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Chanda UL, Knapp C. A rare case of metastatic paraspinal rhabdomyosarcoma presenting with proptosis in an adult patient. Orbit 2024; 43:280-282. [PMID: 36131600 DOI: 10.1080/01676830.2022.2125537] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
Secondary metastasis of rhabdomyosarcoma (RMS) to the orbit from a distant primary site is extremely rare in adults. In this article, we describe the case of a 24-year-old male presenting with proptosis, diplopia, and headaches concurrently with a histologically confirmed diagnosis of PAX3-FOXO1 positive paraspinal alveolar rhabdomyosarcoma. An orbital MRI revealed a fusiform mass arising from the inferior rectrus, displaying necrotic and irregular morphology consistent with malignancy. The patient is currently undergoing intensive chemotherapy. The objective of this case report is to highlight the rarity of an extraocular metastasis of RMS in an adult patient, alongside the importance of considering metastatic disease in a patient with fulminant unilateral proptosis.
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Affiliation(s)
- U Leo Chanda
- School of Medicine, University of Nottingham, Nottingham, UK
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Dawar B, Rothwell I, Mudhar HS, Eason J, Knapp C. Primary lacrimal gland plexiform neurofibroma: a case report and review of the literature. Orbit 2023; 42:561-566. [PMID: 35312416 DOI: 10.1080/01676830.2022.2052112] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) affects cell growth in neural tissues, resulting in neurofibromas of the internal organs, peripheral nerves and/or autonomic nerves. We describe a highly unusual case of plexiform neurofibroma presenting with lacrimal gland enlargement in an 18 year old male, which led to a diagnosis of NF1.
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Affiliation(s)
- Basu Dawar
- Department of Ophthalmology, Lincoln County Hospital, Lincoln, UK
| | - Ian Rothwell
- Department of Radiology, Lincoln County Hospital, Lincoln, UK
| | - Hardeep-Singh Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Jacqueline Eason
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Isherwood S, Mudhar H, Knapp C. An atypical presentation of a rare lesion. Can J Ophthalmol 2023; 58:e219-e221. [PMID: 37084767 DOI: 10.1016/j.jcjo.2023.03.018] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Steven Isherwood
- United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom.
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Knapp C, Bhatia K, Columb M, Elriedy M. Remifentanil patient-controlled analgesia for labour in pregnant patients with heart disease. Int J Obstet Anesth 2023; 55:103902. [PMID: 37302184 DOI: 10.1016/j.ijoa.2023.103902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Affiliation(s)
- C Knapp
- Department of Anaesthesia, Health Education England North-West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, Saint Mary's Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Columb
- Intensive Care Unit, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - M Elriedy
- Department of Anaesthesia, University Hospitals of Derby and Burton, Derby and Burton on Trent, UK
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Webb AJ, Oetken HJ, Plott AJ, Knapp C, Munger DN, Gibson E, Schreiber M, Barton CA. The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: A retrospective cohort study. J Trauma Acute Care Surg 2023; 94:320-327. [PMID: 35999660 DOI: 10.1097/ta.0000000000003772] [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: 01/28/2023]
Abstract
BACKGROUND Current Brain Injury Guidelines (BIG) characterize patients with intracranial hemorrhage taking antiplatelet or anticoagulant agents as BIG 3 (the most severe category) regardless of trauma severity. This study assessed the risk of in-hospital mortality or need for neurosurgery in patients taking low-dose aspirin who otherwise would be classified as BIG 1. METHODS This was a retrospective study at an academic level 1 trauma center. Patients were included if they were admitted with traumatic intracerebral hemorrhage and were evaluated by the BIG criteria. Exclusion criteria included indeterminate BIG status or patients with missing primary outcomes documentation. Patients were categorized as BIG 1, BIG 2, BIG 3, or BIG 1 on aspirin (patients with BIG 1 features taking low-dose aspirin). The primary endpoint was a composite of neurosurgical intervention and all-cause in-hospital mortality. Key secondary endpoints include rate of intracranial hemorrhage progression, and intensive care unit- and hospital-free days. RESULTS A total of 1,520 patients met the inclusion criteria. Median initial Glasgow Coma Scale was 14 (interquartile range [IQR], 12-15), Injury Severity Scale score was 17 (IQR, 10-25), and Abbreviated Injury Scale subscore head and neck (AIS Head ) was 3 (IQR, 3-4). The rate of the primary outcome for BIG 1, BIG 1 on aspirin, BIG 2, and BIG 3 was 1%, 2.2%, 1%, and 27%, respectively; the difference between BIG 1 on aspirin and BIG 3 was significant ( p < 0.001). CONCLUSION Patients taking low-dose aspirin with otherwise BIG 1-grade injuries experienced mortality and required neurosurgery significantly less often than other patients categorized as BIG 3. Inclusion of low-dose aspirin in the BIG criteria should be reevaluated. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Andrew J Webb
- From the Department of Pharmacy (A.J.W., H.J.O., C.A.B.), Oregon Health and Science University, Portland, Oregon; Department of Pharmacy (A.J.W.), Massachusetts General Hospital, Boston, Massachusetts; Department of Pharmacy (A.J.P.), University Hospital, Newark, New Jersey; Department of Surgery (C.K., E.G., M.S.), Oregon Health and Science University; and Department of Neurosurgery (D.N.M.), Oregon Health and Science University, Portland, Oregon
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Johansen KL, Li S, Liu J, Weinhandl ED, Gilbertson DT, Kou I, Knapp C, Wetmore JB. Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022. JAMA Netw Open 2023; 6:e230806. [PMID: 36848086 PMCID: PMC9972188 DOI: 10.1001/jamanetworkopen.2023.0806] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE The Centers for Medicare & Medicaid Services designed a mandatory payment model to incentivize home dialysis use: the End-Stage Renal Disease Treatment Choices (ETC). Outpatient dialysis facilities and health care professionals providing nephrology services were randomly assigned to ETC participation at the hospital referral region level. OBJECTIVE To assess the association between ETC and home dialysis use in the incident dialysis population in its first 18 months of implementation. DESIGN, SETTING, AND PARTICIPANTS A cohort study with controlled, interrupted time series analysis of the US End-Stage Renal Disease Quality Reporting System database was conducted, using generalized estimating equations. All adults initiating home-based dialysis in the US between January 1, 2016, and June 30, 2022, without a prior kidney transplant were included in the analysis. EXPOSURES Prior to vs after ETC onset in January 1, 2021, and random assignment to ETC participation of facilities and health care professionals involved in patient care. MAIN OUTCOMES AND MEASURES Percentage of patients started on incident home dialysis and yearly change in percentage initiating home dialysis. RESULTS A total of 817 177 adults initiated home dialysis during the study period, of whom 750 314 were included in the study cohort. The cohort included 41.4% women; 26.2% of the patients were Black, 17.4% were Hispanic, and 49.1% were White. Approximately half (49.6%) of the patients were aged at least 65 years. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service coverage. Overall, home dialysis use increased from 10.0% in January 2016 to 17.4% in June 2022. Home dialysis use increased more in ETC markets than in non-ETC markets after January 2021 (by 1.07%; 95% CI, 0.16%-1.97%). The rate of increase in home dialysis use in the entire cohort nearly doubled after January 2021 to 1.66% per year (95% CI, 1.14%-2.19%) compared with before 2021, when the rate was 0.86% per year (95% CI, 0.75%-0.97%), but the difference in rate of increase in home dialysis use was not significant between ETC and non-ETC markets. CONCLUSIONS AND RELEVANCE This study noted that, although the overall rate of dialysis use at home was greater after ETC implementation, the increase occurred more among patients in ETC markets than among those in non-ETC markets. These findings suggest that federal policy and financial incentives affected care for the entire incident dialysis population in the US.
