarin treatment, making them an especially suitable setting for assessing effectiveness and safety of NOACs against warfarin.
Purpose
The BEYOND Pooled (BEnefit of NOACs studY of nOn-valvular AF patieNts in NorDic countries) study compared risks of ischaemic or haemorrhagic stroke/systemic embolism (S/SE), and risk of bleeding with acute hospitalisation with an overnight stay (bleeding) in NVAF patients treated with apixaban, dabigatran or rivaroxaban, each compared with warfarin treatment.
Methods
A cohort study of treatment-naïve adult NVAF patients dispensed apixaban, dabigatran, rivaroxaban or warfarin was identified from 01 Jan 2013 to 31 Dec 2016. The population and study variables were identified from national registries in Denmark, Norway and Sweden. After 1:1 propensity score (PS) matching for each NOAC-warfarin comparison, individual-level data were pooled across the countries. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (aHRs) of the endpoints.
Results
PS matched NOAC cohort sizes were: apixaban (55,696) dabigatran (28,526) and rivaroxaban (30,701), and the total follow-up in the PS-matched population was 291,171 years (mean 1.3 years). During the follow-up, 35,450 oral anticoagulation (OAC) patients had a S/SE and 38,620 OAC patients had bleeding. Adjusted HRs for the two endpoints are presented in the table. PH assumption has not been formally tested but cum incidence curves did not indicate substantial differences in the effects over time.
Table 1. Adjusted hazard ratios (aHR) of stroke/systemic embolism and bleeding for non-vitamin K oral anticoagulants versus warfarin Endpoint Apixaban vs Warfarin: aHR (95% CI) Dabigatran vs Warfarin: aHR (95% CI) Rivaroxaban vs Warfarin: aHR (95% CI) Stroke/SE 0.93 (0.85–1.03) 0.89 (0.80–1.00) 0.97 (0.88–1.08) Bleeding 0.72 (0.67–0.77) 0.87 (0.80–0.95) 1.12 (1.04–1.20)
Conclusions
Relative to warfarin, apixaban and dabigatran were associated with lower rates of bleeding whereas rivaroxaban was associated with a higher rate. The three NOACs had comparable rates of stroke and systemic embolism relative to warfarin.
Acknowledgement/Funding
This study was funded by the Pfizer/Bristol-Myers Squibb Alliance.
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Affiliation(s)
- S Johnsen
- Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M Linder
- Karolinska Institute, Centre for Pharmacoepidemiology, Stockholm, Sweden
| | - G Sulo
- Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway
| | - W Ghanima
- Oestfold Hospital Trust, Department of Hematology, Fredrikstad, Norway
| | - G Gislason
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - S Halvorsen
- Ulleval University Hospital, Department of Cardiology, Oslo, Norway
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - F Al-Khalili
- Sophiahemmets Hospital, Heart, Lung and Allergy Clinic, Stockholm, Sweden
| | - G S Tell
- University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
| | - V Ehrenstein
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
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32
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Chan F, Lax NZ, Voss CM, Aldana BI, Whyte S, Jenkins A, Nicholson C, Nichols S, Tilley E, Powell Z, Waagepetersen HS, Davies CH, Turnbull DM, Cunningham MO. The role of astrocytes in seizure generation: insights from a novel in vitro seizure model based on mitochondrial dysfunction. Brain 2019; 142:391-411. [PMID: 30689758 DOI: 10.1093/brain/awy320] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/29/2018] [Indexed: 12/22/2022] Open
Abstract
Approximately one-quarter of patients with mitochondrial disease experience epilepsy. Their epilepsy is often severe and resistant towards conventional antiepileptic drugs. Despite the severity of this epilepsy, there are currently no animal models available to provide a mechanistic understanding of mitochondrial epilepsy. We conducted neuropathological studies on patients with mitochondrial epilepsy and found the involvement of the astrocytic compartment. As a proof of concept, we developed a novel brain slice model of mitochondrial epilepsy by the application of an astrocytic-specific aconitase inhibitor, fluorocitrate, concomitant with mitochondrial respiratory inhibitors, rotenone and potassium cyanide. The model was robust and exhibited both face and predictive validity. We then used the model to assess the role that astrocytes play in seizure generation and demonstrated the involvement of the GABA-glutamate-glutamine cycle. Notably, glutamine appears to be an important intermediary molecule between the neuronal and astrocytic compartment in the regulation of GABAergic inhibitory tone. Finally, we found that a deficiency in glutamine synthetase is an important pathogenic process for seizure generation in both the brain slice model and the human neuropathological study. Our study describes the first model for mitochondrial epilepsy and provides a mechanistic insight into how astrocytes drive seizure generation in mitochondrial epilepsy.
