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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Codd V, Denniff M, Swinfield C, Warner SC, Papakonstantinou M, Sheth S, Nanus DE, Budgeon CA, Musicha C, Bountziouka V, Wang Q, Bramley R, Allara E, Kaptoge S, Stoma S, Jiang T, Butterworth AS, Wood AM, Di Angelantonio E, Thompson JR, Danesh JN, Nelson CP, Samani NJ. Measurement and initial characterization of leukocyte telomere length in 474,074 participants in UK Biobank. Nat Aging 2022; 2:170-179. [PMID: 37117760 DOI: 10.1038/s43587-021-00166-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/21/2021] [Indexed: 04/30/2023]
Abstract
Leukocyte telomere length (LTL) is a proposed marker of biological age. Here we report the measurement and initial characterization of LTL in 474,074 participants in UK Biobank. We confirm that older age and male sex associate with shorter LTL, with women on average ~7 years younger in 'biological age' than men. Compared to white Europeans, LTL is markedly longer in African and Chinese ancestries. Older paternal age at birth is associated with longer individual LTL. Higher white cell count is associated with shorter LTL, but proportions of white cell subtypes show weaker associations. Age, ethnicity, sex and white cell count explain ~5.5% of LTL variance. Using paired samples from 1,351 participants taken ~5 years apart, we estimate the within-individual variability in LTL and provide a correction factor for this. This resource provides opportunities to investigate determinants and biomedical consequences of variation in LTL.
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Affiliation(s)
- V Codd
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
| | - M Denniff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C Swinfield
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S C Warner
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - M Papakonstantinou
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - S Sheth
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - D E Nanus
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - C A Budgeon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - C Musicha
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - V Bountziouka
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Q Wang
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - R Bramley
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - E Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - S Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
| | - S Stoma
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - T Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - A S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - A M Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - E Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - J R Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J N Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - C P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
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Hoeben BA, Seravalli E, Wood AM, Bosman M, Matysiak WP, Maduro JH, van Lier AL, Maspero M, Bol GH, Janssens GO. Influence of eye movement on lens dose and optic nerve target coverage during craniospinal irradiation. Clin Transl Radiat Oncol 2021; 31:28-33. [PMID: 34522796 PMCID: PMC8427085 DOI: 10.1016/j.ctro.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Optic nerves are part of the craniospinal irradiation (CSI) target volume. Modern radiotherapy techniques achieve highly conformal target doses while avoiding organs-at-risk such as the lens. The magnitude of eye movement and its influence on CSI target- and avoidance volumes are unclear. We aimed to evaluate the movement-range of lenses and optic nerves and its influence on dose distribution of several planning techniques. Methods Ten volunteers underwent MRI scans in various gaze directions (neutral, left, right, cranial, caudal). Lenses, orbital optic nerves, optic discs and CSI target volumes were delineated. 36-Gy cranial irradiation plans were constructed on synthetic CT images in neutral gaze, with Volumetric Modulated Arc Therapy, pencil-beam scanning proton therapy, and 3D-conventional photons. Movement-amplitudes of lenses and optic discs were analyzed, and influence of gaze direction on lens and orbital optic nerve dose distribution. Results Mean eye structures' shift from neutral position was greatest in caudal gaze; -5.8±1.2 mm (±SD) for lenses and 7.0±2.0 mm for optic discs. In 3D-conventional plans, caudal gaze decreased Mean Lens Dose (MLD). In VMAT and proton plans, eye movements mainly increased MLD and diminished D98 orbital optic nerve (D98OON) coverage; mean MLD increased up to 5.5 Gy [total ΔMLD range -8.1 to 10.0 Gy], and mean D98OON decreased up to 3.3 Gy [total ΔD98OON range -13.6 to 1.2 Gy]. VMAT plans optimized for optic disc Internal Target Volume and lens Planning organ-at-Risk Volume resulted in higher MLD over gaze directions. D98OON became ≥95% of prescribed dose over 95/100 evaluated gaze directions, while all-gaze bilateral D98OON significantly changed in 1 of 10 volunteers. Conclusion With modern CSI techniques, eye movements result in higher lens doses and a mean detriment for orbital optic nerve dose coverage of <10% of prescribed dose.
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Key Words
- 3D-conventional
- COM, center of mass
- CSI, craniospinal irradiation
- CTVvoxelwise min, voxelwise minimum CTV
- Craniospinal irradiation
- D98OON, D98 orbital optic nerve
- ITVoptic disc, internal target volume around optic discs
- Lens
- MLD, mean lens dose
- OON, orbital optic nerve
- Optic nerve
- PBS, pencil-beam scanning
- PRVlens, planning organ-at-risk volume around lenses
- Proton
- SIOPE, European International Society for Paediatric Oncology
- VMAT
- sCT, synthetic CT
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Affiliation(s)
- Bianca A.W. Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Corresponding author at: Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, PO Box 85500, Q.00.311, 3508 GA Utrecht, the Netherlands.
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amber M.L. Wood
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Radboud University, Nijmegen, the Netherlands
| | - Mirjam Bosman
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Witold P. Matysiak
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - John H. Maduro
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Matteo Maspero
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gijsbert H. Bol
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Myatt A, Saleeb H, Robertson GAJ, Bourhill JK, Page PRJ, Wood AM. Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review. Br Med Bull 2021; 139:48-58. [PMID: 34227647 DOI: 10.1093/bmb/ldab013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. SOURCES OF DATA We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. AREAS OF AGREEMENT AND CONTROVERSY Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. GROWING POINTS It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. AREAS TIMELY FOR DEVELOPING RESEARCH A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.