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Affiliation(s)
- Kirsten L. Johansen
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Nephrology, University of Minnesota, Minneapolis
| | - Shuling Li
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Eric D. Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Nephrology, University of Minnesota, Minneapolis
- Satellite Healthcare, Crestwood, Illinois
| | - David T. Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Nephrology, University of Minnesota, Minneapolis
| | - Iris Kou
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Christopher Knapp
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - James B. Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Department of Nephrology, University of Minnesota, Minneapolis
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Knapp C, Bhatia K. Maternal collapse in pregnancy. Br J Hosp Med (Lond) 2022; 83:1-12. [PMID: 36594762 DOI: 10.12968/hmed.2022.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal collapse is a rare life-threatening event that can occur at any stage of pregnancy or up to 6 weeks postpartum. Prompt identification and timely intervention by a multidisciplinary team that includes an obstetrician, midwifery staff and an obstetric anaesthetist are essential to improve maternal and fetal outcomes. Standard adult resuscitation guidelines need to be followed with some modifications, taking into account the maternal-fetal physiology, which clinicians should be familiar with. During cardiac arrest, the emphasis is on advanced airway management, manual uterine displacement to relieve aortocaval compression and performing a resuscitative hysterotomy (peri-mortem caesarean delivery) swiftly in patients who are more than 20 weeks gestation to improve maternal survival. Annual multidisciplinary simulation training is recommended for all professionals involved in maternity care; this can improve teamwork, communication and emergency preparedness during maternal collapse.
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Affiliation(s)
- C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - K Bhatia
- Department of Anaesthesia, St Mary's Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
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Knapp C. Creating Safe and Inclusive Spacing for LGBT2Q+ Youth in Public and School Libraries. Journal of Library Administration 2022. [DOI: 10.1080/01930826.2022.2102385] [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: 10/14/2022]
Affiliation(s)
- Christopher Knapp
- Youth Community Engagement Librarian, Prince George Public Library, Prince George, Canada
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Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman LG, Ascolillo S, Sebra RP, Collins BL, Levy T, Buxbaum JD, Sealfon SC, Jordan DM, Thompson RC, Gettler K, Chaudhary K, Belbin GM, Preuss M, Hoggart C, Choi S, Underwood SJ, Salib I, Britvan B, Keller K, Tang L, Peruggia M, Hiester LL, Niblo K, Aksentijevich A, Labkowsky A, Karp A, Zlatopolsky M, Zyndorf M, Charney AW, Beckmann ND, Schadt EE, Abul-Husn NS, Cho JH, Itan Y, Kenny EE, Loos RJF, Nadkarni GN, Do R, O’Reilly P, Huckins LM, Ferreira MAR, Abecasis GR, Leader JB, Cantor MN, Justice AE, Carey DJ, Chittoor G, Josyula NS, Kosmicki JA, Horowitz JE, Baras A, Gass MC, Yadav A, Mirshahi T, Hottenga JJ, Bartels M, de geus EEJC, Nivard MMG, Verma A, Ritchie MD, Rader D, Li B, Verma SS, Lucas A, Bradford Y, Abedalthagafi M, Alaamery M, Alshareef A, Sawaji M, Massadeh S, AlMalik A, Alqahtani S, Baraka D, Harthi FA, Alsolm E, Safieh LA, Alowayn AM, Alqubaishi F, Mutairi AA, Mangul S, Almutairi M, Aljawini N, Albesher N, Arabi YM, Mahmoud ES, Khattab AK, Halawani RT, Alahmadey ZZ, Albakri JK, Felemban WA, Suliman BA, Hasanato R, Al-Awdah L, Alghamdi J, AlZahrani D, AlJohani S, Al-Afghani H, AlDhawi N, AlBardis H, Alkwai S, Alswailm M, Almalki F, Albeladi M, Almohammed I, Barhoush E, Albader A, Alotaibi S, Alghamdi B, Jung J, fawzy MS, Alrashed M, Zeberg H, Nkambul L, Frithiof R, Hultström M, Lipcsey M, Tardif N, Rooyackers O, Grip J, Maricic T, Helgeland Ø, Magnus P, Trogstad LIS, Lee Y, Harris JR, Mangino M, Spector TD, Emma D, Moutsianas L, Caulfield MJ, Scott RH, Kousathanas A, Pasko D, Walker S, Stuckey A, Odhams CA, Rhodes D, Fowler T, Rendon A, Chan G, Arumugam P, Karczewski KJ, Martin AR, Wilson DJ, Spencer CCA, Crook DW, Wyllie DH, O’Connell AM, Atkinson EG, Kanai M, Tsuo K, Baya N, Turley P, Gupta R, Walters RK, Palmer DS, Sarma G, Solomonson M, Cheng N, Lu W, Churchhouse C, Goldstein JI, King D, Zhou W, Seed C, Daly MJ, Neale BM, Finucane H, Bryant S, Satterstrom FK, Band G, Earle SG, Lin SK, Arning N, Koelling N, Armstrong J, Rudkin JK, Callier S, Bryant S, Cusick C, Soranzo N, Zhao JH, Danesh J, Angelantonio ED, Butterworth AS, Sun YV, Huffman JE, Cho K, O’Donnell CJ, Tsao P, Gaziano JM, Peloso G, Ho YL, Smieszek SP, Polymeropoulos C, Polymeropoulos V, Polymeropoulos MH, Przychodzen BP, Fernandez-Cadenas I, Planas AM, Perez-Tur J, Llucià-Carol L, Cullell N, Muiño E, Cárcel-Márquez J, DeDiego ML, Iglesias LL, Soriano A, Rico V, Agüero D, Bedini JL, Lozano F, Domingo C, Robles V, Ruiz-Jaén F, Márquez L, Gomez J, Coto E, Albaiceta GM, García-Clemente M, Dalmau D, Arranz MJ, Dietl B, Serra-Llovich A, Soler P, Colobrán R, Martín-Nalda A, Martínez AP, Bernardo D, Rojo S, Fiz-López A, Arribas E, de la Cal-Sabater P, Segura T, González-Villa E, Serrano-Heras G, Martí-Fàbregas J, Jiménez-Xarrié E, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Domínguez-Mayoral A, Villalonga JM, Menéndez-Valladares P, Chasman DI, Sesso HD, Manson JE, Buring JE, Ridker PM, Franco G, Davis L, Lee S, Priest J, Sankaran VG, van Heel D, Biesecker L, Kerchberger VE, Baillie JK. A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
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Knapp C, Ince M, Zacharzewski A. Peripartum management of tuberous sclerosis complex complicated by massive angiomyolipomas. Anaesth Rep 2022; 10:e12176. [PMID: 35813405 DOI: 10.1002/anr3.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
Abstract
Tuberous sclerosis complex is a genetic disease that can affect multiple organs, commonly the renal, central nervous, cardiac and respiratory systems. Here, we present the peripartum management of a woman with a new diagnosis of tuberous sclerosis complex associated with massive renal angiomyolipomas. There was significant risk of catastrophic haemorrhage from the angiomyolipomas during pregnancy. This created a challenging scenario for the anaesthetists, obstetricians, urologists and interventional radiologists involved in their care, necessitating collaborative working, numerous investigations and honest patient-centred discussions. Evidence for the management of tuberous sclerosis and angiomyolipomas in pregnancy does not appear to have been previously reported. After much consideration, arterial embolisation of the most vascular area of the angiomyolipoma was completed at 28 weeks gestation under remifentanil sedation. An elective caesarean section under combined spinal epidural anaesthesia was completed at 37 + 3 weeks gestation. Central nervous system involvement must always be considered; benign tumours within the brain and spinal cord may contraindicate neuraxial techniques. Early multidisciplinary involvement is essential due to the diverse and complex nature of tuberous sclerosis. Individuals differ in their presentation and disease severity; therefore, they must be assessed on an individual basis with management tailored accordingly.