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Affiliation(s)
- Felix Chan
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK.,Wellcome Centre for Mitochondrial Research, Newcastle University, Institute of Neuroscience, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Nichola Z Lax
- Wellcome Centre for Mitochondrial Research, Newcastle University, Institute of Neuroscience, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Caroline Marie Voss
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Blanca Irene Aldana
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Shuna Whyte
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Claire Nicholson
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Sophie Nichols
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Elizabeth Tilley
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Zoe Powell
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Helle S Waagepetersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Ceri H Davies
- Neural Pathways DPU, GSK, 11 Biopolis Way, Singapore
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Newcastle University, Institute of Neuroscience, The Medical School, Framlington Place, Newcastle upon Tyne, UK
| | - Mark O Cunningham
- Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK.,Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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33
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Moore J, Raine T, Jenkins A, Livens F, Law K, Morris K, Law G, Yeates S. Decontamination of caesium and strontium from stainless steel surfaces using hydrogels. REACT FUNCT POLYM 2019. [DOI: 10.1016/j.reactfunctpolym.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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Jenkins A, Bhuva AN, Hughes AD, Manisty CH, Moon JC, Treibel TA. P432aortic stenosis. the role of aortoseptal angulation as a predictive factor for asymmetrical septal hypertrophy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Jenkins
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A N Bhuva
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
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35
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Sánchez RG, Parrish RR, Rich M, Webb WM, Lockhart RM, Nakao K, Ianov L, Buckingham SC, Broadwater DR, Jenkins A, de Lanerolle NC, Cunningham M, Eid T, Riley K, Lubin FD. Human and rodent temporal lobe epilepsy is characterized by changes in O-GlcNAc homeostasis that can be reversed to dampen epileptiform activity. Neurobiol Dis 2019; 124:531-543. [PMID: 30625365 PMCID: PMC6379093 DOI: 10.1016/j.nbd.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Temporal Lobe Epilepsy (TLE) is frequently associated with changes in protein composition and post-translational modifications (PTM) that exacerbate the disorder. O-linked-β-N-acetyl glucosamine (O-GlcNAc) is a PTM occurring at serine/threonine residues that is derived from and closely associated with metabolic substrates. The enzymes O-GlcNActransferase (OGT) and O-GlcNAcase (OGA) mediate the addition and removal, respectively, of the O-GlcNAc modification. The goal of this study was to characterize OGT/OGA and protein O-GlcNAcylation in the epileptic hippocampus and to determine and whether direct manipulation of these proteins and PTM's alter epileptiform activity. We observed reduced global and protein specific O-GlcNAcylation and OGT expression in the kainate rat model of TLE and in human TLE hippocampal tissue. Inhibiting OGA with Thiamet-G elevated protein O-GlcNAcylation, and decreased both seizure duration and epileptic spike events, suggesting that OGA may be a therapeutic target for seizure control. These findings suggest that loss of O-GlcNAc homeostasis in the kainate model and in human TLE can be reversed via targeting of O-GlcNAc related pathways.
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Affiliation(s)
- Richard G Sánchez
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - R Ryley Parrish
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Megan Rich
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - William M Webb
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - Roxanne M Lockhart
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - Kazuhito Nakao
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - Lara Ianov
- Civitan International Research Center, University of Alabama, Birmingham, AL, United States
| | - Susan C Buckingham
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States
| | - Devin R Broadwater
- School of Medicine, University of Alabama, Birmingham, AL, United States
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Nihal C de Lanerolle
- Department of Laboratory Medicine and of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | - Mark Cunningham
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Tore Eid
- Department of Laboratory Medicine and of Neurosurgery, Yale School of Medicine, New Haven, CT, United States
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama, Birmingham, AL, United States
| | - Farah D Lubin
- Department of Neurobiology, University of Alabama, Birmingham, AL, United States.