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Affiliation(s)
- A Myatt
- Department of Trauma & Orthopaedics, ST4 Orthopaedic Registrar Leeds General Infirmary MRCSEd, Great George St, Leeds LS1 3EX, UK
| | - H Saleeb
- Department of Trauma & Orthopaedics, Orthopaedic Registrar Oxford University Hospital MRCS, Headley Way, Headington, Oxford OX3 9DU, UK
| | - G A J Robertson
- Department of Trauma & Orthopaedics, Orthopaedic Registrar Royal Infirmary of Edinburgh FRCSEd (T&O), 51 Little France Cres, Old Dalkeith Rd, Edinburgh EH16 4SA, UK
| | - Jana Keren Bourhill
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - P R J Page
- Department of Trauma & Orthopaedics, Trauma Fellow, John Radcliffe Hospital Oxford, FRCS(T&O), Headley Way, Headington, Oxford OX3 9DU, UK
| | - A M Wood
- Department of Trauma & Orthopaedics, Trauma Fellow, John Radcliffe Hospital Oxford, FRCS(T&O), Headley Way, Headington, Oxford OX3 9DU, UK
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Kerr A, McVey JT, Wood AM, Van Haren F. Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study. Anaesth Intensive Care 2017; 44:758-761. [PMID: 27832565 DOI: 10.1177/0310057x1604400621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT. The groups were case-matched for sex, age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was administration of antipsychotic medication. Secondary outcomes included use of physical restraints, 30-day mortality, and ventilation requirements. Antipsychotic medication was prescribed in 43 (34.1%) patients who received NRT compared to 14 (11.1%) in controls (P <0.01). Physical restraints were used in 37 (29.4%) patients who received NRT, compared to 12 (9.5%) of controls (P <0.01). The 30-day mortality and number of patients intubated was not statistically different between groups. Average length of intubation time was greater in the NRT group (2.56 days; standard deviation 4.16) compared to the control group (1.44 days; standard deviation 2.68) (P=0.012). The use of NRT to prevent nicotine withdrawal in ICU patients is associated with increased use of antipsychotic medication and physical restraint, and with prolonged mechanical ventilation.
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Affiliation(s)
- A Kerr
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - J T McVey
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - A M Wood
- Junior Medical Officer, Intensive Care Unit, The Canberra Hospital, ACT
| | - Fmp Van Haren
- Intensive Care Physician, Intensive Care Unit, The Canberra Hospital, Associate Professor, Australian National University Medical School, Canberra, ACT
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Robertson GAJ, Goffin JS, Wood AM. Return to sport following stress fractures of the great toe sesamoids: a systematic review. Br Med Bull 2017; 122:135-149. [PMID: 28444129 DOI: 10.1093/bmb/ldx010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This review aims to provide information on return rates and times to sport following stress fractures of the great toe sesamoids (SFGTSs). SOURCES OF DATA A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'stress', 'fractures', 'great', 'toe', 'sesamoid', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT Fourteen studies were included: three studies reported on the outcome of conservatively-managed SFGTSs; thirteen studies reported on the outcome of surgically-managed SFGTSs. The management principles were to attempt conservative management for 2-6 months using activity modification, analgesia, orthotics and physiotherapy; if symptoms persisted following this, surgical management was to be recommended, either with internal fixation or sesamoidectomy. AREAS OF CONTROVERSY The optimal treatment modalities for SFGTSs remain to be defined. GROWING POINTS Internal fixation shows the best return to full-level sport rates with low rates of complications. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for SFGTSs.
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Affiliation(s)
- G A J Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
| | - J S Goffin
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
| | - A M Wood
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
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Jackson, J, Hart S, Fries CA, Robinson J, Murray J, Wood AM. CrossFitter’s knee: patellofemoral chondral injury following high-intensity functional training. J R Nav Med Serv 2017; 103:35-38. [PMID: 30088738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present a case series of patients with patellofemoral joint (PFJ) chondral injuries presenting as anterior knee pain secondary to participation in high-intensity functional training programmes. We aim to highlight PFJ chondral injuries as a potential complication of military servicemen engaging in high-intensity functional training programmes. This may allow medical staff to identify the injuries early, and highlight this possible injury mechanism to Physical Training staff to help educate participants and mitigate the risk of injury.
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Abstract
INTRODUCTION This review aims to provide information on the return rates and return times to sport following clavicle fractures. SOURCES OF DATA A systematic search of Medline, EMBASE, CINAHAL, Cochrane, Web of Science, PEDro, SPORTDiscus, Scopus and Google Scholar was performed using the keywords 'clavicle', 'clavicular', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative', 'return to sport'. AREAS OF AGREEMENT Twenty-three studies were included: 10 reported on mid-shaft fractures, 14 on lateral fractures. The management principles for athletic patients were to attempt non-operative management for undisplaced fractures to undertake operative intervention for displaced lateral fractures and to recommend operative intervention for displaced mid-shaft fractures. AREAS OF CONTROVERSY The optimal surgical modality for mid-shaft and lateral clavicle fractures. GROWING POINTS Operative management of displaced mid-shaft fractures offers improved return rates and times to sport compared to non-operative management. Suture fixation and non-acromio-clavicular joint (ACJ)-spanning plate fixation of displaced lateral fractures show promising results. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for clavicle fractures.
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Affiliation(s)
- G A J Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
| | - A M Wood
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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Keenan AJ, Keenan OJF, Tubb C, M Wood A, Rowlands T, Christensen SE. Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment. J ROY ARMY MED CORPS 2016; 162:476-478. [DOI: 10.1136/jramc-2016-000665] [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] [Received: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/03/2022]
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Heil KM, Oakley EHN, Wood AM. British Military freezing cold injuries: a 13-year review. J ROY ARMY MED CORPS 2016; 162:413-418. [DOI: 10.1136/jramc-2015-000445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 11/17/2015] [Accepted: 11/22/2015] [Indexed: 11/03/2022]
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Abstract
INTRODUCTION This review aims to provide information on the time taken to resume sport following tibial diaphyseal stress fractures (TDSFs). SOURCES OF DATA A systematic search of Medline, EMBASE, CINHAL, Cochrane, Web of Science, PEDro, Sports Discus, Scopus and Google Scholar was performed using the keywords 'tibial', 'tibia', 'stress', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT Twenty-seven studies were included: 16 reported specifically on anterior TDSFs and 5 on posterior TDSFs. The general principles were to primarily attempt non-operative management for all TDSFs and to consider operative intervention for anterior TDSFs that remained symptomatic after 3-6 months. Anterior TDSFs showed a prolonged return to sport. AREAS OF CONTROVERSY The best time to return to sport and the optimal management modalities for TDSFs remain undefined. GROWING POINTS Management of TDSFs should include a full assessment of training methods, equipment and diet to modify pre-disposing factors. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for TDSFs.