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Affiliation(s)
- C Knapp
- North West School of Anaesthesia Health Education England North West Manchester UK
| | - M Ince
- North West School of Anaesthesia Health Education England North West Manchester UK
| | - A Zacharzewski
- Department of Anaesthesia, St Mary's Hospital Manchester University NHS Foundation Trust Manchester UK
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11
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Knapp C, Bhatia K, Columb M. P.27 Haemodynamic stability of remifentanil patient-controlled analgesia during labour in parturients with cardiac disease. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Satzinger KJ, Liu YJ, Smith A, Knapp C, Newman M, Jones C, Chen Z, Quintana C, Mi X, Dunsworth A, Gidney C, Aleiner I, Arute F, Arya K, Atalaya J, Babbush R, Bardin JC, Barends R, Basso J, Bengtsson A, Bilmes A, Broughton M, Buckley BB, Buell DA, Burkett B, Bushnell N, Chiaro B, Collins R, Courtney W, Demura S, Derk AR, Eppens D, Erickson C, Faoro L, Farhi E, Fowler AG, Foxen B, Giustina M, Greene A, Gross JA, Harrigan MP, Harrington SD, Hilton J, Hong S, Huang T, Huggins WJ, Ioffe LB, Isakov SV, Jeffrey E, Jiang Z, Kafri D, Kechedzhi K, Khattar T, Kim S, Klimov PV, Korotkov AN, Kostritsa F, Landhuis D, Laptev P, Locharla A, Lucero E, Martin O, McClean JR, McEwen M, Miao KC, Mohseni M, Montazeri S, Mruczkiewicz W, Mutus J, Naaman O, Neeley M, Neill C, Niu MY, O'Brien TE, Opremcak A, Pató B, Petukhov A, Rubin NC, Sank D, Shvarts V, Strain D, Szalay M, Villalonga B, White TC, Yao Z, Yeh P, Yoo J, Zalcman A, Neven H, Boixo S, Megrant A, Chen Y, Kelly J, Smelyanskiy V, Kitaev A, Knap M, Pollmann F, Roushan P. Realizing topologically ordered states on a quantum processor. Science 2021; 374:1237-1241. [PMID: 34855491 DOI: 10.1126/science.abi8378] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
| | - Y-J Liu
- Department of Physics, Technical University of Munich, 85748 Garching, Germany.,Munich Center for Quantum Science and Technology (MCQST), Schellingstraße 4, 80799 München, Germany
| | - A Smith
- Department of Physics, Technical University of Munich, 85748 Garching, Germany.,School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2RD, UK.,Centre for the Mathematics and Theoretical Physics of Quantum Non-Equilibrium Systems, University of Nottingham, Nottingham NG7 2RD, UK
| | - C Knapp
- Department of Physics and Institute for Quantum Information and Matter, California Institute of Technology, Pasadena, CA, USA.,Walter Burke Institute for Theoretical Physics, California Institute of Technology, Pasadena, CA, USA
| | - M Newman
- Google Quantum AI, Mountain View, CA, USA
| | - C Jones
- Google Quantum AI, Mountain View, CA, USA
| | - Z Chen
- Google Quantum AI, Mountain View, CA, USA
| | - C Quintana
- Google Quantum AI, Mountain View, CA, USA
| | - X Mi
- Google Quantum AI, Mountain View, CA, USA
| | | | - C Gidney
- Google Quantum AI, Mountain View, CA, USA
| | - I Aleiner
- Google Quantum AI, Mountain View, CA, USA
| | - F Arute
- Google Quantum AI, Mountain View, CA, USA
| | - K Arya
- Google Quantum AI, Mountain View, CA, USA
| | - J Atalaya
- Google Quantum AI, Mountain View, CA, USA
| | - R Babbush
- Google Quantum AI, Mountain View, CA, USA
| | - J C Bardin
- Google Quantum AI, Mountain View, CA, USA.,Department of Electrical and Computer Engineering, University of Massachusetts, Amherst, MA, USA
| | - R Barends
- Google Quantum AI, Mountain View, CA, USA
| | - J Basso
- Google Quantum AI, Mountain View, CA, USA
| | | | - A Bilmes
- Google Quantum AI, Mountain View, CA, USA
| | | | | | - D A Buell
- Google Quantum AI, Mountain View, CA, USA
| | - B Burkett
- Google Quantum AI, Mountain View, CA, USA
| | - N Bushnell
- Google Quantum AI, Mountain View, CA, USA
| | - B Chiaro
- Google Quantum AI, Mountain View, CA, USA
| | - R Collins
- Google Quantum AI, Mountain View, CA, USA
| | - W Courtney
- Google Quantum AI, Mountain View, CA, USA
| | - S Demura
- Google Quantum AI, Mountain View, CA, USA
| | - A R Derk
- Google Quantum AI, Mountain View, CA, USA
| | - D Eppens
- Google Quantum AI, Mountain View, CA, USA
| | - C Erickson
- Google Quantum AI, Mountain View, CA, USA
| | - L Faoro
- Laboratoire de Physique Theorique et Hautes Energies, Sorbonne Université, 75005 Paris, France
| | - E Farhi
- Google Quantum AI, Mountain View, CA, USA
| | - A G Fowler
- Google Quantum AI, Mountain View, CA, USA
| | - B Foxen
- Google Quantum AI, Mountain View, CA, USA
| | - M Giustina
- Google Quantum AI, Mountain View, CA, USA
| | - A Greene
- Google Quantum AI, Mountain View, CA, USA.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - J A Gross
- Google Quantum AI, Mountain View, CA, USA
| | | | | | - J Hilton
- Google Quantum AI, Mountain View, CA, USA
| | - S Hong
- Google Quantum AI, Mountain View, CA, USA
| | - T Huang
- Google Quantum AI, Mountain View, CA, USA
| | | | - L B Ioffe
- Google Quantum AI, Mountain View, CA, USA
| | - S V Isakov
- Google Quantum AI, Mountain View, CA, USA
| | - E Jeffrey
- Google Quantum AI, Mountain View, CA, USA
| | - Z Jiang
- Google Quantum AI, Mountain View, CA, USA
| | - D Kafri
- Google Quantum AI, Mountain View, CA, USA
| | | | - T Khattar
- Google Quantum AI, Mountain View, CA, USA
| | - S Kim
- Google Quantum AI, Mountain View, CA, USA
| | - P V Klimov
- Google Quantum AI, Mountain View, CA, USA
| | - A N Korotkov
- Google Quantum AI, Mountain View, CA, USA.,Department of Electrical and Computer Engineering, University of California, Riverside, CA, USA
| | | | - D Landhuis
- Google Quantum AI, Mountain View, CA, USA
| | - P Laptev
- Google Quantum AI, Mountain View, CA, USA
| | - A Locharla
- Google Quantum AI, Mountain View, CA, USA
| | - E Lucero
- Google Quantum AI, Mountain View, CA, USA
| | - O Martin
- Google Quantum AI, Mountain View, CA, USA
| | | | - M McEwen
- Google Quantum AI, Mountain View, CA, USA.,Department of Physics, University of California, Santa Barbara, CA, USA
| | - K C Miao
- Google Quantum AI, Mountain View, CA, USA
| | - M Mohseni
- Google Quantum AI, Mountain View, CA, USA
| | | | | | - J Mutus
- Google Quantum AI, Mountain View, CA, USA
| | - O Naaman
- Google Quantum AI, Mountain View, CA, USA
| | - M Neeley
- Google Quantum AI, Mountain View, CA, USA
| | - C Neill
- Google Quantum AI, Mountain View, CA, USA
| | - M Y Niu
- Google Quantum AI, Mountain View, CA, USA
| | | | - A Opremcak
- Google Quantum AI, Mountain View, CA, USA
| | - B Pató
- Google Quantum AI, Mountain View, CA, USA
| | - A Petukhov
- Google Quantum AI, Mountain View, CA, USA
| | - N C Rubin
- Google Quantum AI, Mountain View, CA, USA
| | - D Sank
- Google Quantum AI, Mountain View, CA, USA
| | - V Shvarts
- Google Quantum AI, Mountain View, CA, USA
| | - D Strain
- Google Quantum AI, Mountain View, CA, USA
| | - M Szalay
- Google Quantum AI, Mountain View, CA, USA
| | | | - T C White
- Google Quantum AI, Mountain View, CA, USA
| | - Z Yao
- Google Quantum AI, Mountain View, CA, USA
| | - P Yeh
- Google Quantum AI, Mountain View, CA, USA
| | - J Yoo
- Google Quantum AI, Mountain View, CA, USA
| | - A Zalcman
- Google Quantum AI, Mountain View, CA, USA
| | - H Neven
- Google Quantum AI, Mountain View, CA, USA
| | - S Boixo
- Google Quantum AI, Mountain View, CA, USA
| | - A Megrant
- Google Quantum AI, Mountain View, CA, USA
| | - Y Chen
- Google Quantum AI, Mountain View, CA, USA
| | - J Kelly
- Google Quantum AI, Mountain View, CA, USA
| | | | - A Kitaev
- Google Quantum AI, Mountain View, CA, USA.,Department of Physics and Institute for Quantum Information and Matter, California Institute of Technology, Pasadena, CA, USA.,Walter Burke Institute for Theoretical Physics, California Institute of Technology, Pasadena, CA, USA
| | - M Knap
- Department of Physics, Technical University of Munich, 85748 Garching, Germany.,Munich Center for Quantum Science and Technology (MCQST), Schellingstraße 4, 80799 München, Germany.,Institute for Advanced Study, Technical University of Munich, 85748 Garching, Germany
| | - F Pollmann
- Department of Physics, Technical University of Munich, 85748 Garching, Germany.,Munich Center for Quantum Science and Technology (MCQST), Schellingstraße 4, 80799 München, Germany
| | - P Roushan
- Google Quantum AI, Mountain View, CA, USA
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13
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Bhatia K, Columb M, Bewlay A, Tageldin N, Knapp C, Qamar Y, Dooley A, Kamath P, Hulgur M. Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic. Anaesthesia 2021; 76:1051-1059. [PMID: 33891311 PMCID: PMC8251307 DOI: 10.1111/anae.15489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/29/2023]
Abstract
General anaesthesia is known to achieve the shortest decision‐to‐delivery interval for category‐1 caesarean section. We investigated whether the COVID‐19 pandemic affected the decision‐to delivery interval and influenced neonatal outcomes in patients who underwent category‐1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre‐COVID‐19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID‐19 pandemic (1 April 2020–1 July 2020) (post‐COVID‐19 group). Primary outcome measures were: decision‐to‐delivery interval; number of caesarean sections achieving decision‐to‐delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5‐min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre‐ and post‐COVID‐19 groups (risk ratio 0.48 (95%CI 0.37–0.62); p < 0.0001). Compared with the pre‐COVID‐19 group, the post‐COVID‐19 group had an increase in median (IQR [range]) decision‐to‐delivery interval (26 (18–32 [4–124]) min vs. 27 (20–33 [3–102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision‐to‐delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre‐ and post‐COVID‐19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision‐to‐delivery interval observed during the COVID‐19 pandemic did not adversely affect neonatal outcomes.