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36
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Pitsika M, Nissen J, Jenkins A, Mitchell P. P4 Spinal cord haemangioblastomas: surgical management and clinical outcome. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.87] [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: 11/03/2022]
Abstract
ObjectivesSpinal haemangioblastomas are rare tumours that can be either sporadic or as part of the CNS expression of Von Hippel Lindau syndrome (VHL). The aim of this study was to identify the characteristics of the haemangioblastomas both in sporadic and in VHL cases and to assess the outcome of the surgical management.MethodsWe retrospectively reviewed all spinal haemangioblastomas that were operated between 2004 and 2017 including clinical letters, MRIs and pathology reports.ResultsA total of 14 patients underwent excision of a spinal haemangioblastoma. Average follow up time was 50 months (range 4–164 months). The location was: medulla n=3, cervical region n=4, thoracic region n=5 and conus n=2. Six patients had VHL (42%) and from those n=5 had more than one lesion. A syrinx was present in n=9 cases (VHL n=6, multiple lesions n=5) and 2 had a syringoperitoneal shunt inserted followed by excision of the haemangioblastoma. In all but one case a total excision was achieved and the syrinx disappeared or improved in 6 cases. A clinical improvement was seen in n=10 patients, in n=2 a deterioration was seen post-operatively and in n=2 new symptoms developed during their follow up from the other lesions. None of the haemangioblastomas that were removed recurred.ConclusionsTotal excision of spinal haemangioblastomas offers a good outcome with possible cure in cases of a single lesion. Patients with VHL present more commonly with multiple lesions and large syrinxes which pose a challenge to the surgical management.
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37
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Cao J, Waldman B, O’Connell R, Sullivan D, Gebski V, Marschner I, Scott R, Taskinen M, Simes J, McGill N, Jenkins A, Keech A. Baseline and Short-Term Change in Plasma Uric Acid on Fenofibrate Predict Cardiovascular Risk: A Post Hoc Analysis of FIELD. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Sivashanmugarajah A, Fulcher J, Sullivan D, Jenkins A, Keech A. A Suggested Clinical Approach for the Diagnosis and Management of ‘Statin Intolerance’. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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39
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Finnigan-Fox G, Allen L, Matlock D, Jenkins A. THE COST CONUNDRUM: NAVIGATING DISCUSSIONS AROUND COST FOR HEART FAILURE MEDICATIONS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - L Allen
- University of Colorado Denver
| | - D Matlock
- University of Colorado School of Medicine
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40
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Augustin K, Williams S, Cunningham M, Devlin AM, Friedrich M, Jayasekera A, Hussain MA, Holliman D, Mitchell P, Jenkins A, Chen PE, Walker MC, Williams RSB. Perampanel and decanoic acid show synergistic action against AMPA receptors and seizures. Epilepsia 2018; 59:e172-e178. [PMID: 30324610 DOI: 10.1111/epi.14578] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 01/27/2023]
Abstract
Perampanel is an adjunctive treatment for epilepsy that works through the direct inhibition of AMPA receptors. The same molecular mechanism has recently been shown for a fatty acid, decanoic acid, prescribed in the medium chain triglyceride ketogenic diet for the treatment of patients with drug-resistant epilepsy. Because each compound has been proposed to act through a distinct AMPA receptor binding site, we predicted that perampanel and decanoic acid would act synergistically against AMPA receptors and, consequently, seizures. Here, we show a synergistic interaction between perampanel and decanoic acid in direct AMPA receptor inhibition, in an ex vivo model of seizure activity, and against seizure-induced activity in human brain slices. These data support a potential role for combination treatment using perampanel and dietary decanoic acid to provide enhanced seizure control.
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Affiliation(s)
- Katrin Augustin
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, UK
| | - Sophie Williams
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Mark Cunningham
- Institute of Neuroscience, University of Newcastle upon Tyne, Newcastle, UK
| | - Anita M Devlin
- Department of Paediatric Neurology, Great North Children's Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maximilian Friedrich
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ashan Jayasekera
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mohammed A Hussain
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Patrick Mitchell
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip E Chen
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, UK
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Robin S B Williams
- Centre for Biomedical Sciences, School of Biological Sciences, Royal Holloway University of London, Egham, UK
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41
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Farrell LJ, Lo R, Wanford JJ, Jenkins A, Maxwell A, Piddock LJV. Revitalizing the drug pipeline: AntibioticDB, an open access database to aid antibacterial research and development. J Antimicrob Chemother 2018; 73:2284-2297. [DOI: 10.1093/jac/dky208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L J Farrell
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R Lo
- School of Biological Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - J J Wanford
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - A Jenkins
- British Society for Antimicrobial Chemotherapy, Griffin House, 53 Regent Place, Birmingham B1 3NJ, UK
| | - A Maxwell
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - L J V Piddock
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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42
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Brazionis L, Jenkins A, Keech A, Ryan C, Brown A, Boffa J, Bursell S. Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project. Diabet Med 2018; 35:630-639. [PMID: 29405370 DOI: 10.1111/dme.13596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 01/29/2023]
Abstract
AIM To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. METHODS A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. RESULTS Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. CONCLUSIONS A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404.
