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Shields AM, Anantharachagan A, Arumugakani G, Baker K, Bahal S, Baxendale H, Bermingham W, Bhole M, Boules E, Bright P, Chopra C, Cliffe L, Cleave B, Dempster J, Devlin L, Dhalla F, Diwakar L, Drewe E, Duncan C, Dziadzio M, Elcombe S, Elkhalifa S, Gennery A, Ghanta H, Goddard S, Grigoriadou S, Hackett S, Hayman G, Herriot R, Herwadkar A, Huissoon A, Jain R, Jolles S, Johnston S, Khan S, Laffan J, Lane P, Leeman L, Lowe DM, Mahabir S, Lochlainn DJM, McDermott E, Misbah S, Moghaddas F, Morsi H, Murng S, Noorani S, O'Brien R, Patel S, Price A, Rahman T, Seneviratne S, Shrimpton A, Stroud C, Thomas M, Townsend K, Vaitla P, Verma N, Williams A, Burns SO, Savic S, Richter AG. Outcomes following SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK. Clin Exp Immunol 2022; 209:247-258. [PMID: 35641155 PMCID: PMC8807296 DOI: 10.1093/cei/uxac008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to the hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir, and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count, and the presence of co-morbidities are additional risk factors for poor outcome in this cohort.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | | | - Gururaj Arumugakani
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Kenneth Baker
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sameer Bahal
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Malini Bhole
- The Dudley Group NHS Foundation Trust, Birmingham, UK
| | - Evon Boules
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Philip Bright
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Charu Chopra
- Department of Haematology & Immunology, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Lucy Cliffe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Betsy Cleave
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - John Dempster
- Specialist Allergy and Clinical Immunology, University College London Hospitals, London, UK
| | - Lisa Devlin
- Regional Immunology Service, The Royal Hospitals, Belfast, UK
| | - Fatima Dhalla
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lavanya Diwakar
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Elizabeth Drewe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christopher Duncan
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | | | - Suzanne Elcombe
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Shuayb Elkhalifa
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew Gennery
- Translational and Clinical Research Institute, Newcastle University, and Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Harichandrana Ghanta
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Sarah Goddard
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Sofia Grigoriadou
- Immunology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Scott Hackett
- Paediatric Immunology Department, University Hospitals of Birmingham, Birmingham, UK
| | - Grant Hayman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Richard Herriot
- Immunology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Archana Herwadkar
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Aarnoud Huissoon
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sarah Johnston
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Sujoy Khan
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James Laffan
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Peter Lane
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Lucy Leeman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Shanti Mahabir
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Elizabeth McDermott
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Siraj Misbah
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hadeil Morsi
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sai Murng
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Sadia Noorani
- Clinical Immunology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rachael O'Brien
- Department of Clinical Immunology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Smita Patel
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arthur Price
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | - Tasneem Rahman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | | | - Anna Shrimpton
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Catherine Stroud
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Moira Thomas
- Clinical Immunology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Katie Townsend
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Prashantha Vaitla
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nisha Verma
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Anthony Williams
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Godfrey B, Duncan C, Rosenbaum-Chou T. Comparison of Self-Reported vs Objective Measures of Long-Term Community Ambulation in Lower Limb Prosthesis Users. Arch Rehabil Res Clin Transl 2022; 4:100220. [PMID: 36123988 PMCID: PMC9482032 DOI: 10.1016/j.arrct.2022.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine normal variation in walking metrics in a population of lower limb amputees who use lower limb prostheses over a 6-month period and to provide a means to interpret clinically meaningful change in those community walking metrics. Design Prospective cohort study monitoring walking behavior and subjective and objective measures of activity. Setting Veterans Administration and university amputee clinics. Participants 86 individuals with lower limb amputation who use protheses. Interventions StepWatch activity monitor tracked subjects’ walking for 24 weeks; Global Mobility Change Rating collected weekly. Main Outcome Measures Association between change in Global Mobility Change Rating and change in any of the walking metrics. Results Walking metrics including step count, cadence, cadence variability, and walking distance in a population of lower limb prosthesis users were obtained. There was a high correlation in the walking metrics indicating higher function with higher functional classification level (K-levels) but also substantial overlap in all metrics and a very weak correlation between subject-reported activity level and objective measures of walking performance. Conclusion The overlap in walking metrics with all K-levels demonstrates that no single metric measured by StepWatch can determine K-level with 100% accuracy. As previously demonstrated in other populations, subjects’ interpretations of their general activity level was inaccurate, regardless of their age or activity level. Objective measures of walking appear to provide a more accurate representation of patients’ activity levels in the community than self-report. Therefore, objective measures of walking are useful in supporting K-level determinations. However, clinicians cannot rely on a single metric to determine K-level.
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Affiliation(s)
- Bradeigh Godfrey
- Department of PM&R, University of Utah, Salt Lake City, Utah
- Polytrauma Amputation Network Site, Salt Lake City VA Medical Center, Salt Lake City, Utah
- Corresponding author Bradeigh Godfrey, DO, Department of PM&R, University of Utah, 500 Foothill Boulevard, Salt Lake City, UT 84148.
| | | | - Teri Rosenbaum-Chou
- Department of PM&R, University of Utah, Salt Lake City, Utah
- Modus Health, Edmonds, Washington
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3
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Lorden C, Welsh S, Puvaneswaran B, Gandhi S, Baker K, Duncan C, Mountford C. COVID-19 management in a UK Tertiary Centre with High Consequence Infectious Diseases Centre: Nutritional status, intervention and outcome. Clin Nutr ESPEN 2022. [PMCID: PMC8937581 DOI: 10.1016/j.clnesp.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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4
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van der Velden FJS, van Delft F, Owens S, Llevadias J, McKean M, Pulford L, Taha Y, Williamson G, Campbell-Hewson Q, Hambleton S, Payne R, Duncan C, Johnston C, Spegarova J, Emonts M. Case Report: Severe Acute Pulmonary COVID-19 in a Teenager Post Autologous Hematopoietic Stem Cell Transplant. Front Pediatr 2022; 10:809061. [PMID: 35311038 PMCID: PMC8927762 DOI: 10.3389/fped.2022.809061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Pulmonary severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is generally described as mild, and SARS-CoV-2 infection in immunocompromised children are observed as generally mild as well. A small proportion of pediatric patients will become critically ill due to (cardio)respiratory failure and require intensive care treatment. We report the case of a teenager with Hodgkin's lymphoma who acquired SARS-CoV-2 (detected by PCR) on the day of her autologous stem cell transplant and developed acute respiratory distress syndrome, successfully treated with a combination of antivirals, immunomodulation with steroids and biologicals, and ECMO.