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Affiliation(s)
- K Bhatia
- Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Manchester Medical School, University of Manchester, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK.,Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - N Tageldin
- Department of Anaesthesia and Peri-operative Medicine, Saint Mary's Hospital, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - C Knapp
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Y Qamar
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - A Dooley
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - P Kamath
- Department of Anaesthesia, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital Foundation Trust, Wigan, UK
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14
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Sivagnanasithiyar T, Okafor L, Faust G, Mudhar HS, Sii S, Knapp C, Sampath R. Metastatic testicular choriocarcinoma presenting as eyelid swelling and ptosis. Orbit 2021; 41:498-501. [PMID: 33632056 DOI: 10.1080/01676830.2021.1890134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 34-year-old man presented with an 8-day history of swelling and ptosis affecting the right upper eyelid. An MRI scan showed right superior rectus enlargement. Histology of an incisional biopsy of the muscle demonstrated metastatic choriocarcinoma to the orbit, positive for pan-cytokeratins, beta-HCG and GATA3. Possible primary sites included testis. An ultrasound of the testes identified bilateral testicular masses, highly suspicious for primary testicular malignancy. A CT scan of the chest, abdomen and pelvis identified disseminated metastatic disease conferring a poor prognostic germ cell tumour. The overall interpretation was of disseminated testicular choriocarcinoma and the patient is currently undergoing intensive chemotherapy.
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Affiliation(s)
| | - Linda Okafor
- Ophthalmology Department, University Hospitals of Leicester, Leicester, UK
| | - Guy Faust
- Oncology Department, University Hospitals of Leicester, Leicester, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Samantha Sii
- Ophthalmology Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Christopher Knapp
- Ophthalmology Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Raghavan Sampath
- Ophthalmology Department, University Hospitals of Leicester, Leicester, UK
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15
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Abstract
Amyloidosis is a protein metabolism disorder characterised by extracellular deposition of insoluble amorphous hyaline material. Orbital and ocular amyloid lesions account for only 4% of localised disease affecting the head and neck. Ocular adnexal lymphoma accounts for 1-2% of lymphoma, with lacrimal gland lymphomas being relatively uncommon. The most common form affecting the orbit is extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue (MALT lymphoma). We report an extremely rare case of co-existent EMZL and amyloidosis of the lacrimal gland. Initial biopsy of the right lacrimal gland confirmed an EMZL with amyloid deposit, and a course of radiotherapy treatment was given. Recurrent lacrimal gland swelling developed within a year. Subsequent biopsy identified amyloidosis with scanty lymphoid tissue. To our knowledge, this is the first reported case of localised lacrimal gland amyloidosis of uncertain type with previous EMZL; the association described in this case report is not yet fully understood.
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Affiliation(s)
- Chung Shen Chean
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK
| | - Vishakha Sovani
- Department of Histopatholog, Nottingham University Hospitals NHS Trust (City Campus), Nottingham, UK
| | - Ali Boden
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK
| | - Christopher Knapp
- United Lincolnshire Hospitals NHS Trust, Lincoln County Hospital, Lincoln, UK
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16
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Eisele TA, Adadevoh K, Anderson G, Brause A, Briesmeister D, Burke J, Cherix G, Ellis C, Hendricks S, Ho CT, Huang CJ, Iuliano T, Kline L, Knapp C, Krueger D, Terwel L. Determination of D-Malic Acid in Apple Juice by Liquid Chromatography: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/79.1.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Eleven laboratories collaboratively studied a liquid chromatographic (LC) method for determination of D-malic acid in apple juice. The mobile phase consisted of 16 mM L-valine and 8 mM copper acetate adjusted to pH 5.5 with NaOH. The UV detector was set at 330 nm, and a single reversed-phase LC column was used. Seven paired samples containing various amounts of D-malic acid ranging from 0 to 188 mg/100 mL of 12 Brix pasteurized apple juice were tested by each collaborator. Repeatability and reproducibility coefficients of variation ranged from 1.0 to 3.5% and 7.7 to 11.7%, respectively, within the range of 26 to 188 mg D-malic acid/100 mL of 12 Brix apple juice. The collabora tive study results demonstrated that the method could quantitate the economic adulteration of ap ple juice with DL-malic acid at lower levels than those reported with previous methods. The LC method for determination of D-malic acid in apple juice has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
- Thomas A Eisele
- Tree Top, Inc., Technical Center, PO Box 248, Selah, WA 98942
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17
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Abstract
Background It has been previously reported that one copy of the variable number tandem repeat (VNTR) B alleles of the GPIbα gene increases the risk of non-arteritic ischaemic optic neuropathy (NAION) and the second eye involvement. This is the first case where the presence of both alleles is associated with bilateral NAION. Case presentation A 52-year-old male presented with loss of vision in one eye and was diagnosed with NAION. The following year, he suffered another attack of NAION in the fellow eye. Genetic testing showed that he had both copies of VNTR B alleles of the GPIbα gene. Conclusions We report a case of bilateral NAION in the presence of two copies of VNTR B alleles of the GPIbα gene. This may have further implications for the function of platelet glycoproteins.
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Affiliation(s)
- Christina S Lim
- Ophthalmology Department, Lincoln County Hospital, Greetwell Road, Lincoln, Lincolnshire, UK. .,Present Address: Ophthalmology Department, Northampton General Hospital, Cliftonville Road, Northampton, UK.
| | - Ajoy Sarkar
- Department of Clinical Genetics, City Hospital Campus, The Gables, Gate 3, Hucknall Road, Nottingham, Nottinghamshire, UK
| | - Christopher Knapp
- Ophthalmology Department, Lincoln County Hospital, Greetwell Road, Lincoln, Lincolnshire, UK
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Affiliation(s)
- J. J. Child
- Prairie Regional Laboratory, National Research Council, Saskatoon, Saskatchewan, Canada
| | - C. Knapp
- Prairie Regional Laboratory, National Research Council, Saskatoon, Saskatchewan, Canada
| | - D. E. Eveleigh
- Department of Biochemistry and Microbiology, College of Agriculture, Rutgers—The State University, New Brunswick, New Jersey 08903
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19
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Abstract
Cogan's syndrome is a relatively rare inflammatory disorder presenting with a combination of ocular and vestibuloauditory symptoms. The first cases were described by David Cogan in 1945. Typically the ocular signs involve the anterior segment; however there are no descriptions of orbital inflammation associated with Cogan's syndrome. We describe such a case. A 66-year-old immunosuppressed male patient with known Cogan's syndrome presented to the eye department with right-sided proptosis, chemosis and ocular injection. Ocular motility was reduced. Other than Cogan's syndrome there were no other systemic disorders. Medical treatment included: Azathioprine 125 mg/day and low dose Tab Prednisolone 30 mg/day. A provisional diagnosis of orbital cellulitis was made and intravenous antibiotics started. Blood investigations showed raised CRP levels 475 mg/L and raised WCC (24 × 10(9)/l). An urgent CT scan of the head and orbits ruled out orbital cellulititis. The diagnosis was revised and the patient was treated for orbital inflammatory disease. Pulsed intravenous methlyprednisolone was commenced and oral steroids were increased to 60 mg/day, the Azathioprine was continued. Over the following week, the proptosis had resolved, and oral steroids were reduced back to the maintenance dose. To our knowledge this is the first description of orbital inflammatory disease associated with Cogan's syndrome.