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Affiliation(s)
- G A J Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - A M Wood
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
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Moraitis AA, Oliver-Williams C, Wood AM, Fleming M, Pell JP, Smith G. Previous caesarean delivery and the risk of unexplained stillbirth: retrospective cohort study and meta-analysis. BJOG 2015; 122:1467-74. [PMID: 26033155 DOI: 10.1111/1471-0528.13461] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether caesarean delivery in the first pregnancy is a risk factor for unexplained antepartum stillbirth in a second pregnancy. DESIGN A population-based retrospective cohort study and meta-analysis. SETTING All maternity units in Scotland. PARTICIPANTS A cohort of 128 585 second births, 1999-2008. METHODS Time-to-event analysis and random-effects meta-analysis. MAIN OUTCOME MEASURE Risk of unexplained antepartum stillbirth in a second pregnancy. RESULTS There were 88 stillbirths among 23 688 women with a previous caesarean delivery (2.34 per 10 000 women per week) and 288 stillbirths in 104 897 women who had previously delivered vaginally (1.67 per 10 000 women per week, P = 0.002). When analysed by cause, women with a previous caesarean delivery had an increased risk of unexplained stillbirth (hazard ratio, HR 1.47; 95% confidence interval, 95% CI 1.12-1.94; P = 0.006) and, as previously observed, the excess risk was apparent from 34 weeks of gestation onwards. The risk did not differ in relation to the indication of the caesarean delivery, and was independent of maternal characteristics and previous obstetric complications. We identified three other comparable studies (two in North America and one in Europe), and meta-analysis of these studies showed a statistically significant association between previous caesarean delivery and the risk of antepartum stillbirth in the second pregnancy (pooled HR 1.40; 95% CI 1.10-1.77; P = 0.006). CONCLUSIONS Women who have had a previous caesarean delivery are at increased risk of unexplained stillbirth in the second pregnancy. TWEETABLE ABSTRACT Caesarean first delivery is associated with an increased risk of unexplained stillbirth in the next pregnancy.
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Affiliation(s)
- A A Moraitis
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.,National Institute for Health Research (NIHR), Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
| | - C Oliver-Williams
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - A M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.,National Institute for Health Research (NIHR), Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
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Affiliation(s)
- R J Truscott
- Australian Cataract Research Foundation, University of Wollongong
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Liebhart D, Neale S, Garcia-Rueda C, Wood AM, Bilic I, Wernsdorf P, Jaskulska B, Hess M. A single strain of Tetratrichomonas gallinarum causes fatal typhlohepatitis in red-legged partridges (Alectoris rufa) to be distinguished from histomonosis. Avian Pathol 2015; 43:473-80. [PMID: 25175532 DOI: 10.1080/03079457.2014.959435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Typhlohepatitis was observed in a flock of 2500 red-legged partridges in Great Britain, characterized by the sudden deaths of 15 birds within 2 days. Necropsy of five dead birds revealed severe lesions in the caeca with thickened caecal walls, a reddened lining and bloody contents. The livers contained multiple miliary lesions and similar pathological changes were found in the spleens of some birds. Microscopic examination of intestinal contents showed the occurrence of coccidial oocysts in two partridges. Different methods for the detection of bacteria from liver and intestine samples were conducted without positive results. Histopathological examination revealed the presence of protozoan parasites in the caecum, liver and spleen of the affected birds. In situ hybridization (ISH) for the detection of trichomonads resulted in positive findings and polymerase chain reaction (PCR) confirmed the presence of Tetratrichomonas gallinarum in the lesions. Additionally, archived tissues of red-legged partridges from different flocks suffering from severe typhlohepatitis in Great Britain in 2008 and 2009 were re-investigated by ISH and PCR. Beside the sporadic occurrence of histomonosis, in most of the cases trichomonads were detected by ISH in the caecum and liver of affected birds. Furthermore, dissemination of the flagellate into the lung and bursa of Fabricius could be demonstrated. Analyses of T. gallinarum DNA obtained from the different cases resulted in homologous nucleotide sequences. Altogether, the results demonstrate the circulation of a virulent strain of T. gallinarum in reared red-legged partridges.
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Affiliation(s)
- D Liebhart
- a Clinic for Poultry and Fish Medicine, Department for Farm Animals and Veterinary Public Health , University of Veterinary Medicine , Vienna , Austria
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Oliver-Williams C, Fleming M, Wood AM, Smith G. Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980-2008: a historical cohort study. BJOG 2015; 122:1525-34. [PMID: 25626593 PMCID: PMC4611958 DOI: 10.1111/1471-0528.13276] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the relationship between previous miscarriage and risk of preterm birth changed over the period 1980-2008, and to determine whether the pattern varied according to the cause of the preterm birth. DESIGN Linked birth databases. SETTING All Scottish NHS hospitals. POPULATION A total of 732 719 nulliparous women with a first live birth between 1980 and 2008. METHODS Risk was estimated using logistic regression. MAIN OUTCOME MEASURES Preterm birth, subdivided by cause (spontaneous, induced with a diagnosis of pre-eclampsia, or induced without a diagnosis of pre-eclampsia) and severity [extreme (24-28 weeks of gestation), moderate (29-32 weeks of gestation), and mild (33-36 weeks of gestation)]. RESULTS Consistent with previous studies, previous miscarriage was associated with an increased risk of all-cause preterm birth (adjusted odds ratio, aOR 1.26; 95% confidence interval, 95% CI 1.22-1.29). This arose from associations with all subtypes. The strongest association was found with extreme preterm birth (aOR 1.73; 95% CI 1.57-1.90). Risk increased with the number of miscarriages. Women with three or more miscarriages had the greatest risk of all-cause preterm birth (aOR 2.14; 95% CI 1.93-2.38), and the strongest association was with extreme preterm birth (aOR 3.87; 95% CI 2.85-5.26). The strength of the association between miscarriage and preterm birth decreased from 1980 to 2008. This was because of weakening associations with spontaneous preterm birth and induced preterm birth without a diagnosis of pre-eclampsia. CONCLUSIONS The association between a prior history of miscarriage and the risk of preterm birth declined in Scotland over the period 1980-2008. We speculate that changes in the methods of managing incomplete termination of pregnancy might explain the trend, through reduced cervical damage.