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Affiliation(s)
- Fabian J. S. van der Velden
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Frederik van Delft
- Paediatric Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Judit Llevadias
- Paediatric Intensive Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michael McKean
- Paediatric Respiratory Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lindsey Pulford
- Paediatric Intensive Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Yusri Taha
- Virology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Grace Williamson
- Paediatric Intensive Care, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Quentin Campbell-Hewson
- Paediatric Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca Payne
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher Duncan
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Infectious Disease and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Catriona Johnston
- Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jarmila Spegarova
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases and Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Sanchez-Gonzalez A, Fox H, Narayanan M, Samuel J, Schwab U, Duncan C. Atypical presentation of an uncommon pathogen. Clinical Infection in Practice 2022. [DOI: 10.1016/j.clinpr.2021.100120] [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: 11/27/2022] Open
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6
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Durkin K, Kelleher J, Stark L, Griffin K, Lynn C, Filigno S, Everhart R, Fedele D, Moffett-Bradford K, Duncan C. 269: Food security and nutritional adherence in adolescents with cystic fibrosis during the COVID-19 pandemic. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01694-5] [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: 10/20/2022]
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7
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Mountan S, Duncan C, Hansen C. Resolution of prosthesis-related residual limb wounds after botulinum toxin for secondary hyperhidrosis. PM R 2021; 14:1026-1028. [PMID: 34564952 DOI: 10.1002/pmrj.12714] [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] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Shanalee Mountan
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.,Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Christopher Duncan
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Colby Hansen
- Division of Physical Medicine & Rehabilitation, The University of Utah, Salt Lake City, Utah, USA.,Primary Children's Hospital, Salt Lake City, Utah, USA
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Campbell A, Montgomery S, Richardson B, Duncan C, Howles C. P–282 A time lapse analysis of 36,671 embryos to compare the incidence of early stage abnormal cleavage events in ICSI and IVF derived embryos. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is this incidence of early stage abnormal cleavage events different between embryos created following ICSI compared with IVF?
Summary answer
Embryos derived from ICSI are more likely to exhibit abnormal cleavage compared with those from IVF. This difference is most marked in women ≥35 years.
What is known already
Time lapse imaging (TLI) has been instrumental in allowing detailed annotation of early embryo development to provide an objective aid for embryo selection in ART cycles. Amongst several abnormal cleavage events reported, rapid cleavage and multichotomous mitosis/direct cleavage, during the first days after fertilisation have been demonstrated to be associated with lower blastulation rates, reduced implantation potential, increased aneuploidy and poor pregnancy outcomes. With ICSI being utilised commonly, and being the insemination method of choice in some clinics, the incidence of abnormal cleavage was investigated in association with insemination method, ICSI or IVF.
Study design, size, duration
The incidence of abnormal cleavage events was evaluated in a large multicentre retrospective analysis of 36,671 embryos from 6689 patients treated in 8 IVF clinics enabled with time lapse imaging, between 2011 - 2019. This constituted 10931 IVF embryos and 25740 ICSI embryos.
Participants/materials, setting, methods
Following ICSI or after IVF fertilisation check, embryos were time-lapse imaged every 10 minutes and annotated using the EmbryoScope. Second cell cycle durations were calculated as follows: time to reach 3-cell (t3) from 2-cell (t2) (t3-t2 = cc2). These were analysed using a welch t-test as three groups of abnormal cleavage: direct cleavage/trichotomous mitosis (DC) - where cc2=0 hours(h), rapid cleavage within 2h (R2) - where 0<cc2<2h and rapid cleavage between 2–5h (R5) where 2h<cc2<5h.
Main results and the role of chance
The incidence of DC, R2 and R5 in the whole cohort of embryos was 5%, 8% and 9% respectively. In the subpopulation of IVF embryos the incidence of DC, R2 and R5 was 4%, 8% and 9% respectively. In the subpopulation of ICSI embryos the incidence of DC, R2 and R5 was 6%, 8% and 9% respectively. The incidence of DC was significantly higher in ICSI embryos compared with IVF (p < 0.001) whilst R2 and R5 were the same. ICSI derived embryos had a mean (± SE) cc2 value of 9.39 ± 0.03h, compared with 9.56 ± 0.05h for IVF embryos (p < 0.0038). Examination of data split by maternal age demonstrated that ICSI oocytes from women of advanced maternal age (≥35) also had significantly more embryos exhibiting rapid cleavages R2 and R5 than IVF oocytes (p < 0.007). There were no significant differences however, in rates of abnormal cleavages between ICSI and IVF in embryos from women aged <30 (p = 0.06).
Male-factor diagnoses showed no significant differences in abnormal cleavage values between ICSI or IVF in all three abnormal cleavage categories.
Limitations, reasons for caution
This analysis could not control for all potential confounders therefore it is possible that the increased abnormal cleavages observed in this investigation are a result of another, or combination of factors. Despite quality assurance programs being in place across all clinics, there is a risk of annotation bias.
Wider implications of the findings: There is a higher incidence of early abnormal cleavage in embryos derived from ICSI, particularly in those from women of increased age and this research may help elucidate the reasons for this and add to the debate regarding the appropriateness of the increasing use of ICSI.
Trial registration number
Not applicable
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Affiliation(s)
- A Campbell
- CARE Fertility Group, Embryology, Cheshire, United Kingdom
| | - S Montgomery
- CARE Fertility Group, Embryology, Cheshire, United Kingdom
| | - B Richardson
- University of Edinburgh, Biology, Edinburgh, United Kingdom
| | - C Duncan
- University of Edinburgh, Biology, Edinburgh, United Kingdom
| | - C Howles
- University of Edinburgh, Biology, Edinburgh, United Kingdom
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D'Souza R, Duncan C, Whiting D, Brown M, Warner M, Smith H, Kremers H, Stewart T. Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty. Bosn J Basic Med Sci 2021; 21:471-476. [PMID: 33119480 PMCID: PMC8292867 DOI: 10.17305/bjbms.2020.5060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/14/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p < 0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p = 0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient −0.582, 95% CI −1.008-−0.156, p = 0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p = 0.023) and reduced total hospital cost of care by 6.45% (p < 0.001), room and board costs by 11.76% (p < 0.001), and transfusion costs by 81.65% (p < 0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.
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Affiliation(s)
- Ryan D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christopher Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Daniel Whiting
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew Warner
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Hugh Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Hilal Kremers
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with many potentially fatal complications. Renal involvement in various forms is common in addition to serum electrolyte disturbances. Early reports suggest that hypokalaemia may frequent those with SARS-CoV-2 infection and various aetiological factors may cause this electrolyte disturbance. A Chinese retrospective study has demonstrated renal potassium wasting in patients infected with SARS-CoV-2, however, it is not known if these patients were receiving diuretic therapy which may be a contributing factor. This case report illustrates an example of renal potassium wasting in SARS-CoV-2 infection in the absence of diuretics and extra-renal mechanisms with important lessons learned.