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20
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Redmond M, Knapp C, Salim M, Shanbhag S, Jaumdally R. Use of vasopressors in Takotsubo cardiomyopathy: a cautionary tale. Br J Anaesth 2013; 110:487-8. [DOI: 10.1093/bja/aes586] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Knapp C, Weiden N, Kass H, Dinse KP, Pietzak B, Waiblinger M, Weidinger A. Electron paramagnetic resonance study of atomic phosphorus encapsulated in [60]fullerene. Mol Phys 2011. [DOI: 10.1080/00268979809483233] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Knapp
- a Phys. Chem. III , TU Darmstadt , Darmstadt , Germany
| | - N. Weiden
- a Phys. Chem. III , TU Darmstadt , Darmstadt , Germany
| | - H. Kass
- a Phys. Chem. III , TU Darmstadt , Darmstadt , Germany
| | - K.-P. Dinse
- a Phys. Chem. III , TU Darmstadt , Darmstadt , Germany
| | - B. Pietzak
- b Hahn-Meitner-Institut Berlin , Berlin , Germany
| | | | - A. Weidinger
- b Hahn-Meitner-Institut Berlin , Berlin , Germany
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Abstract
PURPOSE Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. METHODS Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. RESULTS Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. CONCLUSION Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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23
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Abstract
Neurofibromatosis type II (NF II) is rare and most commonly presents with hearing loss, tinnitus and/or vestibular disturbance in the third decade of life. The authors describe a rare case presenting with NF II with vertical diplopia due to IV(th) nerve palsy. The patient was otherwise asymptomatic despite multiple extensive lesions on MRI.
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Affiliation(s)
- Ahmed Sokwala
- Marmara University School of Medicine, Istanbul, Turkey
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24
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Abstract
Children have traditionally been referred to palliative care when curative treatments were exhausted. Recently, experts have suggested that children could benefit from palliative care early in their courses of illness. Using survey data from 303 paediatricians in Florida and California, this study assesses if paediatricians would refer children to palliative care early in their course of illness. Results showed that more years in practice were associated with decreased odds of referring children to palliative care. Academic practice setting and more Medicaid patients were associated with greater odds of referral prior to the end of life. Hispanic paediatricians, those with more experience and those who practice in a hospital setting were associated with decreased odds of referral prior to the end of life. Results suggest that health planners who wish to implement or refine integrated paediatric palliative care programs should consider outreach strategies targeted at paediatricians with specific characteristics.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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25
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Hampel C, Knapp C, Gillitzer R, Wiesner C, Thüroff JW. INFLUENCE OF DECREASING TUR-P FREQUENCY ON RESECTION EFFICIENCY IN A UNIVERSITY SETTING. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61952-2] [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: 11/28/2022]
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26
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Abstract
Spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.
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Affiliation(s)
- Christopher Knapp
- Department of Ophthalmology, University Hospitals of Leicester, Leicester, UK
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27
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Cogdon C, Lovell M, Knapp C, Park A, Baker J. Numerical analysis of an anastomotic device. Comput Methods Biomech Biomed Engin 2002; 5:53-65. [PMID: 12186734 DOI: 10.1080/1025584021000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The explicit dynamic finite element method was utilized to investigate the deformation behaviour of a woven wire mesh tubular device that is used in a side-to-side anastomotic procedure for achieving gastrointestinal anastomosis. The numerical model was initially verified by comparison to experimental results that were obtained using a specialized testing mechanism. Once validated, the finite element model (FEM) was parameterized to ascertain the influence of several device parameters on its deformation behaviour. The importance of these parameters, as related to its optimal design for use in minimally invasive surgery (MIS), was subsequently ascertained and discussed.
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Affiliation(s)
- C Cogdon
- Department of Mechanical Engineering, University of Kentucky, Lexington, KY 40506, USA
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Patwardhan A, Evans J, Bruce E, Knapp C. Heart rate variability during sympatho-excitatory challenges: comparison between spontaneous and metronomic breathing. Integr Physiol Behav Sci 2001; 36:109-20. [PMID: 11666040 DOI: 10.1007/bf02734045] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Respiration influences heart rate variability, leading to the suggestion that respiration should be controlled to assess autonomic function by using heart rate variability. Clearly, control of respiration is advantageous or even essential in several experimental circumstances. However, control of respiration, by itself, produces a small, but significant, increase in mean heart rate and a decrease in respiratory synchronous variation in heart rate. We tested whether, in some experimental situations, it may be possible to arrive at similar interpretation about autonomic function with and without using control of respiratory rate. Heart rate spectral powers from nine subjects were compared between spontaneous and metronomic breathing during two sympatho-excitatory stresses, lower body negative pressure (LBNP) and head up tilt (HUT). The normalized spectral powers in supine and HUT during spontaneous breathing were: 0.43 and 0.75 in very low (VLF) and 0.28 and 0.09 in high frequency (HF) regions. The powers during metronomic breathing were: 0.36 and 0.82 (VLF) and 0.36 and 0.09 (HF). The powers in supine and LBNP during spontaneous breathing were: 0.43 and 0.81 (VLF) and 0.28 and 0.06 (HF). The powers during metronomic breathing were: 0.36 and 0.80 (VLF) and 0.36 and 0.07 (HF). All p values were <0.05. Therefore, changes in heart rate spectral powers during HUT and LBNP were similar during metronomic breathing and spontaneous breathing. These results suggest that in experimental designs such as in our study, using metronomic breathing may not provide any additional insight into autonomic function than that can be obtained during spontaneous breathing.
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Affiliation(s)
- A Patwardhan
- Center for Biomedical Engineering, University of Kentucky, Lexington 40506-0070, USA.
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29
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Barry AL, Pfaller MA, Brown SD, Espinel-Ingroff A, Ghannoum MA, Knapp C, Rennie RP, Rex JH, Rinaldi MG. Quality control limits for broth microdilution susceptibility tests of ten antifungal agents. J Clin Microbiol 2000; 38:3457-9. [PMID: 10970403 PMCID: PMC87406 DOI: 10.1128/jcm.38.9.3457-3459.2000] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Broth microdilution susceptibility tests of Candida species have now been standardized by the National Committee for Clinical Laboratory Standards (NCCLS). An eight-laboratory collaborative study was carried out in order to document reproducibility of tests of Candida parapsilosis ATCC 22019 and Candida krusei ATCC 6258 by the NCCLS method. Replicate broth microdilution tests were used to define control limits for 24- and 48-h MICs of amphotericin B, flucytosine, fluconazole, voriconazole, ketoconazole, itraconazole, caspofungin (MK 0991), ravuconazole (BMS 207147), posaconazole (SCH 56592), and LY 303366.
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Affiliation(s)
- A L Barry
- The Clinical Microbiology Institute, Wilsonville, Oregon.