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Affiliation(s)
- C Oliver-Williams
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - M Fleming
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | - A M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gcs Smith
- Department of Obstetrics and Gynaecology, NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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Wood AM, Porter A. Lower limb stress fractures in military training. J R Nav Med Serv 2015; 101:182-185. [PMID: 26867421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article describes stress fractures that are seen in military training, and reviews the relevant literature. The information is vital for medical personnel who work with the United Kingdom (UK) Armed Forces, particularly those working in training establishments. The author suggests areas for further research and discusses some of the issues in current UK Armed Forces training.
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Wood AM, Moss C, Keenan A, Reed MR, Leaper DJ. Infection control hazards associated with the use of forced-air warming in operating theatres. J Hosp Infect 2014; 88:132-40. [PMID: 25237035 DOI: 10.1016/j.jhin.2014.07.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 07/06/2014] [Indexed: 01/25/2023]
Abstract
A review is presented of the published experimental and clinical research into the infection control hazards of using forced air-warming (FAW) in operating theatres to prevent inadvertent hypothermia. This evidence has been reviewed with emphasis on the use of ultra-clean ventilation, any interaction it has with different types of patient warming (and FAW in particular), and any related increased risk of surgical site infection (SSI). We conclude that FAW does contaminate ultra-clean air ventilation; however, there appears to be no definite link to an increased risk of SSI based on current research. Nevertheless, whereas this remains unproven, we recommend that surgeons should at least consider alternative patient-warming systems in areas where contamination of the operative field may be critical. Although this is not a systematic review of acceptable randomized controlled clinical trials, which do not exist, it does identify that there is a need for definitive research in this field.
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Affiliation(s)
- A M Wood
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - C Moss
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - A Keenan
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - D J Leaper
- Huddersfield University, Huddersfield, UK.
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Howes RJ, Wood AM, Calder A, Cowan H, Burrows H. The management of the acutely swollen ankle. J R Nav Med Serv 2014; 100:288-292. [PMID: 25895409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients presenting with an acutely swollen ankle are common in both the military and civilian settings. Accurate diagnosis is vital, as there are various potentially serious causes. This article aims to review the common causes of an acutely swollen ankle, as well as the rarer causes, with their significant consequences.
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Arthur CHC, Bakker-Dyos J, Hales RJ, Chapman M, Wood AM. Anterior cruciate ligament injury in Royal Marine basic training. J R Nav Med Serv 2014; 100:10-11. [PMID: 24881420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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20
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Baker A, Wood CL, Wood AM, Timms P, Allsopp AJ. Changes in vitamin D and matrix metalloproteinase-9 in submariners during a submerged patrol. Occup Environ Med 2013; 71:104-8. [DOI: 10.1136/oemed-2013-101793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
We report ten-year clinical and radiological follow-up data for the Sigma Press Fit Condylar total knee replacement system (Sigma PFC TKR). Between October 1998 and October 1999 a total of 235 consecutive PFC Sigma TKRs were carried out in 203 patients. Patients were seen at a specialist nurse-led clinic seven to ten days before admission and at six and 18 months, three, five and eight to ten years after surgery. Data were recorded prospectively at each clinic visit. Radiographs were obtained at the five- and eight- to ten-year follow-up appointments. Of the 203 patients, 147 (171 knees) were alive at ten years and 12 were lost to follow-up. A total of eight knees (3.4%) were revised, five for infection and three to change the polyethylene insert. The survival at ten years with an endpoint of revision for any reason was 95.9%, and with an endpoint of revision for aseptic failure was 98.7%. The mean American Knee Society Score (AKSS) was 79 (10 to 99) at eight to ten years, compared with 31 (2 to 62) pre-operatively. Of 109 knee with radiographs reviewed, 47 knees had radiolucent lines but none showed evidence of loosening.
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22
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Hammond T, Wood AM. Injuries and medical issues on the Zambezi "Great River". J R Nav Med Serv 2013; 99:25-27. [PMID: 23691860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report the injuries and medical issues incurred during a rowing expedition conducted along the Zambezi River in May 2011. All injuries and illnesses requiring medical intervention were recorded during a 30-day expedition. There were 22 rowers and 8 support staff sustaining 32 injuries, an injury incidence of 36 per 1000 days. We discuss the medical issues regarding conducting an expedition along the Zambezi and the medical preparation and education required to successfully support wilderness expeditions.
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Arthur CHC, Wood AM, Neill D, Porter D. The 'tobruk method'--a useful tool in treating femoral shaft fractures in children. J R Nav Med Serv 2013; 99:57. [PMID: 24079204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C H C Arthur
- Royal Hospital for Sick Children, Edinburgh, 9 Sciennes Road, Edinburgh, Midlothian EH9 1LF
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Heil KM, Wood AM, Penn-Barwell J, Keenan ACM, McKie S. Femoral acetabular impingement: the sex- and age-linked distribution of alpha angles in 146 patients of service age without pre-existing osteoarthritic or other hip pathology. J R Nav Med Serv 2013; 99:111-114. [PMID: 24511792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The use of the alpha angle to help the diagnosis of Femoral Acetabular Impingement (FAI) is common. However, there is currently no standard value available across an asymptomatic pre-arthritic population. We present the first large cohort of Computerised Tomography (CT) based alpha angles in patients with no history of hip pathology, including intra- and interobserver validation. We carried out a retrospective analysis of 73 consecutive individuals (146 hip joints) with ages ranging from 18 to 39 years. The age range 18-39 represents 82.4% of those currently serving in the UK Armed Forces. The cohort was drawn from those patients who had received a CT scan in the Lothian Region between 1 Jan 2011 and 31 Dec 2011 due to abdominal pathology. These patients had their electronic patient record checked to rule out any hip-related problems. The alpha angle of Nötzli was measured on the axial view bilaterally. The mean value for the 18-39 age range was found to be 51.89 degree for the left hip and 52.53 degree for the right. Femoral alpha angle is a reproducible measurement for assessing the femoral neck. However, there is wide variability in the alpha angle for patients, irrespective of the presence of symptoms. Our results would suggest that the alpha angle alone should not be used to diagnose FAI in service personnel, as even large angles may be normal.