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Affiliation(s)
- Holly Mabillard
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE77DN, UK
| | - Hilary Tedd
- Department of Respiratory Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
| | - Ally Speight
- Department of Gastroenterology, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
| | - Christopher Duncan
- Department of Infection and Tropical Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
| | - David A. Price
- Department of Infection and Tropical Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
| | - John A. Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE77DN, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE45PL, UK
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Mabillard H, Tedd H, Speight A, Duncan C, Price DA, Sayer JA. Case Report: Renal potassium wasting in SARS-CoV-2 infection. F1000Res 2020; 9:659. [PMID: 33299549 PMCID: PMC7702164 DOI: 10.12688/f1000research.24621.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 03/31/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with many potentially fatal complications. Renal involvement in various forms is common in addition to serum electrolyte disturbances. Early reports suggest that hypokalaemia may frequent those with SARS-CoV-2 infection and various aetiological factors may cause this electrolyte disturbance. A Chinese retrospective study has demonstrated renal potassium wasting in patients infected with SARS-CoV-2, however, it is not known if these patients were receiving diuretic therapy which may be a contributing factor. This case report illustrates an example of renal potassium wasting in SARS-CoV-2 infection in the absence of diuretics and extra-renal mechanisms with important lessons learned.
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Affiliation(s)
- Holly Mabillard
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE77DN, UK
| | - Hilary Tedd
- Department of Respiratory Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
| | - Ally Speight
- Department of Gastroenterology, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
| | - Christopher Duncan
- Department of Infection and Tropical Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
| | - David A. Price
- Department of Infection and Tropical Medicine, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE14LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
| | - John A. Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE77DN, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE13BZ, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, Tyne and Wear, NE45PL, UK
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Polineni D, Lindwall J, Muther E, Durkin K, Ahrabi-Nejad C, Ruvalcaba E, Nelson E, White M, Bord E, Goodman A, Riekert K, Duncan C. P342 Development of a pilot trial of a novel tele-coaching intervention to improve treatment adherence in cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30671-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Thorley J, Duncan C, Sharp SP, Gaynor D, Manser MB, Clutton-Brock T. Sex-independent senescence in a cooperatively breeding mammal. J Anim Ecol 2020; 89:1080-1093. [PMID: 31943191 DOI: 10.1111/1365-2656.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/05/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022]
Abstract
Researchers studying mammals have frequently interpreted earlier or faster rates of ageing in males as resulting from polygyny and the associated higher costs of reproductive competition. Yet, few studies conducted on wild populations have compared sex-specific senescence trajectories outside of polygynous species, making it difficult to make generalized inferences on the role of reproductive competition in driving senescence, particularly when other differences between males and females might also contribute to sex-specific changes in performance across lifespan. Here, we examine age-related variation in body mass, reproductive output and survival in dominant male and female meerkats, Suricata suricatta. Meerkats are socially monogamous cooperative breeders where a single dominant pair virtually monopolizes reproduction in each group and subordinate group members help to rear offspring produced by breeders. In contrast to many polygynous societies, we find that neither the onset nor the rate of senescence in body mass or reproductive output shows clear differences between males and females. Both sexes also display similar patterns of age-related survival across lifespan, but unlike most wild vertebrates, survival senescence (increases in annual mortality with rising age) was absent in dominants of both sexes, and as a result, the fitness costs of senescence were entirely attributable to declines in reproductive output from mid- to late-life. We suggest that the potential for intrasexual competition to increase rates of senescence in females-who are hormonally masculinized and frequently aggressive-is offset by their ability to maintain longer tenures of dominance than males, and that these processes when combined lead to similar patterns of senescence in both sexes. Our results stress the need to consider the form and intensity of sexual competition as well as other sex-specific features of life history when investigating the operation of senescence in wild populations.
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Affiliation(s)
- Jack Thorley
- Department of Zoology, University of Cambridge, Cambridge, UK.,Kalahari Research Centre, Kuruman River Reserve, South Africa
| | - Christopher Duncan
- Department of Zoology, University of Cambridge, Cambridge, UK.,Kalahari Research Centre, Kuruman River Reserve, South Africa
| | - Stuart P Sharp
- Lancaster Environment Centre, Lancaster University, Lancashire, UK
| | - David Gaynor
- Kalahari Research Centre, Kuruman River Reserve, South Africa.,Mammal Research Institute, University of Pretoria, Pretoria, South Africa
| | - Marta B Manser
- Kalahari Research Centre, Kuruman River Reserve, South Africa.,Mammal Research Institute, University of Pretoria, Pretoria, South Africa.,Animal Behaviour, Department of Evolutionary Biology and Environmental Studies, University of Zurich, Zurich, Switzerland
| | - Tim Clutton-Brock
- Department of Zoology, University of Cambridge, Cambridge, UK.,Kalahari Research Centre, Kuruman River Reserve, South Africa.,Mammal Research Institute, University of Pretoria, Pretoria, South Africa
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14
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Shamir S, Wolynski J, Duncan C, Puttlitz C, Duerr F. Use of a Novel Osteotomy Guide (Bonetractor) for Closing Wedge Osteotomies: Ex vivo Evaluation of Osteotomy Accuracy. Vet Comp Orthop Traumatol 2019. [DOI: 10.1055/s-0039-1692290] [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: 10/26/2022]
Affiliation(s)
- S.K. Shamir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, United States
| | - J. Wolynski
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, United States
| | - C. Duncan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, United States
| | - C.M. Puttlitz
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, United States
| | - F.M. Duerr
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, United States
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15
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Abstract
Aims We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. Patients and Methods We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications. Results At ten years, the Kaplan–Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners. Conclusion Constrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123–126.
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Affiliation(s)
- M. El-Husseiny
- Department of Orthopaedics and Trauma, Barts Health NHS Trust, London, UK
| | - B. Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - C. Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - D. S. Garbuz
- Division of Lower Limb Reconstruction and Oncology, University of British Columbia, Vancouver, Canada
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16
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Qu Y, McGiffin D, Kure C, McLean J, Duncan C, Peleg A. A Comprehensive In Vitro Evaluation of Medihoney as an Anti-Biofilm Agent in Preventing Ventricular Assist Device Driveline Infections. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.236] [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: 10/27/2022] Open
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17
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Kluger D, Duncan C, Davis T, Warren DJ, Hutchinson D, Clark G. Abstract #35: Using High-Electrode-Count Intrafascicular Peripheral Nerve Interfaces for Selective Mitigation of Chronic Pain. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.042] [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: 11/16/2022] Open
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18
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McGinn C, Duncan C, Nadolski G. 03:18 PM Abstract No. 35 Does the implementation of routine end-tidal CO2 monitoring during moderate sedation in IR change incidence of oversedation? J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.074] [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: 11/24/2022] Open
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19
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Duncan C, Wass A, Logan J. 43IMPROVING THE COMMUNICATION OF RESUSCITATION STATUS ON DISCHARGE FROM COMMUNITY HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.43] [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: 11/14/2022] Open
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20
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Duncan C. Mid-Urethral Sling: Utilizing Porcine Urinary Bladder Extra-Cellular Matrix (ECM) and Poly-Ether-Ether-Ketone (PEEK) Anchors. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.757] [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: 10/28/2022]
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21
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Page DM, George JA, Kluger DT, Duncan C, Wendelken S, Davis T, Hutchinson DT, Clark GA. Motor Control and Sensory Feedback Enhance Prosthesis Embodiment and Reduce Phantom Pain After Long-Term Hand Amputation. Front Hum Neurosci 2018; 12:352. [PMID: 30319374 PMCID: PMC6166773 DOI: 10.3389/fnhum.2018.00352] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [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: 02/10/2018] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
We quantified prosthesis embodiment and phantom pain reduction associated with motor control and sensory feedback from a prosthetic hand in one human with a long-term transradial amputation. Microelectrode arrays were implanted in the residual median and ulnar arm nerves and intramuscular electromyography recording leads were implanted in residual limb muscles to enable sensory feedback and motor control. Objective measures (proprioceptive drift) and subjective measures (survey answers) were used to assess prosthesis embodiment. For both measures, there was a significant level of embodiment of the physical prosthetic limb after open-loop motor control of the prosthesis (i.e., without sensory feedback), open-loop sensation from the prosthesis (i.e., without motor control), and closed-loop control of the prosthesis (i.e., motor control with sensory feedback). There was also a statistically significant reduction in reported phantom pain after experimental sessions that included open-loop nerve microstimulation, open-loop prosthesis motor control, or closed-loop prosthesis motor control. The closed-loop condition provided no additional significant improvements in phantom pain reduction or prosthesis embodiment relative to the open-loop sensory condition or the open-loop motor condition. This study represents the first long-term (14-month), systematic report of phantom pain reduction and prosthesis embodiment in a human amputee across a variety of prosthesis use cases.