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Affiliation(s)
- L Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - A Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - A Keech
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - C Ryan
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - A Brown
- SAHMRI, University of South Australia, Adelaide, Australia
| | - J Boffa
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - S Bursell
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
- Telehealth Research Unit, University of Hawaii, HI, USA
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Smith JA, Andersen TJ, Shortt M, Gaffney AM, Truffer M, Stanton TP, Bindschadler R, Dutrieux P, Jenkins A, Hillenbrand CD, Ehrmann W, Corr HFJ, Farley N, Crowhurst S, Vaughan DG. Erratum: Corrigendum: Sub-ice-shelf sediments record history of twentieth-century retreat of Pine Island Glacier. Nature 2017; 549:292. [DOI: 10.1038/nature23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kolb I, Stoy WA, Rousseau EB, Moody OA, Jenkins A, Forest CR. Cleaning patch-clamp pipettes for immediate reuse. Sci Rep 2016; 6:35001. [PMID: 27725751 PMCID: PMC5057089 DOI: 10.1038/srep35001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 08/15/2016] [Accepted: 09/22/2016] [Indexed: 01/19/2023] Open
Abstract
Patch-clamp recording has enabled single-cell electrical, morphological and genetic studies at unparalleled resolution. Yet it remains a laborious and low-throughput technique, making it largely impractical for large-scale measurements such as cell type and connectivity characterization of neurons in the brain. Specifically, the technique is critically limited by the ubiquitous practice of manually replacing patch-clamp pipettes after each recording. To circumvent this limitation, we developed a simple, fast, and automated method for cleaning glass pipette electrodes that enables their reuse within one minute. By immersing pipette tips into Alconox, a commercially-available detergent, followed by rinsing, we were able to reuse pipettes 10 times with no degradation in signal fidelity, in experimental preparations ranging from human embryonic kidney cells to neurons in culture, slices, and in vivo. Undetectable trace amounts of Alconox remaining in the pipette after cleaning did not affect ion channel pharmacology. We demonstrate the utility of pipette cleaning by developing the first robot to perform sequential patch-clamp recordings in cell culture and in vivo without a human operator.
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Affiliation(s)
- I Kolb
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - W A Stoy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - E B Rousseau
- Colleges of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY, 12203 USA
| | - O A Moody
- Neuroscience Graduate Program, GDBBS, Emory University, Atlanta, GA, 30322 USA
| | - A Jenkins
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, 30322 USA.,Department of Anesthesiology, Emory University, Atlanta, GA, 30322 USA
| | - C R Forest
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta GA, 30332 USA
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Royer P, Weber L, Jenkins A, Sanders J, Gawron L, Turok D. Family planning knowledge and contraceptive use among resettled African refugee women. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Royer P, Jenkins A, Weber L, Jackson B, Sanders J, Turok D. Group versus individual contraceptive counseling for resettled African refugee women: a pilot randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Deep brain stimulation for movement disorders is becoming a commonly used procedure. In this article we describe a complication which has not been described previously. Post op intra-cranial air must be considered as a possible complication of DBS insertion and should be on the list of differentials if a patient presents with post operative neurological deficit.
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Affiliation(s)
- M A Hussain
- a Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - A Jenkins
- a Royal Victoria Infirmary , Newcastle Upon Tyne , UK
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King E, Yuan J, Kong S, Dunn L, Stocker R, Keech A, Jenkins A, Ng M. Hypoxia Tolerance in Diabetes Mellitus: The Role of Fenofibrate in Facilitating Protective Metabolic Reprogramming. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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50
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Manski-Nankervis J, Yates CJ, Blackberry I, Furler J, Ginnivan L, Cohen N, Jenkins A, Vasanthakumar S, Gorelik A, Young D, Best J, O'Neal D. Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study. Diabet Med 2016; 33:803-11. [PMID: 26435033 DOI: 10.1111/dme.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/13/2023]
Abstract
AIM To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. METHODS We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. RESULTS Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. CONCLUSION Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.
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Affiliation(s)
- J Manski-Nankervis
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - C J Yates
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - I Blackberry
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
- La Trobe University, Wodonga, Vic., Australia
| | - J Furler
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - L Ginnivan
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - N Cohen
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - A Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Vasanthakumar
- Monash Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia
| | - A Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - D Young
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - J Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - D O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic., Australia
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