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Affiliation(s)
- K M Heil
- Second Lieutenant KM Heil RMR, Glasgow University Medical School, Royal Marines Reserve Scotland
| | - A M Wood
- Surgeon Lieutenant Commander AM Wood, Institute of Naval Medicine
| | - J Penn-Barwell
- Surgeon Lieutenant Commander J Penn-Barwell, Institute of Naval Medicine
| | - A C M Keenan
- Major ACM Keenan, Royal Infirmary of Edinburgh, 205 Field Hospital
| | - S McKie
- Major ACM Keenan, Royal Infirmary of Edinburgh, 205 Field Hospital
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Keenan ACM, Wood AM, Arthur CA, Jenkins PJ, Brenkel IJ, Walmsley PJ. Ten-year survival of cemented total knee replacement in patients aged less than 55 years. ACTA ACUST UNITED AC 2012; 94:928-31. [PMID: 22733947 DOI: 10.1302/0301-620x.94b7.27031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the ten-year survival of a cemented total knee replacement (TKR) in patients aged < 55 years at the time of surgery, and compare the functional outcome with that of patients aged > 55 years. The data were collected prospectively and analysed using Kaplan-Meier survival statistics, with revision for any reason, or death, as the endpoint. A total of 203 patients aged < 55 years were identified. Four had moved out of the area and were excluded, leaving a total of 221 TKRs in 199 patients for analysis (101 men and 98 women, mean age 50.6 years (28 to 55)); 171 patients had osteoarthritis and 28 had inflammatory arthritis. Four patients required revision and four died. The ten-year survival using revision as the endpoint was 98.2% (95% confidence interval 94.6 to 99.4). Based on the Oxford knee scores at five and ten years, the rate of dissatisfaction was 18% and 21%, respectively. This was no worse in the patients aged < 55 years than in patients aged > 55 years. These results demonstrate that the cemented PFC Sigma knee has an excellent survival rate in patients aged < 55 ten years post-operatively, with clinical outcomes similar to those of an older group. We conclude that TKR should not be withheld from patients on the basis of age.
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Affiliation(s)
- A C M Keenan
- Victoria Hospital, Department of Orthopaedics, Kirkcaldy KY2 5AH, UK
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Silverwood R, Gordon JB, Baron R, Walmsley P, Watson J, Wood AM. Cyclops lesions in military personnel: a reason for delayed return to fitness post anterior cruciate ligament reconstruction. J R Nav Med Serv 2012; 98:3-5. [PMID: 23311235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Carter M, Hull R, Wood AM. Selecting the correct emollient for the treatment of dry skin in cold weather warfare training. J R Nav Med Serv 2012; 98:27-28. [PMID: 22558739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wood AM, Arthur CHC, Myatt R, Sargeant I. Role 4 trauma fellowship: the military registrar's training experience. J R Nav Med Serv 2012; 98:15-16. [PMID: 23311239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- A M Wood
- Institute of Naval Medicine, Queen Elizabeth Hospital Birmingham
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Thomas R, Wood AM, Watson J, Arthur CHC, Nicol AM. Delay in diagnosis of neck of femur stress fracture in a female military recruit. J R Nav Med Serv 2012; 98:27-29. [PMID: 22970643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report the delay in diagnosis of a Neck of Femur (NOF) stress fracture in mixed sex basic military training. Stress fractures are common in military training with the incidence reported as ranging between 3.2-31%. NOF stress fractures, whilst only representing around 8% of stress fractures are associated with a high morbidity. It is imperative that medical officers looking after military recruits have a sound knowledge of the potential signs, symptoms and presentation of these injuries. Medical officers should always remains vigilant for stress fractures especially in mixed military training.
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Affiliation(s)
- R Thomas
- Medical Reception Station Edinburgh
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Strugnell BW, McMullin P, Wood AM, Nicholas RAJ, Ayling R, Irvine RM. Unusual eggshell defects in a free-range layer flock in Great Britain. Vet Rec 2011; 169:237-8. [PMID: 21873397 DOI: 10.1136/vr.d5430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Morris H, Morgan MD, Wood AM, Smith SW, Ekeowa UI, Herrmann K, Holle JU, Guillevin L, Lomas DA, Perez J, Pusey CD, Salama AD, Stockley R, Wieczorek S, McKnight AJ, Maxwell AP, Miranda E, Williams J, Savage CO, Harper L. ANCA-associated vasculitis is linked to carriage of the Z allele of α₁ antitrypsin and its polymers. Ann Rheum Dis 2011; 70:1851-6. [PMID: 21821620 DOI: 10.1136/ard.2011.153569] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Small studies have linked α1 antitrypsin (α1AT) deficiency to patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). OBJECTIVE To test the validity and the mechanism of this association between α1AT and AAV. METHODS The distribution of α1AT deficiency alleles Z and S was compared between 856 White Europeans with AAV and 1505 geographic and ethnically matched healthy controls. Genotyping was performed by allelic discrimination assay. RESULTS were compared between cases and controls using χ(2) tests. The serum and renal biopsies for α1AT polymers were compared using the polymer-specific 2C1 antibody. The role of α1AT polymers in promoting inflammation was investigated by examining their ability to prime neutrophils for ANCA activation as assessed by CD62L shedding, superoxide production and myeloperoxidase degranulation. Results The Z but not the S allele was over-represented in the patients compared with controls (HR=2.25, 95% CI 1.60 to 3.19). Higher concentrations of polymers of α1AT were detected in serum from patients carrying the Z allele than in those not carrying the Z allele (median (IQR) 1.40 (0.91-3.32) mg/dl vs 0.17 (0.06-0.28) mg/dl, p<0.001); polymers of α1AT were also seen in the renal biopsy of a patient with vasculitic glomerulonephritis. Polymers of α1AT primed neutrophils with CD62L shedding and increased superoxide production following ANCA activation. Carriage of the Z allele was not associated with disease severity, survival or relapse. CONCLUSIONS The Z but not the S deficiency allele is associated with AAV. Polymers of α1AT are present in the serum and glomeruli of at least some patients with the Z allele, which may promote inflammation through priming of neutrophils.