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Affiliation(s)
- David M. Page
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Jacob A. George
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - David T. Kluger
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Christopher Duncan
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Suzanne Wendelken
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | | | - Gregory A. Clark
- Department of Bioengineering, University of Utah, Salt Lake City, UT, United States
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22
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Cram DL, Monaghan P, Gillespie R, Dantzer B, Duncan C, Spence-Jones H, Clutton-Brock T. Rank-Related Contrasts in Longevity Arise from Extra-Group Excursions Not Delayed Senescence in a Cooperative Mammal. Curr Biol 2018; 28:2934-2939.e4. [DOI: 10.1016/j.cub.2018.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/14/2018] [Accepted: 07/08/2018] [Indexed: 12/11/2022]
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23
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Duncan C, Trerotola SO, Stavropoulos SW. Endovascular Removal of Inferior Vena Cava Filters with Arterial Penetration. J Vasc Interv Radiol 2018; 29:486-490. [PMID: 29477624 DOI: 10.1016/j.jvir.2017.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/08/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the safety and outcomes of endovascular percutaneous removal of inferior vena cava filters (IVCFs) with elements penetrating an artery. MATERIALS AND METHODS From an IVCF retrieval database, computerized tomographic scans of patients who underwent IVCF retrieval from 2011 to 2017 were reviewed for IVCF elements penetrating through the caval wall and into an adjacent arterial wall (AW) or penetrating into an adjacent arterial lumen (AL). Forty-two patients were identified, including 20 with elements penetrating into an AW and 22 with elements penetrating into an AL; 30 of these IVCFs were tip embedded. RESULTS All of the filters in both groups were removed. Of the arterial-interacting filters, 9 were removed with the use of standard techniques and 33 with the use of endobronchial forceps. Arterial access was obtained before removal in 3 patients (7%) with post-removal arteriography revealing no abnormalities, such as extravasation, pseudoaneurysm, or new fractured components. There was no significant difference between groups in tip embedding, retrieval technique, or fluoroscopy time. CONCLUSIONS Endovascular removal of IVCFs with elements that have penetrated into adjacent arterial walls or lumens can be performed safely in the majority of patients.
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Affiliation(s)
- Christopher Duncan
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104.
| | - S William Stavropoulos
- Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein 3400 Spruce Street, Philadelphia, PA 19104
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24
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Wendelken S, Page DM, Davis T, Wark HAC, Kluger DT, Duncan C, Warren DJ, Hutchinson DT, Clark GA. Restoration of motor control and proprioceptive and cutaneous sensation in humans with prior upper-limb amputation via multiple Utah Slanted Electrode Arrays (USEAs) implanted in residual peripheral arm nerves. J Neuroeng Rehabil 2017; 14:121. [PMID: 29178940 PMCID: PMC5702130 DOI: 10.1186/s12984-017-0320-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 10/20/2017] [Indexed: 01/08/2023] Open
Abstract
Background Despite advances in sophisticated robotic hands, intuitive control of and sensory feedback from these prostheses has been limited to only 3-degrees-of-freedom (DOF) with 2 sensory percepts in closed-loop control. A Utah Slanted Electrode Array (USEA) has been used in the past to provide up to 81 sensory percepts for human amputees. Here, we report on the advanced capabilities of multiple USEAs implanted in the residual peripheral arm nerves of human amputees for restoring control of 5 DOF and sensation of up to 131 proprioceptive and cutaneous hand sensory percepts. We also demonstrate that USEA-restored sensory percepts provide a useful source of feedback during closed-loop virtual prosthetic hand control. Methods Two 100-channel USEAs were implanted for 4–5 weeks, one each in the median and ulnar arm nerves of two human subjects with prior long-duration upper-arm amputations. Intended finger and wrist positions were decoded from neuronal firing patterns via a modified Kalman filter, allowing subjects to control many movements of a virtual prosthetic hand. Additionally, USEA microstimulation was used to evoke numerous sensory percepts spanning the phantom hand. Closed-loop control was achieved by stimulating via an electrode of the ulnar-nerve USEA while recording and decoding movement via the median-nerve USEA. Results Subjects controlled up to 12 degrees-of-freedom during informal, ‘freeform’ online movement decode sessions, and experienced up to 131 USEA-evoked proprioceptive and cutaneous sensations spanning the phantom hand. Independent control was achieved for a 5-DOF real-time decode that included flexion/extension of the thumb, index, middle, and ring fingers, and the wrist. Proportional control was achieved for a 4-DOF real-time decode. One subject used a USEA-evoked hand sensation as feedback to complete a 1-DOF closed-loop virtual-hand movement task. There were no observed long-term functional deficits due to the USEA implants. Conclusions Implantation of high-channel-count USEAs enables multi-degree-of-freedom control of virtual prosthetic hand movement and restoration of a rich selection of both proprioceptive and cutaneous sensory percepts spanning the hand during the short 4–5 week post-implant period. Future USEA use in longer-term implants and in closed-loop may enable restoration of many of the capabilities of an intact hand while contributing to a meaningful embodiment of the prosthesis. Electronic supplementary material The online version of this article (10.1186/s12984-017-0320-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Wendelken
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - David M Page
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Heather A C Wark
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84102, USA
| | - David T Kluger
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Christopher Duncan
- Division of Phys. Med. and Rehabilitation, University of Utah, Salt Lake City, UT, 84132, USA
| | - David J Warren
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | | | - Gregory A Clark
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
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Duncan C. Vaginal Hysteropexy: Four Point Sacrospinous Liganent Suspension Utilizing ACell Extracellular Matrix and Anchorsure. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.636] [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: 11/17/2022]
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26
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Dugena O, Bujtar P, Robertson B, Scrimshire A, Brannigan K, Richardson D, Mohanrao S, Burn S, Parks C, Sinha A, Duncan C. Understanding craniofacial dermoids: 10-year experience at the Liverpool Craniofacial Centre. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.874] [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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27
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Robertson B, Dai H, Pears N, Duncan C. A morphable model of the human head validating the outcomes of an age-dependent scaphocephaly correction. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Bonshock R, McLaughlin S, Duncan C, Gade T, Hunt S, Trerotola S, Soulen M, Shlansky-Goldberg R, Nadolski G. Complication rates of percutaneous biliary drainage in the presence of ascites. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.717] [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: 10/20/2022] Open
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29
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Duncan C, Trerotola S, Stavropoulos S. Endovascular removal of inferior vena caval filters with struts penetrating into adjacent arteries, a retrospective case-control study. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.803] [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: 10/20/2022] Open
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30
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Duncan C, Trerotola SO. Outcomes of a Percutaneous Technique for Shortening of Totally Implanted Indwelling Central Venous Chest Port Catheters. J Vasc Interv Radiol 2016; 27:1034-7. [PMID: 27338498 DOI: 10.1016/j.jvir.2016.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/20/2022] Open
Abstract
Central venous port catheters that are too long are typically removed or revised. The subcutaneous position of port reservoirs precludes standard over-the-wire exchange techniques, and a method of percutaneous revision using an intravascular loop snare technique has been previously described. A retrospective review was conducted of 38 procedures that were performed at a single academic institution between 2005 and 2015. Technical success was 100%, without immediate or delayed complications with follow-up until port removal or death in 94% of patients. Percutaneous revision is an effective method for shortening too-long port catheters, allowing uninterrupted use of the port.