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Abstract
BACKGROUND Lymphoepithelioma (squamous cell carcinoma with associated lymphoid stroma) commonly occurs in the nasopharynx, rarely at other sites. As a result, the clinical course and optimal treatment of nonnasopharyngeal lymphoepithelioma of the head and neck have not been well described. This retrospective study was undertaken to analyze the clinical course of the disease in patients treated at a single institution and to formulate recommendations for treatment based on that experience as well as results reported in the literature. METHODS Between 1950 and 1994, 34 patients with nonnasopharyngeal lymphoepithelioma of the head and neck were treated at the University of Texas M. D. Anderson Cancer Center. The patients' medical records were reviewed and their pathologic specimens evaluated. The primary tumor sites were: oropharynx (24 patients), salivary gland (4), laryngohypopharynx (4), and the maxillary sinus/nasal cavity (2). Assessed in accordance with the 1992 American Joint Committee Against Cancer TNM staging system, T classifications were TX-2, T1-7, T2-8, T3-10, and T4-7, and N classifications were N0-8, N1-5, N2-15, and N3-6. Treatment consisted of radiotherapy for 24 patients, excisional biopsy of the primary tumor followed by radiotherapy for 7 patients, and surgery for 3 patients. Of the patients treated with radiotherapy, neck dissections were performed on only two, both of whom had persistent lymph node masses after completing radiotherapy. The median dose delivered to the primary tumor was 65 gray (Gy) (range, 46-78 Gy). The median fraction size was 2.1 Gy (range, 1.6-3.2 Gy). RESULTS The 5-year actuarial disease specific survival and overall survival rates were 59% and 39%, respectively. The 5-year actuarial local control rate for all patients was 94%. For the irradiated patients, the 5-year regional control rates were 77% overall and 83% within the radiation field. The 5-year actuarial rate of distant metastasis for all patients was 30%. For patients who presented with and without regional adenopathy, the 5-year rates of distant metastasis were 36% and 12%, respectively (P = 0.27). CONCLUSIONS Nonnasopharygeal lymphoepithelioma is a radiosensitive disease. High rates of locoregional tumor control were achieved with radiotherapy at all head and neck sites. The main cause of treatment failure was distant metastasis, which occurred more frequently in patients with lymph node involvement. Radiotherapy is appropriate initial locoregional therapy for patients with this disease. Surgery should be reserved for patients who have persistent disease after completing radiotherapy. Systemic therapy is a reasonable approach for patients who present with regional adenopathy because they have a relatively high rate of distant metastasis.
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Affiliation(s)
- P Dubey
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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Patwardhan A, Vallurupalli S, Evans J, Knapp C, Bruce E. Use of amplitude-modulated breathing for assessment of cardiorespiratory frequency response within subrespiratory frequencies. IEEE Trans Biomed Eng 1998; 45:268-73. [PMID: 9473850 DOI: 10.1109/10.661275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a new technique which uses amplitude-modulated breathing patterns to obtain estimates of frequency response between respiration and heart rate within subrespiratory frequencies. Frequency response between respiration and heart rate has been previously estimated using broadband respiration and metronomic breathing. However, the estimates obtained using these techniques show low coherence between respiration and heart rate within the subrespiratory frequencies (< 0.12-0.15 Hz). The advantages of amplitude-modulated breathing are: enhancement in the degree of perturbation within subrespiratory frequencies as indicated by relatively higher coherencies between respiration and heart rate (approximately equal to 0.7), and the subjects do not have to breathe at very low breathing frequencies or resort to breath holds. Use of a squared sine wave carrier modulated by sinusoidal functions enabled us to obtain energy distributions at subrespiratory frequencies without using demodulation. Results obtained at eight subrespiratory frequencies from ten subjects show that the new technique is easy to implement and produces relatively higher coherence between respiration and heart rate. The advantage of the new technique in terms of enhancing the level of perturbations within subrespiratory frequencies is particularly important, because it is in this frequency range that the interpretation of variability in heart rate in terms of autonomic origins is incompletely understood and is confounded by respiratory interactions.
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Affiliation(s)
- A Patwardhan
- Center for Biomedical Engineering, University of Kentucky, Lexington 40506-0070, USA.
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Abstract
The effect of 30 min of cycling exercise at 60% VO2max on hemodynamic responses to the Stroop and cold pressor tests in 12 normotensive males was examined. Subjects were randomly assigned in a counterbalanced design to perform the stressors pre- and postexercise and served as their own controls. Cardiac output (CO), heart rate (HR), and stroke volume were measured continuously by impedance cardiography. Blood pressure was measured beat to beat using a photoplethysmographic volume transducer. Total peripheral resistance (TPR) was calculated. The systolic blood pressure response (elevation) to the Stroop test was significantly attenuated postexercise (4.2 +/- 1.4%, p < 0.05) as compared to preexercise and control (10.1 +/- 1.8%). Postexercise HR reactivity was also significantly attenuated to the Stroop test postexercise (0.3 +/- 1.7%) compared to preexercise and control (6.5 +/- 2.3%, p < 0.05). Hemodynamic variables among treatment groups, with the possible exception of HR, appeared to be unaffected during the cold pressor postexercise. Neither central (i.e., CO) nor peripheral (i.e., TPR) responses appeared to be solely responsible for the attenuated blood pressure response to the Stroop stressor.
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Affiliation(s)
- M Probst
- Department of Kinesiology, University of Kentucky, Lexington 40506, USA
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Abstract
UNLABELLED Peripheral retinal cryotherapy alone, without additional cyclocryotherapy, can for the short term lead to intraocular pressure reduction and regression of neovascularization. As there is little information concerning the long-term results of this treatment we reexamined all patients treated with peripheral retinal cryotherapy at the Department of Ophthalmology at Freiburg University between 1979 and 1990. PATIENTS AND METHODS Neovascularization was secondary to proliferative diabetic retinopathy in 33 eyes (65%), secondary to retinal vascular occlusion in 13 eyes (25%), and secondary to a combination of both in 5 eyes (10%). Usually, 2 quadrants of each eye were treated with 9 applications per quadrant. RESULTS Intraocular pressure was adequately reduced in 49% of the eyes and rubeosis iridis regressed in 57%. Visual acuity deteriorated in 53% of all cases. CONCLUSION Intraocular pressure and rubeosis iridis can in the long term successfully be treated with peripheral retinal cryotherapy. Despite good intraocular pressure control and regression of rubeosis iridis visual acuity does not improve.
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Affiliation(s)
- C Knapp
- Universitäts-Augenklinik Freiburg
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Ciraulo DA, Barnhill JG, Ciraulo AM, Sarid-Segal O, Knapp C, Greenblatt DJ, Shader RI. Alterations in pharmacodynamics of anxiolytics in abstinent alcoholic men: subjective responses, abuse liability, and electroencephalographic effects of alprazolam, diazepam, and buspirone. J Clin Pharmacol 1997; 37:64-73. [PMID: 9048275 DOI: 10.1177/009127009703700111] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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] [Indexed: 02/03/2023]
Abstract
Subjective responses, including those associated with abuse liability and changes in frontal electroencephalographic activity, were assessed in abstinent alcoholic men and control subjects after administration of alprazolam, diazepam, buspirone, and placebo. Plasma concentrations of alprazolam, diazepam, and desmethyldiazepam also were determined. Abuse liability scales were elevated for alcoholic participants above control levels after alprazolam and diazepam. Areas under the concentration-time curve differed only for desmethyldiazepam, which was lower for the alcoholic participants. Compared with control subjects, alcoholic participants had greater declines in the absolute power of the alpha band after diazepam challenge. Alcoholic participants, unlike control subjects, had areas under the effect-time curve for alpha and theta bands that were lower after administration of alprazolam or diazepam than they were after receiving placebo. These results suggest that alprazolam and diazepam are more likely to be abused by alcoholic men than by nonalcoholic men and that alcoholic men have enhanced sensitivity to the effects of benzodiazepines on alpha and theta activity.