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Affiliation(s)
- H Morris
- School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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McAllister M, Wood AM, Dunn G, Shiloh S, Todd C. The Genetic Counseling Outcome Scale: a new patient-reported outcome measure for clinical genetics services. Clin Genet 2011; 79:413-24. [PMID: 21255005 DOI: 10.1111/j.1399-0004.2011.01636.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to develop a patient-reported outcome measure (PROM) for clinical genetics services. Previous research was used to develop a draft 84-item questionnaire, which was completed by 527 members of patient support groups. Responses were subjected to exploratory factor analysis (EFA). Parallel analysis was used to identify the number of factors to extract using oblique rotation. Twenty-four questions were selected to form the Genetic Counseling Outcome Scale (GCOS-24). Two hundred and forty-one patients completed a questionnaire pack before and after attendance at a genetics clinic that included the GCOS-24, and validated measures of health locus of control, perceived personal control, anxiety, depression, satisfaction with life and authenticity. Concurrent validity of the GCOS-24 was assessed using bivariate correlation. Sensitivity to change of the GCOS-24 was assessed using analysis of variance. EFA identified a single overarching construct consisting of seven dimensions. Internal consistency (α = 0.87) and test-retest reliability (r = 0.86) are good. The GCOS-24 shows convergent and divergent validities, and sensitivity to change over time with a medium-to-large effect size (Cohen's d = 0.70). The GCOS-24 has potential as a clinical genetics-specific PROM.
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Affiliation(s)
- M McAllister
- Medical Genetics Research Group, School of Biomedicine, The University of Manchester, Manchester, UK.
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Smith GCS, Wood AM, Pell JP, Hattie J. Recurrent miscarriage is associated with a family history of ischaemic heart disease: a retrospective cohort study. BJOG 2011; 118:557-63. [PMID: 21244619 DOI: 10.1111/j.1471-0528.2010.02890.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether women experiencing recurrent miscarriage were more likely to have a family history of cardiovascular disease. DESIGN Retrospective cohort study. SETTING Women having a first birth in Scotland between 1992 and 2006. SAMPLE A total of 74, 730 first births were linked to the hospital admission and death certification data for the women's parents through the women's birth certificates. METHODS The incidence of cardiovascular disease in the women's parents was related to the number of miscarriages experienced before their daughters' first births using a Cox proportional hazards model. MAIN OUTCOME MEASURES Death or hospital admission of the women's parents for ischaemic heart disease (IHD), cerebrovascular disease (CVD) or venous thromboembolism (VTE). MAIN RESULTS There was an increased incidence of IHD in the parents of women who experienced two miscarriages before their first birth (hazard ratio 1.25, 95% CI 1.04-1.49) and parents of women who experienced three or more miscarriages before their first birth (hazard ratio 1.56, 95% CI 1.14-2.15). Adjustment for the characteristics of the women at the time of the first birth was without material effect. There was no significant association between miscarriage and family history of CVD or VTE. There was no significant association between the number of therapeutic terminations of pregnancy before the first birth and the incidence of any type of cardiovascular disease in the women's parents. CONCLUSIONS The parents of women who experience recurrent miscarriage are more likely to experience IHD. Recurrent miscarriage and IHD may have common patho-physiological pathways and genetic predispositions.
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Affiliation(s)
- G C S Smith
- Department of Obstetrics and Gynaecology, Cambridge University, Rosie Maternity Hospital, Cambridge, UK.
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Bell DJ, Morrison R, Wood AM, Keenan A, Arthur C. Knee dislocation in touch rugby: a case study. J R Nav Med Serv 2011; 97:5-10. [PMID: 21714305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Howes RJ, Evans J, Keenan ACM, Wood AM. Operating in the cold weather environment--a medical officer's perspective. J R Nav Med Serv 2011; 97:62-65. [PMID: 22013638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- R J Howes
- Royal Navy, ACCS(EM) CT1, North Tees & Hartlepool NHS Trust
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Wood AM, Keenan ACM, Arthur C, Wood IM. Common training injuries concerning potential Royal Marine applicants. J R Nav Med Serv 2011; 97:106-109. [PMID: 22372015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Puppala S, Hoey ETD, Mankad K, Wood AM. Primary cardiac angiosarcoma arising from the interatrial septum: magnetic resonance imaging appearances. Br J Radiol 2010; 83:e230-4. [PMID: 20965894 DOI: 10.1259/bjr/29501513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We present a case of primary cardiac angiosarcoma arising from the interatrial septum that had imaging features overlapping with those of right atrial myxoma. The mass was initially discovered on a thoracic CT study. Further evaluation with echocardiography was limited by poor acoustic windows and cardiac magnetic resonance (CMR) imaging was performed prior to surgical resection. CMR provided a detailed morphological assessment; imaging features included a frond-like surface architecture, a narrow attachment point at the interatrial septum, mild signal hyperintensity compared with that of myocardium on T(1) weighted sequences, patchy foci of delayed gadolinium enhancement and a haemorrhagic pericardial effusion. To the best of our knowledge, this is the first reported case of angiosarcoma arising from the interatrial septum that has undergone evaluation with CMR.