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Affiliation(s)
- Christopher Duncan
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Interventional Radiology, and Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Abstract
High tension burn injuries comprise 1% of admissions to burns units and have a high incidence of mortality or amputation of an extremity in patients who survive. A dichotomy regarding treatment rationale for high tension electrically injured patients exists and is supported by two separate views of the pathophysiology of the injury. One view contends that the full extent of the injury occurs at the time of injury and this concept is used to support a philosophy of early radical debridement and reconstruction. Another view is that an element of chronicity exists in wound development and that serial examinations and debridements may be required prior to definitive reconstruction. The treatment rationale presented by the authors is that the high complication rate associated with these injuries, including partial or complete flap failure, as well as the need to preserve vital tissue justifies a cautious reconstructive approach similar to that used in high velocity lower limb injuries with serial examinations and debridements taking place prior to definitive reconstruction. A historical overview and discussion of some of the unique features of high tension electrical injuries is presented and used to support the authors’ philosophy of management.
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Affiliation(s)
- C Duncan
- Department of Biomaterials, Dental School, St Chads Queensway, Birmingham, UK
| | - P Aiyer
- Department of Plastic Surgery, KEM Hospital, Parel, Mumbai, India
| | - F Peart
- Department of Plastic Surgery and Burns, University Hospital NHS Trust, Raddlebarn Road, Selly Oak, Birmingham, UK
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32
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Duncan C, Trerotola S. Outcomes of a percutaneous technique for shortening of totally implanted chest port catheters. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.512] [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: 11/24/2022] Open
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33
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Duncan C, Hunt SJ, Gade T, Shlansky-Goldberg RD, Nadolski GJ. Outcomes of Percutaneous Cholecystostomy in the Presence of Ascites. J Vasc Interv Radiol 2016; 27:562-6.e1. [PMID: 26898624 DOI: 10.1016/j.jvir.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate whether the presence of ascites increases complications following placement of percutaneous cholecystostomy tubes (PCTs). MATERIALS AND METHODS Retrospective review of all transhepatic PCTs placed between January 2005 and June 2014 was performed: 255 patients were included (median age of 65 y; range, 20-95 y). Of these patients, 97 had ascites and 158 had no ascites or only pelvic fluid. In all, 115 patients had calculous cholecystitis (45%), 127 had acalculous cholecystitis (50%), and 13 had common bile duct obstruction (5%). The primary outcome of interest was all complications, including bile peritonitis, pericatheter leakage requiring PCT change, pericholecystic abscess formation, drain dislodgment, or death from biliary sepsis within 14 days of initial PCT insertion. RESULTS The overall complication rate was 11% among patients with ascites (n = 11), compared with 10% in those without (n = 16; P = .834). No difference was found between the two groups in any one complication. The overall outcome of PCT drainage differed between groups, with significantly shorter survival times in patients with ascites. Patients with ascites underwent cholecystectomy less often than patients without ascites (21% vs 39%; P = .002). Likewise, patients with ascites were more likely than those without ascites to die with the PCT in place (49% vs 25%; P = .001). CONCLUSIONS Frequencies of complications following PCT insertion were similar in patients with and without ascites. Additionally, the overall complication rate was low and not significantly different between the two groups. These observations support the use of PCT placement in patients with ascites.
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Affiliation(s)
- Christopher Duncan
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Stephen J Hunt
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Terence Gade
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
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Cupit MC, Duncan C, Savani BN, Hashmi SK. Childhood to adult transition and long-term follow-up after blood and marrow transplantation. Bone Marrow Transplant 2015; 51:176-81. [DOI: 10.1038/bmt.2015.228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/21/2015] [Accepted: 08/20/2015] [Indexed: 12/24/2022]
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Laraway D, Richardson D, Domingez-Gonzalez S, Duncan C. Changes in overjet and overbite following midface advancement in syndromic craniosynostosis. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.652] [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: 11/17/2022]
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Walker KM, Okitsu S, Porter DW, Duncan C, Amacker M, Pluschke G, Cavanagh DR, Hill AVS, Todryk SM. Antibody and T-cell responses associated with experimental human malaria infection or vaccination show limited relationships. Immunology 2015; 145:71-81. [PMID: 25471322 DOI: 10.1111/imm.12428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 02/02/2023] Open
Abstract
This study examined specific antibody and T-cell responses associated with experimental malaria infection or malaria vaccination, in malaria-naive human volunteers within phase I/IIa vaccine trials, with a view to investigating inter-relationships between these types of response. Malaria infection was via five bites of Plasmodium falciparum-infected mosquitoes, with individuals reaching patent infection by 11-12 days, having harboured four or five blood-stage cycles before drug clearance. Infection elicited a robust antibody response against merozoite surface protein-119 , correlating with parasite load. Classical class switching was seen from an early IgM to an IgG1-dominant response of increasing affinity. Malaria-specific T-cell responses were detected in the form of interferon-γ and interleukin-4 (IL-4) ELIspot, but their magnitude did not correlate with the magnitude of antibody or its avidity, or with parasite load. Different individuals who were immunized with a virosome vaccine comprising influenza antigens combined with P. falciparum antigens, demonstrated pre-existing interferon-γ, IL-2 and IL-5 ELIspot responses against the influenza antigens, and showed boosting of anti-influenza T-cell responses only for IL-5. The large IgG1-dominated anti-parasite responses showed limited correlation with T-cell responses for magnitude or avidity, both parameters being only negatively correlated for IL-5 secretion versus anti-apical membrane antigen-1 antibody titres. Overall, these findings suggest that cognate T-cell responses across a range of magnitudes contribute towards driving potentially effective antibody responses in infection-induced and vaccine-induced immunity against malaria, and their existence during immunization is beneficial, but magnitudes are mostly not inter-related.