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Affiliation(s)
- D A Ciraulo
- National Institute on Drug Abuse/Veterans Affairs Medication Development Research Unit, Boston Veterans Affairs Medical Center, Massachusetts, USA
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36
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Sanders CC, Barry AL, Washington JA, Shubert C, Moland ES, Traczewski MM, Knapp C, Mulder R. Detection of extended-spectrum-beta-lactamase-producing members of the family Enterobacteriaceae with Vitek ESBL test. J Clin Microbiol 1996; 34:2997-3001. [PMID: 8940437 PMCID: PMC229448 DOI: 10.1128/jcm.34.12.2997-3001.1996] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A three-phase analysis of the Vitek ESBL test and a double-disk (2 disk) test was performed to assess their ability to detect extended-spectrum beta-lactamases (ESBLs) in members of the family Enterobacteriaceae. In the first two phases involving detection of ESBLs in 157 stains processing well-characterized beta-lactamases, sensitivity and specificity were found to be 99.5 and 100%, respectively, for the Vitek ESBl test and 98.1 and 99.4%, respectively, for the 2-disk test. In the third phase, in which the ability of each test to detect ESBLs in 295 clinical isolates was assessed, there was only one false positive (Vitek ESBL test). Across all three phases, the Vitek ESBL test was found to be much easier to perform than the 2-disk test. The latter also involved subjective interpretation of results. There were a total of 176 Escherichia coli and 157 Klebsiella pneumoniae isolates and less than 40 isolates of each of 14 other species evaluated. In a supplemental study of Klebsiella oxytoca, an organism possessing a chromosomal beta-lactamase similar to an ESBL, the Vitek ESBL test was found to be capable of detecting hyperproduction of this enzyme in strains of this species as well. These data indicate that the Vitek ESBL test is reliable for the detection of ESBLs in E. coli and K. pneumoniae, the two species in which ESBLs are most common, and of hyperproduction of the K. oxytoca beta-lactamase, a situation which engenders a level of resistance to this species similar to that seen with ESBLs.
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Affiliation(s)
- C C Sanders
- Center for Research in Anti-Infectives and Biotechnology, Creighton University, School of Medicine, Omaha, Nebraska 68178, USA
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37
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Knapp C, Lecomte JP, Mesmaeker AK, Orellana G. Photoinduced electron transfer from nucleotides to DNA intercalating viologens. A study by laser-flash photolysis and spectroelectrochemistry. J Photochem Photobiol B 1996; 36:67-76. [PMID: 8988613 DOI: 10.1016/s1011-1344(96)07332-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fluorescent DNA-binding N,N'-dialkyl 6-(2-pyridinium)phenanthridinium dications (where dialkyl stands for -(CH2)2-or-(CH2)3-, abbreviated dq2pyp and dq3pyp, respectively) associate with GMP (guanosine-5'-monophosphate) in 0.1-mol l-1, pH 3.5-5.5, phosphate buffer solution to yield 1:1 and 1:2 non-emissive complexes, the formation constants of which range from 197-63 and 19-11 l mol-1, respectively. In addition to the strong static quenching, dynamic deactivation of their excited state occurs at diffusion-controlled rate ki = 5.2 x 10(9) l mol-1 s-1). Illumination of the GMP-containing solutions of the dyes with a 355 nm laser pulse produces a transient, with strong absorbance at 510 and 720 nm for dq2pyp, and 420 and 560 nm for dq3pyp. An identical transient is produced in the presence of ascorbic acid instead of the mononucleotide. By comparison to the electrochemically generated absorption spectra of the monoreduced dyes, the photogenerated transients have been assigned unequivocally to their corresponding radical-cations, formed by electron transfer to the anglet excited state. The back redox reaction between the oxidized quencher and dq2pyp+ proceeds at a rate of 1-2 x 10(9) l mol-1 s-1. The same transient has been observed also for the DNA intercalated viologens; this result, together with the little ability of these dyes to sensitize the formation of singlet dioxygen or to produce superoxide anion, demonstrate that their DNA photocleavaging activity is initiated by an efficient light-induced electron transfer from the nucleobases.
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Affiliation(s)
- C Knapp
- Departamento de Química Orgánica, Facultad de Ciencias Químicas, Universidad Compultense de Madrid, Spain
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Abstract
OBJECTIVE The purpose of this study was to determine mood changes in women with a parental history of alcohol dependence (daughters of alcoholics) after challenge does of alprazolam and placebo in comparison with responses in women without a history of parental alcohol dependence. METHOD Visual analog scales that assess liability to benzodiazepine abuse were administered to 12 adult daughters of alcoholics and 11 comparison subjects after alprazolam challenge. RESULTS The daughters of alcoholics had greater pleasant mood responses after a single dose of alprazolam than did the comparison subjects despite having similar plasma alprazolam levels. CONCLUSIONS The findings of this study suggest that the mood-enhancing effects of alprazolam are greater in daughters of alcoholics than in subjects without a history of parental alcohol dependence.
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Affiliation(s)
- D A Ciraulo
- Psychiatry Service, VA Medical Center, Boston, MA 02130, USA
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Abstract
Prolonged exposure to weightlessness is known to produce a variety of cardiovascular changes, some of which may influence the astronaut's performance during a mission. In order to find a reliable indicator of cardiovascular adaptation to weightlessness, we analyzed data from nine male subjects after a 24-hour period of normal activity and after a period of simulated weightlessness produced by two hours in a launch position followed by 20 hours of 6 degrees head-down tilt plus pharmacologically induced diuresis (furosemide). Heart rate, arterial pressure, thoracic fluid index, and radial flow were analyzed. Autoregressive spectral estimation and decomposition were used to obtain the spectral components of each variable from the subjects in the supine position during pre- and post-simulated weightlessness. We found a significant decrease in heart rate power and an increase in thoracic fluid index power in the high frequency region (0.2-0.45 Hz) and significant increases in radial flow and arterial pressure powers in the low frequency region (<0.2 Hz) in response to simulated weightlessness. However, due to the variability among subjects, any single variable appeared limited as a dependable index of cardiovascular adaptation to weightlessness. The backward elimination algorithm was then used to select the best discriminatory features from these spectral components. Fisher's linear discriminant and Bayes' quadratic discriminant were used to combine the selected features to obtain an optimal index of adaptation to simulated weightlessness. Results showed that both techniques provided improved discriminant performance over any single variable and thus have the potential for use as an index to track adaptation and prescribe countermeasures to the effects of weightlessness.
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Affiliation(s)
- M Wang
- Motorola Cellular Infrastructure Group, Arlington Heights, IL 60004, USA.
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Schmitt SK, Knapp C, Hall GS, Longworth DL, McMahon JT, Washington JA. Impact of chlorhexidine-silver sulfadiazine-impregnated central venous catheters on in vitro quantitation of catheter-associated bacteria. J Clin Microbiol 1996; 34:508-11. [PMID: 8904403 PMCID: PMC228835 DOI: 10.1128/jcm.34.3.508-511.1996] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To assess the impact of the antiseptic effects of silver sulfadiazine-chlorhexidine-impregnated central venous catheters on catheter culture systems, a series of in vitro experiments was performed. Segments of antiseptic and non-antiseptic-impregnated catheters were sonicated in thioglycolate broth and removed. After the addition of 10(3) CFU of Staphylococcus epidermidis per ml, aliquots of catheter-exposed broth were subcultured onto blood agar at 15-min intervals. Decreased mean colony counts were noted at 45 min for broth exposed to antiseptic-impregnated catheters compared with the colony counts for broth exposed to non-antiseptic-impregnated catheters (170 versus 540 CFU/ml). These effects, which were also demonstrated by the roll-plate method, were abrogated by the use of medium containing inhibitors of silver sulfadiazine and chlorhexidine. To assess the duration of the antiseptic effects, catheter segments were suspended for up to 14 days in phosphate-buffered saline, incubated with 10(6) CFU of S. epidermidis per ml, and cultured. Inhibition of bacterial growth by antiseptic-impregnated catheters disappeared after 14 days. These studies suggest that antiseptic compounds elute from catheters during broth- and solid medium-based culturing processes, making necessary the addition of inhibitors of these compounds in culture media. They further suggest that the antimicrobial effects of antiseptic-impregnated catheters wane within several days of placement.
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Affiliation(s)
- S K Schmitt
- Department of Infectious Disease, The Cleveland Clinic Foundation, Ohio 44195, USA
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41
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Abstract
Energy-minimizing active contour models or snakes can be used in many applications such as edge detection, motion tracking, image matching, computer vision, and three-dimensional (3-D) reconstruction. We present a novel snake that is superior both in accuracy and convergence speed over previous snake algorithms. High performance is achieved by using spline representation and dividing the energy-minimization process into multiple stages. The first stage is designed to optimize the convergence speed in order to allow the snake to quickly approach the minimum-energy state. The second stage is devoted to snake refinement and to local minimization of energy, thereby driving the snake to a quasiminimum-energy state. The third stage uses the Bellman (1957) optimality principle to fine-tune the snake to the global minimum-energy state. This three-stage scheme is optimized for both accuracy and speed.