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Affiliation(s)
- S Puppala
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
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Abstract
There has been much recent interest in the role of the vitamin D axis in lung disease, which includes vitamin D, vitamin D receptor (VDR) and vitamin D-binding protein (VDBP; also known as Gc-globulin). VDBP is a serum protein which has immunomodulatory functions relevant in the lung, predominantly relating to macrophage activation and neutrophil chemotaxis. Variations within its gene are also associated with airways disease, implying a role for the protein product in pathogenesis. Thus far the majority of evidence relates to chronic obstructive pulmonary disease (COPD), but is scant in other airways diseases, such as asthma and bronchiectasis. VDBP also acts as a scavenger protein to clear extracellular G-actin released from necrotic cells, which may be of relevance in severe lung infections and acute lung injury. Vitamin D protects against the development of cancer and tuberculosis, although optimal levels are unknown. The majority of circulating vitamin D is bound to VDBP, and its uptake into cells occurs in both bound and unbound forms, which suggests the role of VDBP warrants further study in these conditions as well. This article reviews the evidence of the role VDBP and its gene (GC) in a range of lung diseases, including asthma, COPD and tuberculosis.
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Affiliation(s)
- L Chishimba
- Lung Investigation Unit, University Hospitals Birmingham, Birmingham B15 2TH, UK
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Wood AM, de Pablo P, Buckley CD, Ahmad A, Stockley RA. Smoke exposure as a determinant of autoantibody titre in α₁-antitrypsin deficiency and COPD. Eur Respir J 2010; 37:32-8. [PMID: 20525711 DOI: 10.1183/09031936.00033710] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Liberation of elastin peptides from damaged lung may be a mechanism of autoimmune lung disease. Citrullination, and anti-citrullinated protein antibody formation occurs in smokers, but the role of smoking in autoantibody generation relevant to pulmonary disease is unclear. Anti-elastin, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) antibodies were measured in 257 subjects with α₁-antitrypsin deficiency (AATD), 113 subjects with usual chronic obstructive pulmonary disease (COPD) and 22 healthy nonsmokers. Levels were compared between groups, against phenotypic features and against smoke exposure. Anti-elastin antibodies were higher in controls relative to AATD (p = 0.008) and usual COPD (p < 0.00001), and in AATD relative to usual COPD (p < 0.00001). Anti-elastin levels showed a threshold at 10 pack-yrs, being higher in those who had smoked less (p = 0.004). No relationships between antibody levels and clinical phenotype were seen after adjustment for smoke exposure. Anti-CCP antibodies were higher in usual COPD than AATD (p = 0.002) but the relationship to smoke exposure was less clear. Smoke exposure is the main determinant of anti-elastin antibody levels, which fall after 10 pack-yrs. Local antibody complexes may be a better measure of elastin directed autoimmunity than circulating levels.
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Affiliation(s)
- A M Wood
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Evans JT, Wood AM, Wood IM. Management of the trauma patient: what happens after the patient leaves Afghanistan--a 40 Commando Royal Marines perspective. J R Nav Med Serv 2010; 96:146-149. [PMID: 21443048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Wood AM, Clement N, Wood IM. Making the European working time directive work for you. J R Nav Med Serv 2010; 96:13-16. [PMID: 20608005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- A M Wood
- ST 4 Trauma and Orthopaedics, Royal Infirmary of Edinburgh
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Wood AM, Wood CM, Bakker-Dyos J. Case study--leprosy. J R Nav Med Serv 2010; 96:92-95. [PMID: 21073092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present the case of a 26 year old Indian base worker who attended the Role 2 enhanced hospital in Iraq with a case of leprosy. The patient presented four times over a 12 month period with non-specific pain in the right hand and forearm combined with a large lesion of dry skin and reduced sensation in the forearm. A clinical diagnosis of leprosy was made, which was subsequently confirmed as paucibacillary leprosy by skin smears sent to the UK. It was not possible to treat the patient locally and a recommendation made to the patient's employer that the patient return to India to commence treatment.
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Affiliation(s)
- A M Wood
- Royal Navy, Royal Infirmary of Edinburgh.
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Keenan A, Wood AM, Arthur C, Bakker-Dyos JJ. Royal Marine Arctic Warfare Training: early field reduction of clinically diagnosed anterior shoulder dislocation. J R Nav Med Serv 2010; 96:136-138. [PMID: 21443046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Johnson J, Gooding PA, Wood AM, Tarrier N. Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS). Behav Res Ther 2009; 48:179-86. [PMID: 19906364 DOI: 10.1016/j.brat.2009.10.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/24/2009] [Accepted: 10/14/2009] [Indexed: 12/01/2022]
Abstract
AIMS The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events. METHOD 78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals. RESULTS Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality. DISCUSSION These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.
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Abstract
An outbreak of neurological disease occurred in pheasant chicks on a game farm in 2007. The disease was first seen in the 10th hatching of chicks on the farm. Affected chicks showed trembling and incoordination from the time of hatching, and subsequently blindness and cataract formation was seen in some of the affected chicks at 3 weeks of age. The peak mortality and culling figure was 21.0% in the worst affected hatch, compared with a maximum of 11.7% in the first nine hatches. No further cases were evident by 7.5 weeks of age. Histopathological examination showed a moderate acute encephalomyelitis in some, but not all, of the chicks with neurological signs. The clinical presentation and histopathological findings were typical of vertically transmitted avian encephalomyelitis as seen in chickens, although avian encephalomyelitis virus could not be detected in inoculated embryonated chicken eggs. However, serological testing by enzyme-linked immunosorbent assay for antibodies to the virus was positive in four of five affected 3-week-old birds and in 23 out of 29 adult breeding birds, and reverse transcriptase-polymerase chain reaction testing of RNA extracted from brain and pancreas tissue of affected chicks yielded nucleotide sequences aligned 82% and 83% with three avian encephalomyelitis sequences in a sequence database. The evidence suggested that the neurological disease was attributable to infection with a strain of avian encephalomyelitis virus that appeared to have entered the flock at the start of the breeding season, and was possibly introduced by carrier pheasants brought on to the farm early in the season.