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Affiliation(s)
- Karen M Walker
- Department of Applied Sciences, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
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Touchèque M, Duncan C, Bee C, Orenstein D, Moffett K, Casimir G, Sacré JP, Pierart F, Malfroot A, Etienne AM. 286 Emotional distress, coping and quality of life in children with cystic fibrosis: A cross-cultural study. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30460-4] [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: 11/25/2022]
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Duncan C, Perret L, Palomba S, Lapine M, Kuhlmey BT, de Sterke CM. New avenues for phase matching in nonlinear hyperbolic metamaterials. Sci Rep 2015; 5:8983. [PMID: 25757863 PMCID: PMC4355635 DOI: 10.1038/srep08983] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/17/2014] [Accepted: 02/09/2015] [Indexed: 12/03/2022] Open
Abstract
Nonlinear optical processes, which are of paramount importance in science and technology, involve the generation of new frequencies. This requires phase matching to avoid that light generated at different positions interferes destructively. Of the two original approaches to achieve this, one relies on birefringence in optical crystals, and is therefore limited by the dispersion of naturally occurring materials, whereas the other, quasi-phase-matching, requires direct modulation of material properties, which is not universally possible. To overcome these limitations, we propose to exploit the unique dispersion afforded by hyperbolic metamaterials, where the refractive index can be arbitrarily large. We systematically analyse the ensuing opportunities and demonstrate that hyperbolic phase matching can be achieved with a wide range of material parameters, offering access to the use of nonlinear media for which phase matching cannot be achieved by other means. With the rapid development in the fabrication of hyperbolic metamaterials, our approach is destined to bring significant advantages over conventional techniques for the phase matching of a variety of nonlinear processes.
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Affiliation(s)
- C. Duncan
- Centre for Ultrahigh bandwidth Devices for Optical Systems (CUDOS), School of Physics, University of Sydney, NSW 2006, Australia
| | - L. Perret
- Institute of Photonics and Optical Science (IPOS), University of Sydney, NSW 2006, Australia
| | - S. Palomba
- Institute of Photonics and Optical Science (IPOS), University of Sydney, NSW 2006, Australia
| | - M. Lapine
- School of Mathematical Sciences, University of Technology Sydney, NSW 2007, Australia
- ITMO University, Saint Petersburg 197101, Russia
| | - B. T. Kuhlmey
- Centre for Ultrahigh bandwidth Devices for Optical Systems (CUDOS), School of Physics, University of Sydney, NSW 2006, Australia
- Institute of Photonics and Optical Science (IPOS), University of Sydney, NSW 2006, Australia
| | - C. Martijn de Sterke
- Centre for Ultrahigh bandwidth Devices for Optical Systems (CUDOS), School of Physics, University of Sydney, NSW 2006, Australia
- Institute of Photonics and Optical Science (IPOS), University of Sydney, NSW 2006, Australia
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Feng H, Lopez G, Kim CK, Alvarez A, Duncan C, Nishikawa R, Nagane M, Su AJ, Hedberg M, Grandis J, Raizer J, Gao WQ, Kim SH, Minata M, Nakano I, Lin HK, Furnari F, Cavenee W, Hu B, Cheng SY. CS-06 * EGFR PHOSPHORYLATION OF DCBLD2 RECRUITS TRAF6 AND STIMULATES Akt-PROMOTED TUMORIGENESIS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou242.6] [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: 11/14/2022] Open
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Mills SW, Musil KM, Davies JL, Hendrick S, Duncan C, Jackson ML, Kidney B, Philibert H, Wobeser BK, Simko E. Prognostic value of histologic grading for feline mammary carcinoma: a retrospective survival analysis. Vet Pathol 2014; 52:238-49. [PMID: 25060990 DOI: 10.1177/0300985814543198] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Feline mammary carcinoma is highly malignant and generally associated with a poor prognosis, although studies suggest the range of survival times in affected cats is broad. Histologic grading of these tumors is achieved using the Elston and Ellis system, originally developed for human breast cancer. In cats, however, classification using this method has variable prognostic value. Therefore, objectives of this study were (1) to evaluate the Elston and Ellis grading system for feline mammary carcinoma in a predominantly spayed population and (2) to determine whether modification of this system or development of a novel system improved the prognostic value of histologic grading. Survey data and histologic features for 108 carcinomas from 97 cats were analyzed with respect to overall survival. Elston and Ellis grading failed to correlate significantly with overall survival. Using multivariable analysis, lymphovascular invasion, nuclear form, and mitotic count each demonstrated independent prognostic significance (P = .008, <.001, and .004, respectively). Modifications of the Elston and Ellis system and a novel grading system were proposed based on these results; all showed significant correlation with overall survival (P < .001). Median survival times were 27, 29, or 31 months for grade I; 14, 12, or 14 months for grade II; and 13, 5, or 8 months for grade III carcinomas using the mitotic-modified Elston and Ellis, the revised Elston and Ellis, or the novel grading system, respectively. Based on this retrospective study, adoption of the species-specific systems as proposed here may improve the prognostic value of histologic grading for feline mammary carcinoma.
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Affiliation(s)
- S W Mills
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada Indicates equal contribution
| | - K M Musil
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada Indicates equal contribution
| | - J L Davies
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - S Hendrick
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - C Duncan
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - M L Jackson
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - B Kidney
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - H Philibert
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - B K Wobeser
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - E Simko
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Grubman A, James SA, James J, Duncan C, Volitakis I, Hickey JL, Crouch PJ, Donnelly PS, Kanninen KM, Liddell JR, Cotman SL, de Jonge, White AR. X-ray fluorescence imaging reveals subcellular biometal disturbances in a childhood neurodegenerative disorder. Chem Sci 2014; 5:2503-2516. [PMID: 24976945 PMCID: PMC4070600 DOI: 10.1039/c4sc00316k] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Biometals such as zinc, iron, copper and calcium play key roles in diverse physiological processes in the brain, but can be toxic in excess. A hallmark of neurodegeneration is a failure of homeostatic mechanisms controlling the concentration and distribution of these elements, resulting in overload, deficiency or mislocalization. A major roadblock to understanding the impact of altered biometal homeostasis in neurodegenerative disease is the lack of rapid, specific and sensitive techniques capable of providing quantitative subcellular information on biometal homeostasis in situ. Recent advances in X-ray fluorescence detectors have provided an opportunity to rapidly measure biometal content at subcellular resolution in cell populations using X-ray Fluorescence Microscopy (XFM). We applied this approach to investigate subcellular biometal homeostasis in a cerebellar cell line isolated from a natural mouse model of a childhood neurodegenerative disorder, the CLN6 form of neuronal ceroid lipofuscinosis, commonly known as Batten disease. Despite no global changes to whole cell concentrations of zinc or calcium, XFM revealed significant subcellular mislocalization of these important biological second messengers in cerebellar Cln6nclf (CbCln6nclf ) cells. XFM revealed that nuclear-to-cytoplasmic trafficking of zinc was severely perturbed in diseased cells and the subcellular distribution of calcium was drastically altered in CbCln6nclf cells. Subtle differences in the zinc K-edge X-ray Absorption Near Edge Structure (XANES) spectra of control and CbCln6nclf cells suggested that impaired zinc homeostasis may be associated with an altered ligand set in CbCln6nclf cells. Importantly, a zinc-complex, ZnII(atsm), restored the nuclear-to-cytoplasmic zinc ratios in CbCln6nclf cells via nuclear zinc delivery, and restored the relationship between subcellular zinc and calcium levels to that observed in healthy control cells. ZnII(atsm) treatment also resulted in a reduction in the number of calcium-rich puncta observed in CbCln6nclf cells. This study highlights the complementarities of bulk and single cell analysis of metal content for understanding disease states. We demonstrate the utility and broad applicability of XFM for subcellular analysis of perturbed biometal metabolism and mechanism of action studies for novel therapeutics to target neurodegeneration.