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Affiliation(s)
- M Wang
- Center for Biomed. Eng., Kentucky Univ., Lexington, KY
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42
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Abstract
The role of heart rate in buffering and/or generating aortic pressure (AP) oscillations that occur at rest and in response to oscillatory blood volume shifts was studied. Six supine dogs with chronic AV blockade were used to examine: 1) resting HR and AP spectra when the ventricular rate was controlled by atrial depolarization (natural sinus rhythm); 2) resting AP and stroke volume (SV) spectra when the heart was AV sequentially paced at 60, 120, and 180 bpm before and after ganglionic blockade; and 3) the frequency response characteristics of AP and SV to whole-body sinusoidal acceleration (+/- 2gz, 0.008-0.23 Hz) at each heart rate before and after ganglionic blockade. During atrial regulation of HR, the spectra of both AP and HR had dominant peaks located at the breathing frequency (0.2-0.4 Hz) and relatively smaller peaks centered at approximately 0.05 Hz. During constant heart rate pacing, the spectra of AP had a dominant component at approximately 0.05 Hz. The power of this component was: 1) larger than during atrial regulation, 2) increased with increasing pacing rate, and 3) abolished by ganglionic blockade. There was no effect of pacing rate or ganglionic blockade on SV spectra. During oscillatory acceleration, AP regulation in the heart paced dogs was frequency dependent. Regions of good regulation occurred below 0.016 Hz and above 0.1 Hz, and poor regulation between 0.035 and 0.075 Hz centered at approximately 0.05 Hz. The oscillations in the poor regulation region were enhanced by increased pacing rate. After ganglionic blockade, the frequency response of AP was primarily hydraulic (low-pass). The frequency response of SV had a neural component. We conclude that: 1) resting AP fluctuations at respiratory frequencies resulted from respiration-linked HR variation; 2) the 0.05-Hz fluctuations in AP during rest and the poor regulation of AP at 0.05 Hz during acceleration resulted from a peripheral vascular response that lagged disturbances by approximately 10 s; 3) HR regulation was important in minimizing AP variation in the 0.05-Hz region both at rest and during oscillatory acceleration; and 4) inotropic control of SV was an important component of AP regulation during low-frequency acceleration.
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Affiliation(s)
- M Wang
- Center for Biomedical Engineering, University of Kentucky, Lexington 40506-0070, USA
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Doern GV, Jones RN, Gerlach EH, Washington JA, Biedenbach DJ, Brueggemann A, Erwin ME, Knapp C, Raymond J. Multicenter clinical laboratory evaluation of a beta-lactamase disk assay employing a novel chromogenic cephalosporin, S1. J Clin Microbiol 1995; 33:1665-7. [PMID: 7650211 PMCID: PMC228242 DOI: 10.1128/jcm.33.6.1665-1667.1995] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
S1, a new chromogenic cephalosporin (International BioClinical, Inc., Portland, Oreg.), was used to detect beta-lactamase production among a variety of commonly encountered bacteria in a four-center collaborative study. Results of an S1 disk assay were compared with those obtained by a nitrocefin-based disk procedure (Cefinase; Becton-Dickinson Microbiology Systems, Cockeysville, Md.), with repetitive testing of five quality control organisms and with individual tests of recent clinical isolates of Neisseria gonorrhoeae (162 strains), Haemophilus influenzae (162 strains), Moraxella catarrhalis (155 strains), Staphylococcus aureus (161 strains), and Bacteroides fragilis (164 strains). The performances of the two beta-lactamase disk assays were comparable for the first three species cited above. However, the S1 assay appeared to be a more sensitive procedure than the Cefinase assay when applied to S. aureus and B. fragilis, with respect to both total numbers of positive results and length of time to a definitive positive endpoint.
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Affiliation(s)
- G V Doern
- University of Massachusetts Medical Center, Worcester 01655, USA
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44
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Salcido R, Fisher SB, Donofrio JC, Bieschke M, Knapp C, Liang R, LeGrand EK, Carney JM. An animal model and computer-controlled surface pressure delivery system for the production of pressure ulcers. J Rehabil Res Dev 1995; 32:149-61. [PMID: 7562655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pressure ulcers continue to be a major health care problem. This paper describes an animal model and surface pressure delivery system for the production of experimentally derived pressure ulcers. A method for inducing dermal pressure lesions on the fuzzy rat was developed using a computer-controlled displacement column which produced a constant tissue interface pressure. The pressure column consists of a force transducer located between two 0.5-in (1.27-cm) diameter metal cylinders. The desired cutaneous pressure is maintained by a computer-controlled miniature stepper motor which displaces the column with the aid of interactive software. The force transducer signal is converted from analog to digital form, amplified, and recorded. Blood perfusion is monitored using a laser Doppler flowmeter (located in the tip of the column) during the application of pressure. The application of 145 mmHg pressure for 5 consecutive 6-hr sessions resulted in a greater than 90% incidence of pressure ulcers. The implications of our model and contributions of earlier animal models are discussed. This model provides a tightly controlled and measured environment making possible the scientific study of ulcer development and the evaluation of potential preventative or curative compounds.
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Affiliation(s)
- R Salcido
- Chandler Medical Center, University of Kentucky, Lexington 40536, USA
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45
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Knapp C. Transplant recipients share expression of music, photography, painting, and writing. Nephrol News Issues 1993; 7:22-3. [PMID: 8479554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Affiliation(s)
- C Rosendorff
- Department of Medicine, Mt. Sinai School of Medicine, New York, N.Y
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47
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Knapp C. AIDS and ESRD: a dilemma for the renal community. Nephrol News Issues 1992; 6:14, 16, 45. [PMID: 1407041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Barry AL, Reller LB, Miller GH, Washington JA, Schoenknect FD, Peterson LR, Hare RS, Knapp C. Revision of standards for adjusting the cation content of Mueller-Hinton broth for testing susceptibility of Pseudomonas aeruginosa to aminoglycosides. J Clin Microbiol 1992; 30:585-9. [PMID: 1551973 PMCID: PMC265114 DOI: 10.1128/jcm.30.3.585-589.1992] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A multilaboratory study was undertaken to reassess the amount of calcium and magnesium that should be added to Mueller-Hinton broth when testing Pseudomonas aeruginosa against amikacin, gentamicin, isepamicin, netilmicin, and tobramycin. To achieve parity with agar dilution tests, cation-adjusted broth should contain 20 to 25 mg of calcium and 10 to 12.5 mg of magnesium per liter rather than the 50- and 25-mg/liter supplements recommended previously. For quality control of tests with contemporary media, MIC control limits should be adjusted by lowering the current MIC limits by at least 1 doubling-dilution interval.
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Affiliation(s)
- A L Barry
- Clinical Microbiology Institute, Tualatin, Oregon 97062
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Abstract
The neuroanatomical localization of kappa opioid receptors in rat and guinea pig brain was determined by quantitative in vitro receptor autoradiography. Our study shows striking differences in kappa 1 and kappa 2 receptor distributions both between species and within each species. In the rat brain, kappa 1 sites (labeled by [3H]U-69,593) are of low density and confined to a small number of structures. These include the claustrum, endopiriform nucleus, caudate putamen, nucleus accumbens, midline nuclear group of the thalamus, superficial grey layer of the superior colliculus, and central grey. kappa 2 sites (labeled by [3H]ethylketocyclazocine or [3H]bremazocine under conditions in which mu, delta, and kappa 1 binding was suppressed) are more widely distributed throughout all levels of rat brain. kappa 2 sites occur at high density in the caudate putamen, nucleus accumbens, amygdala, thalamus, and interpeduncular nuclei. In guinea pig brain, kappa 1 sites predominate and are of high density in layers I and VI of the neocortex, claustrum, endopiriform nucleus, caudate putamen, nucleus accumbens, and molecular layer of the cerebellum. As in rat brain, kappa 2 sites in guinea pig are more uniformly and widely distributed throughout the brain than are kappa 1 sites. The highest density of kappa 2 sites is in the dorsal parabrachial nucleus, interpeduncular nuclei, mammillary nuclei, and posterior thalamic nuclei. Results from this study demonstrate important interspecies differences in the distribution of kappa 1 and kappa 2 opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E M Unterwald
- Department of Neuroscience, Albert Einstein College of Medicine, New York 10461
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Knapp C. For social workers, planning key to a successful vacation for ESRD patients. Nephrol News Issues 1991; 5:32, 38. [PMID: 1961302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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