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Tan SL, Wood AM. Chronic obstructive pulmonary disease and comorbidity: a review and consideration of pathophysiology. Panminerva Med 2009; 51:81-93. [PMID: 19776710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible, though a number of pulmonary phenotypes are recognized. These include small airways diseases, chronic bronchitis and bronchiectasis, as well as pulmonary emphysema, which can be further subdivided by the zone of the lung which it affects, and its radiological appearance. In addition COPD is associated with a number of comorbidities, which are found more frequently than would be expected by chance, even after controlling for common etiological factors (such as smoking or steroid use). These comorbid conditions may be responsible for some of the deterioration and de-conditioning seen in COPD, as well as a significant proportion of mortality, and should be sought and managed where clinically appropriate. This review examines the prevalence and clinical features of associated comorbid conditions, including atherosclerosis, cardiac failure, diabetes, osteoporosis, cachexia, gastro-esophageal reflux disease and depression. A brief consideration of their management in COPD is also given. In addition evidence for the concept of pulmonary overspill leading to systemic inflammation, the consequences of systemic inflammation, the possibility of accelerated aging, and of how these concepts could relate to shared genetic risk factors for both comorbidity and pulmonary aspects of COPD is discussed.
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Affiliation(s)
- S L Tan
- Birmingham Heartlands Hospital, Birmingham, UK
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Jackson D, White I, Kostis JB, Wilson AC, Folsom AR, Wu K, Chambless L, Benderly M, Goldbourt U, Willeit J, Kiechl S, Yarnell JWG, Sweetnam PM, Elwood PC, Cushman M, Psaty BM, Tracy RP, Tybjaerg-Hansen A, Haverkate F, de Maat MPM, Thompson SG, Fowkes FGR, Lee AJ, Smith FB, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, D'Agostino R, Kannel WB, Wilson PWF, Tofler G, Levy D, Marchioli R, Valagussa F, Rosengren A, Wilhelmsen L, Lappas G, Eriksson H, Cremer P, Nagel D, Curb JD, Rodriguez B, Yano K, Salonen JT, Nyyssönen K, Tuomainen TP, Hedblad B, Engström G, Berglund G, Loewel H, Koenig W, Hense HW, Meade TW, Cooper JA, De Stavola B, Knottenbelt C, Miller GJ, Cooper JA, Bauer KA, Rosenberg RD, Sato S, Kitamura A, Naito Y, Iso H, Salomaa V, Harald K, Rasi V, Vahtera E, Jousilahti P, Palosuo T, Ducimetiere P, Amouyel P, Arveiler D, Evans AE, Ferrieres J, Juhan-Vague I, Bingham A, Schulte H, Assmann G, Cantin B, Lamarche B, Despres JP, Dagenais GR, Tunstall-Pedoe H, Lowe GDO, Woodward M, Ben-Shlomo Y, Davey Smith G, Palmieri V, Yeh JL, Meade TW, Rudnicka A, Brennan P, Knottenbelt C, Cooper JA, Ridker P, Rodeghiero F, Tosetto A, Shepherd J, Lowe GDO, Ford I, Robertson M, Brunner E, Shipley M, Feskens EJM, Di Angelantonio E, Kaptoge S, Lewington S, Lowe GDO, Sarwar N, Thompson SG, Walker M, Watson S, White IR, Wood AM, Danesh J. Systematically missing confounders in individual participant data meta-analysis of observational cohort studies. Stat Med 2009; 28:1218-37. [PMID: 19222087 PMCID: PMC2922684 DOI: 10.1002/sim.3540] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One difficulty in performing meta-analyses of observational cohort studies is that the availability of confounders may vary between cohorts, so that some cohorts provide fully adjusted analyses while others only provide partially adjusted analyses. Commonly, analyses of the association between an exposure and disease either are restricted to cohorts with full confounder information, or use all cohorts but do not fully adjust for confounding. We propose using a bivariate random-effects meta-analysis model to use information from all available cohorts while still adjusting for all the potential confounders. Our method uses both the fully adjusted and the partially adjusted estimated effects in the cohorts with full confounder information, together with an estimate of their within-cohort correlation. The method is applied to estimate the association between fibrinogen level and coronary heart disease incidence using data from 154 012 participants in 31 cohorts.† Copyright © 2009 John Wiley & Sons, Ltd.
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Dawkins PA, Dawkins CL, Wood AM, Nightingale PG, Stockley JA, Stockley RA. Rate of progression of lung function impairment in alpha1-antitrypsin deficiency. Eur Respir J 2009; 33:1338-44. [PMID: 19164359 DOI: 10.1183/09031936.00061208] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to identify alpha(1)-antitrypsin (alpha(1)-AT)-deficient patients who had rapidly progressive disease. PiZ patients (n = 101) underwent annual lung function measurements over a 3-yr period, and the results were related to factors that may influence decline. The mean annual decline in forced expiratory volume in 1 s (FEV(1)) was 49.9 mL. The greatest FEV(1) decline occurred in the moderate severity group (FEV(1) 50-80% of the predicted value), with a mean annual decline of 90.1 mL, compared with 8.1 mL in the very severe group (FEV(1) <30% pred). However, annual decline in transfer coefficient of the lung for carbon monoxide (K(CO)) was greatest in the severe and very severe groups. When the whole group was divided into tertiles of FEV(1) decline, the fast tertile compared with the slow tertile had more patients with bronchodilator reversibility (BDR) (73 versus 41%; p = 0.010), more males (79 versus 56%; p = 0.048) and lower body mass index (BMI) (24.0 versus 26.1; p = 0.042). Logistic regression analyses confirmed that FEV(1) decline was independently associated with BMI, BDR, exacerbation rate and high physical component 36-item short-form health survey scores. In PiZ alpha(1)-AT-deficient patients, FEV(1) decline was greatest in moderate disease, unlike K(CO) decline, which was greatest in severe disease. The FEV(1) decline showed associations with BDR, BMI, sex and exacerbation rate.
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Affiliation(s)
- P A Dawkins
- Lung Investigation Unit, UniversityHospital Birmingham and University of Birmingham, Birmingham, UK.
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