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Affiliation(s)
- A Grubman
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
| | - S A James
- Australian Synchrotron, Clayton 3168, Australia ; Materials Science and Engineering and the Preventative Health Flagship, CSIRO, Clayton 3168, Australia
| | - J James
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
| | - C Duncan
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
| | - I Volitakis
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3010, Australia
| | - J L Hickey
- School of Chemistry and Bio21 Institute for Molecular Science and Biotechnology, The University of Melbourne, Parkville 3010, Australia
| | - P J Crouch
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
| | - P S Donnelly
- School of Chemistry and Bio21 Institute for Molecular Science and Biotechnology, The University of Melbourne, Parkville 3010, Australia
| | - K M Kanninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, FI-70211, Finland
| | - J R Liddell
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
| | - S L Cotman
- Molecular Neurogenetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - de Jonge
- Australian Synchrotron, Clayton 3168, Australia
| | - A R White
- Department of Pathology, University of Melbourne, Parkville 3010, Australia
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Thong KY, McDonald TJ, Hattersley AT, Blann AD, Ramtoola S, Duncan C, Carr S, Adamson K, Nayak AU, Khurana R, Hunter SJ, Ali A, Au S, Ryder REJ. The association between postprandial urinary C-peptide creatinine ratio and the treatment response to liraglutide: a multi-centre observational study. Diabet Med 2014; 31:403-11. [PMID: 24246138 DOI: 10.1111/dme.12367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/01/2013] [Accepted: 11/13/2013] [Indexed: 01/22/2023]
Abstract
AIMS The response to glucagon-like peptide 1 receptor agonist treatment may be influenced by endogenous β-cell function. We investigated whether urinary C-peptide creatinine ratio assessed before or during liraglutide treatment was associated with treatment response. METHODS A single, outpatient urine sample for urinary C-peptide creatinine ratio was collected 2 h after the largest meal of the day among two separate groups: (1) subjects initiating liraglutide (0.6 → 1.2 mg daily) or (2) subjects already treated with liraglutide for 20-32 weeks. The associations between pretreatment and on-treatment urinary C-peptide creatinine ratio and HbA1c change at 32 weeks were assessed using univariate and multivariate analyses (the ratio was logarithm transformed for multivariate analyses). Changes in HbA1c according to pretreatment urinary C-peptide creatinine ratio quartiles are shown. RESULTS One hundred and sixteen subjects (70 pretreatment, 46 on treatment) with Type 2 diabetes from 10 diabetes centres were studied. In univariate analyses, neither pretreatment nor on-treatment urinary C-peptide creatinine ratio correlated with HbA1c change (Spearman rank correlation coefficient, r = -0.17, P = 0.17 and r = -0.20, P = 0.19, respectively). In multi-linear regression analyses, entering baseline HbA1c and log urinary C-peptide creatinine ratio, pretreatment and on-treatment log urinary C-peptide creatinine ratio became significantly associated with HbA1c change (P = 0.048 and P = 0.040, respectively). Mean (sd) HbA1c changes from baseline in quartiles 1 to 4 of pretreatment urinary C-peptide creatinine ratio were -3 ± 17 mmol/mol (-0.3 ± 1.6%) (P = 0.52), -12 ± 15 mmol/mol (-1.1 ± 1.4%) (P = 0.003), -11 ± 13 mmol/mol (-1.0 ± 1.2%) (P = 0.002) and -12±17 mmol/mol (-1.1±1.6%) (P=0.016), respectively. CONCLUSIONS Postprandial urinary C-peptide creatinine ratios before and during liraglutide treatment were weakly associated with the glycaemic response to treatment. Low pretreatment urinary C-peptide creatinine ratio may be more useful than higher values by predicting poorer glycaemic response.
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Affiliation(s)
- K Y Thong
- Department of Diabetes, City Hospital, Birmingham, UK
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Kasbekar AV, Garfit H, Duncan C, Mehta B, Davies K, Narasimhan G, Donne AJ. Dog bites to the head and neck in children; an increasing problem in the UK. Clin Otolaryngol 2014; 38:259-62. [PMID: 23398857 DOI: 10.1111/coa.12094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 11/26/2022]
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Whiting DR, Gillette BP, Duncan C, Smith H, Pagnano MW, Sierra RJ. Preliminary results suggest tranexamic acid is safe and effective in arthroplasty patients with severe comorbidities. Clin Orthop Relat Res 2014; 472:66-72. [PMID: 23817754 PMCID: PMC3889421 DOI: 10.1007/s11999-013-3134-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) reduces blood loss and transfusion after total joint arthroplasty (TJA) but concerns remain that patients with severe medical comorbidities might be at increased risk for thromboembolic complications. QUESTIONS/PURPOSES Among patients undergoing primary TJA with severe systemic medical disease, (1) was TXA associated with increased symptomatic thromboembolic events; (2) was TXA associated with decreased blood transfusion rates; and (3) were there differences in symptomatic thromboembolism or transfusions in the subset of patients with a history of, or risk factors for; thromboembolic disease? METHODS We performed a retrospective review of 1131 primary TJAs in 1002 patients with American Society of Anesthesiologists score III or IV. Of these, 402 had at least one of seven risk factors for thromboembolic events and were designated as high risk; 240 of those patients received TXA. Outcome measures included 30-day postoperative symptomatic thromboembolic events and postoperative transfusion. RESULTS There were no differences in symptomatic thromboembolic events within 30 days of surgery between patients who received TXA and those who did not (2.5% versus 2.6%, p = 0.97). Fewer patients treated with TXA received transfusions (11% with versus 41% without; p < 0.0001). In high-risk patients, TXA was not associated with an increase in symptomatic thromboembolic events (6.7% with versus 4.3% without; p = 0.27) and was associated with a decrease in transfusion rates (17% with versus 48% without; p = 0.001). CONCLUSIONS Although TXA seemed safe and effective in this database review of patients with severe medical comorbidities, a larger prospective trial is warranted to confirm these results.
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Affiliation(s)
| | | | | | - Hugh Smith
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Clarke L, Simon A, Ehrhart EJ, Mulick J, Charles B, Powers B, Duncan C. Histologic Characteristics and KIT Staining Patterns of Equine Cutaneous Mast Cell Tumors. Vet Pathol 2013; 51:560-2. [DOI: 10.1177/0300985813493931] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mast cell tumors are uncommon in horses and typically have a benign clinical course, but there are occasional reports of more aggressive behavior. The objective of this study was to review histologic features and KIT expression patterns of 72 previously diagnosed equine cutaneous mast cell tumors to determine if either is associated with clinical outcomes. Biopsy specimens were reviewed using histologic criteria derived from grading schemes, and KIT antibody expression patterns used in canine tumors and surveys were sent to referring veterinarians for follow-up clinical data. Arabians were overrepresented relative to the reference population. Most tumors were well differentiated with low mitotic rates (96%), and aberrant KIT staining patterns, as described in dogs, were uncommonly identified (12%). Associated clinical disease was uncommon and no tumors exhibited malignant behavior. Overall, KIT staining pattern and histologic features were not associated with poor clinical outcome or abnormal tumor behavior.
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Affiliation(s)
- L. Clarke
- Department of Pathology, University of Georgia, Athens, GA, USA
| | - A. Simon
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
| | - E. J. Ehrhart
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
| | - J. Mulick
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
| | - B. Charles
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
| | - B. Powers
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
| | - C. Duncan
- Colorado State University Veterinary Diagnostic Laboratory, Fort Collins, CO, USA
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Ahmad F, Suominen JS, Hassan Z, Pizer BL, Duncan C, Losty PD. Use of a tissue expander as a radio-protective spacer with a latissimus dorsi flap in the management of a peripheral primitive neuroectodermal tumour (pPNET). J Plast Reconstr Aesthet Surg 2013; 66:e169-71. [PMID: 23582507 DOI: 10.1016/j.bjps.2013.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 02/12/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
Peripheral primitive neuroectodermal tumours (pPNET) are aggressive neoplasms that require radical surgical resection with adjuvant chemotherapy and radiotherapy. A pPNET of the posterior chest wall was resected with wide soft tissue margins in a 14 year old male. Following tumour excision a spacer device was positioned in the retroperitoneum adjacent to the ipsilateral left kidney displacing it from the planned radiotherapy field. A pedicled latissimus dorsi myocutaneous flap was used to achieve robust soft tissue cover. Ultrasound demonstrated anteromedial displacement of the left kidney with no hydronephrosis and renal function remained normal during subsequent radiotherapy. This report highlights the usefulness of a tissue expander in providing protection for vital structures during radiotherapy.
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Affiliation(s)
- F Ahmad
- Department of Plastic & Reconstructive Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
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Abstract
Cirrhosis is a chronic liver disease stage that encompasses a variety of etiologies resulting in liver damage. This damage may induce secondary complications such as portal hypertension, esophageal variceal bleeding, spontaneous bacterial peritonitis, and hepatic encephalopathy. Screening for and management of these complications incurs substantial health care costs; thus, determining the most economical and beneficial treatment strategies is essential. This article reviews the economic impact of a variety of prophylactic and treatment regimens employed for cirrhosis-related complications. Prophylactic use of β-adrenergic blockers for portal hypertension and variceal bleeding appears to be cost-effective, but the most economical regimen for treatment of initial bleeding is unclear given that cost comparisons of pharmacologic and surgical regimens are lacking. In contrast, prophylaxis for spontaneous bacterial peritonitis cannot be recommended. Standard therapy for spontaneous bacterial peritonitis includes antibiotics, and the overall economic impact of these medications depends largely on their direct cost. However, the potential development of bacterial antibiotic resistance and resulting clinical failure should also be considered. Nonabsorbable disaccharides are standard therapies for hepatic encephalopathy; however, given their questionable efficacy, the nonsystemic antibiotic rifaximin may be a more cost-effective, long-term treatment for hepatic encephalopathy, despite its increased direct cost, because of its demonstrated efficacy and prevention of hospitalization. Further studies evaluating the cost burden of cirrhosis and cirrhosis-related complications, including screening costs, the cost of treatment and maintenance therapy, conveyance to liver transplantation, liver transplantation success, and health-related quality of life after transplantation, are essential for evaluation of the economic burden of hepatic encephalopathy and all cirrhosis-related complications.
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Loren AW, Brazauskas R, Chow EJ, Gilleece M, Halter J, Jacobsohn DA, Joshi S, Pidala J, Quinn GP, Wang Z, Apperley JF, Burns LJ, Hale GA, Hayes-Lattin BM, Kamble R, Lazarus H, McCarthy PL, Reddy V, Warwick AB, Bolwell BJ, Duncan C, Socie G, Sorror ML, Wingard JR, Majhail NS. Physician perceptions and practice patterns regarding fertility preservation in hematopoietic cell transplant recipients. Bone Marrow Transplant 2013; 48:1091-7. [PMID: 23419436 PMCID: PMC3914209 DOI: 10.1038/bmt.2013.13] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [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: 10/19/2012] [Revised: 01/02/2013] [Accepted: 01/15/2013] [Indexed: 11/09/2022]
Abstract
Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.
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Affiliation(s)
- A W Loren
- Abramson Cancer Center University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Duncan C, Mueller S, Simon E, Renger JJ, Uebele VN, Hogan QH, Wu HE. Painful nerve injury decreases sarco-endoplasmic reticulum Ca²⁺-ATPase activity in axotomized sensory neurons. Neuroscience 2012; 231:247-57. [PMID: 23219911 DOI: 10.1016/j.neuroscience.2012.11.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 12/15/2022]
Abstract
The sarco-endoplasmic reticulum Ca(2+)-ATPase (SERCA) is a critical pathway by which sensory neurons sequester cytosolic Ca(2+) and thereby maintain intracellular Ca(2+) homeostasis. We have previously demonstrated decreased intraluminal endoplasmic reticulum Ca(2+) concentration in traumatized sensory neurons. Here we examine SERCA function in dissociated sensory neurons using Fura-2 fluorometry. Blocking SERCA with thapsigargin (1 μM) increased resting [Ca(2+)](c) and prolonged recovery (τ) from transients induced by neuronal activation (elevated bath K(+)), demonstrating SERCA contributes to control of resting [Ca(2+)](c) and recovery from transient [Ca(2+)](c) elevation. To evaluate SERCA in isolation, plasma membrane Ca(2+) ATPase was blocked with pH 8.8 bath solution and mitochondrial buffering was avoided by keeping transients small (≤ 400 nM). Neurons axotomized by spinal nerve ligation (SNL) showed a slowed rate of transient recovery compared to control neurons, representing diminished SERCA function, whereas neighboring non-axotomized neurons from SNL animals were unaffected. Injury did not affect SERCA function in large neurons. Repeated depolarization prolonged transient recovery, showing that neuronal activation inhibits SERCA function. These findings suggest that injury-induced loss of SERCA function in small sensory neurons may contribute to the generation of pain following peripheral nerve injury.
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Affiliation(s)
- C Duncan
- Medical College of Wisconsin, Department of Anesthesiology, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Wehbe G, Hartwig T, Duncan C. Movement analysis of Australian national league soccer players using global positioning system technology. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.255] [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: 10/27/2022]
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